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말기신장질환에서의 초음파심음향도 연구

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 Echocardiographic assessment of left ventricular function and pericardial effusion in patients with end-stage renal disease 
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[한글]초음파심음향도는 말기신장질환과 같은 중증환자에서 심낭삼출액저류의 유무와 그 정도 를 정확하게 진단하고, 심장의 구조와 기능적 변화를 신속 간편하게 반복적으로 평가함으 로써 심혈관계 합병증을 이해하고 적절한 치료를 기하는 데에 큰 도움이 된다. 저자는 1979년 7월부터 1981년 7월까지 연세대학교 의과대학 부속 세브란스병원 내과에 입원하여 말기신장질환으로 진단된 환자 34례를 대상으로 좌심실기능과 심낭삼출액저류 를 조사하기 위하여 M형 초음파심음향도를 실시하고 다음과 같은 성적을 얻었다. 1. 초음파심음향도 계측에 의하여 34례를 좌심실형태에 따른 4군으로 분류하였을 때, 정상소견균 5례(14.7%), 비후군 15례(44.1%),확장군 6례(17,6%), 비후확장군 8례(23.5%) 로서 좌심실비후의 소견을 보이는 비후군과 비후확장군은 23례(67.6%)로 가장 많았다. 2. 초음파심음향도에서 뚜렷한 심낭삼출액저류가 관찰된 경우는 34례중 16례(47.1%)였 으며, 그 빈도는 확장군, 비후확장군, 정상소견군, 비후군의 순으로 확장군에서 6례중 5 례(83.3%)로 가장 많았다. 3. Hematocrit는 각 군간에 차이는 별로 없으나 정상소견군이 18.5±2.5%로 가장 낮고, 혈압은 비후군에서 193±43/113±28㎜Hg로 가장 높고, 비후확장군, 확장군의 순으로 상 승되어 있었으며 정상소견군은 거의 정상혈압을 유지하고 있었다. 4. 심근수축기능의 지표인 %FS(fractional shortening)의 평균치는 31.0%였으며, 확장 군과 비후확장군에서는 정상보다 약간 저하되어 있었으나 비후군에서는 좌심실벽이 현저 하게 비후되었음에도 불구하고 정상적인 수축기능을 유지하고 있었다.
[영문] Echocardiography (ECHO) has proved to be of great help in cardiac evaluation of symptomatic patients with end-stage renal disease (ESRD) not only in diagnosing the presence and the extent of pericardial effusion, but also assessing the function of left ventricle (LV). Myocardial and pericardial diseases often cause morbidity and mortality as potential major complications in patients with ESRD. ECHO examination permits rapid, convenient, and non-invasive detection of changes of LV contractility and pericardial effusion. Sequential ECHOs in individual patient allow for monitoring of LV function and planning the appropriate therapy, and moreover for the exclusion of patients as potential transplant candidates. ECHO has been performed to evaluate pericardial effusion and % fractional shortening (FS) of LV in 34 unselected patients with clinically proven ESRD before dialysis, and an attempt was made to classify the ECHO findings into four groups. The results of an analysis are as follows. 1. The 34 patients were divided into four distinct groups according to the combination of LV hypertrophy and/or dilatation including: 1) Group N with normal LV in 5 patients (14.7%); 2) Group H with hypertrophic LV in 15 patients (44.1%); 3) Group D with dilated LV in 6 patients (17.6%), and finally 4) Group HD with hypertrophic dilated LV in 8 patients (23.5%). Thus, 23 patients (67.6%) of Group H & HD had hypertrophic change of LV in these series. 2. pericardial effusion (PE) were present in 16 patients (47.1%). High incidence of PE (8303%) was noted in Group D with ECHO picture of congestive cardiomyopathy, but Group H with hypertrophic cardiomyopathy had 26.7% of PE. 3. There was no significant difference of hematocrit among four groups. Group H had highest blood pressure (193±43/113±28㎜Hg), Group HD & D had high elevated pressure, but Group N had normal pressure. 4. Average of % FS for these series was 31.0%. Group N had normal % FS (3308%) and Group H had 32% of FS with normal myocardial contractility despite prominent hypertrophy of LV, but Group D and Group HD had slightly decreased % FS (27.3%, 28% respectively).
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2. Thesis / Dissertation (학위논문) > 1. College of Medicine (의과대학) > Master's Degree (석사)
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