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외상성 척수손상 환자의 합병증에 관한 연구

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 Complications in spinal cord injured patients 
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[한글] 척수손상의 합병증은 다양하며 이로 인해 척수손상환자는 일상생활 및 재활치료에 지장을 초래하여 사회적, 경제적, 육체적으로 많은 손실을 초래하게 되며 심한 경우 사망에까지 이르게 되므로 척수손상에 의한 합병증의 현황과 특성을 파악하여 이를 예방 및 관리 하는 것이 매우 중요하다. 본 저자는 1983년 1월부터 1989년 12월까지 연세대학교 의과대학세브란스병원 재활의학과에 척수손상으로 입원한 133명의 환자를 대상으로 환자의 연령, 성별, 신경학적 소견, 합병증의 종류 및 발생율 그리고 각각의 특성을 조사분석하여 다음과 같은 결과를 얻었다. 1. 조사대상 환자는 남자가 111명(83.5%), 여자가 22명(16.5%)이었으며, 연령분포는 4세에서 70세까지로 평균 33세 였으며, 완전사지마비환자가 18명(13.5%), 불완전사지마비환자가 15명(11.3%), 완전하지마비환자가 71명(53.4%), 불완전하지마비환자가 29명(21.8%)이었다. 2. 척수손상합병증의 발생율은 하부요로감염이 78.2%, 경직이 54.1%, 통증이 51.8%, 욕창이 45.1%, 관절구축이 33.8%, 기립성 저혈압이 27.8%, 자율신경 반사항진이 15.0%, 폐염이 15.0%, 이소성골화증이 9.0%, 무기폐가 5.3%, 방광요관역류가 5.3%, 부고환염이 4.5%, 요로결석이 3.0%였다. 3. 하부요로갑염을 일으킨 가장 많은 균주는 escherichia coli로 38.3%였고 다음은 enterococcus fecalis로 24.6%였다. 4. 욕창의 발생부위는 척추부위에 가장 많이 발생하였고(66.1%),대부분이 Grade 1-2의 경도의 욕창이었으며(86.8%), 재활의학과에 입원한 동안 욕창의 발생율은(16.3%) 타과에서 보다(34.7%) 현저하게 적었다. 5. 기립성저혈압은 제5흉수미만손상군보다 제5흉수이상손상군에서 발생율이 높았으며, 자율신경반사항진은 제6흉수미만손상군보다 제6흉수이상손상군에서 발생율이 높았다. 6. 관절구축은 족관절에서 가장 호발하였으며(40.3%), 재활의학과에 입원한 동안 관절구축의 발생율은(24.6%) 타과에서 보다(42.6%) 현저하게 적었다. 7. 혈색소, 적혈구용적의 값은 손상후 평균 1개월, 3개월, 6개월, 1년에 측정한 결과 점차 정상화 되었으며 혈색소, 적혈구용적의 평균치도 만성화 될수록 높아져서 정상화되는 경향을 보였다. 8. 통증은 대부분이(88.9%) 12개월 이내에 발생하였으며 남녀간에 발생의 차이는 없었다.
[영문] The complications of spinal cord injury which develop in varying sites can lead to death and can impede rehabilitation as well as adversely affect the activities of daily living physically, socially and economically. The purpose of this study is to look for means to prevent and manage complications in spinal cord injury through investigation and analysis. The subjects of this study were 133 spinal cord injury patients who were admitted to the Department of Rehabilitation Medicine, Severance Hospital, Yonsei University, between Mar 1, 1983 and Dec 30, 1989. The results are as follows: 1. The subjects were 111 male and 22 female patients ranging in age from 4 to 70 years, including 18 complete quadriplegics, 15 incomplete quadriplegics, 71 complete paraplegics, and 29 incomplete paraplegics. 2. The incidence of complications in spinal cord injury were as follows: urinary tract infection 78.2%, spasticity 54.1%, pain 51.8%, pressure sore 45.1%, contracture 33.8%, ortho-static hypotension 27.8%, autonomic hyperreflexia 15.0%,pneumonia 15.0%, heterotopic ossification 9.0%, atelectasis 5.3%, vesicoureteral reflux 5.3%, epididymitis 4.5%, urinary stone 3.0%. 3. The moat common causative organism of urinary tract infection was Escherichia coli(38.3%), followed by Enterococcus fecalis(24.6%). 4. The most common pressure sore site was the sacral area(66.1%) and most sores were mild grade 1 to 2. The development of sores during admission in the Rehabilitation Medicine Department was much lower than other departments. 5. The incidence of orthostatic hypotension in patients with injury at or above 75 spinal cord level was higher than at 70 or below. The incidence of autonomic hyperreflexia in patients with injury at or above T6 spinal cord level was higher than at T7 or below. 6. Contractures developed most frequently in the ankle joint. Contracture development during admission in the department of Rehabilitation Medicine was much lower than that of other departments. 7. Below normal values of hemoglobin, hematocrit occuring at one, three, six and twelve months post injury were 83.0%, 74.0%, 59.5% and 34.6% for hemoglobin and 72.3%, 46.0%, 38.1% and 19.2% for hematocrit respectively. 8. Pain developed within 12 months after injury in most cases and the difference in pain incidence between males and females was not statistically significant.
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