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    ๊ฐ€๋ถ€ํ‚ค ์ฆํ›„๊ตฐ์—์„œ์˜ ๊ตฌ๊ฐœ์—ด์˜ ํŠน์ง• : 11๋ช…์˜ ํ™˜์ž๊ตฐ ์—ฐ๊ตฌ

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    ํ•™์œ„๋…ผ๋ฌธ (์„์‚ฌ) -- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ์˜๊ณผ๋Œ€ํ•™ ์˜ํ•™๊ณผ, 2021. 2. ๋ฐฑ๋กฑ๋ฏผ.Kabuki syndrome (KS) is a rare syndrome of multiple congenital anomalies. A significant number of KS patients have cleft palate (CP) or submucous cleft palate (SMCP) and showed delayed speech development. However, there are few reports that discuss about characteristics of CP in KS and outcomes of postoperative speech development. The purpose of this article is to describe KS patients with CP and to discuss the importance of diagnosis of CP or SMCP in KS patients and the determination of operation methods through precise speech evaluation. We conducted a retrospective study on KS patients previously examined in the Department of Plastic and Reconstructive Surgery and the Department of Pediatrics. There were five CP (45.5%) patients and six SMCP patients (54.5%). This suggests that there can be a higher possibility of SMCP in KS than previously reported. In statistical analysis, there was statistical significance in postoperative results between non-syndromic and kabuki syndrome patients and it is assumed that postoperative results of KS patients are not satisfactory compared to patients who had similar degree of severity in preoperative findings. However, the PPF operation was carried out based on speech evaluation, nasopharyngoscopy and we could achieve satisfactory results. In KS patients, we could observe similar deficiency of levator veli palatini muscle such as VCFS patients. The surgeon should keep in mind that it is difficult to produce optimal results with conventional palatoplasty due to hypotonia or absence of muscular structure. Therefore, pharyngeal flap surgery should be considered as proper treatment to obtain favorable results and this approach in KS patients should be carefully designed based on speech evaluation and nasopharyngoscopic findings.๊ฐ€๋ถ€ํ‚ค ์ฆํ›„๊ตฐ์€ ๋‹ค์–‘ํ•œ ์„ ์ฒœ์„ฑ ๊ธฐํ˜•์„ ๋™๋ฐ˜ํ•˜๋Š” ํฌ๊ท€ ์ฆํ›„๊ตฐ์ด๋‹ค. ๊ธฐ์กด์— ๋ณด๊ณ ๋œ ์ „ํ˜•์ ์ธ ํŠน์ง• ์ด์™ธ์—๋„ ์ƒ๋‹น์ˆ˜์˜ ๊ฐ€๋ถ€ํ‚ค ์ฆํ›„๊ตฐ ํ™˜์ž๋“ค์ด ๊ตฌ๊ฐœ์—ด ํ˜น์€ ์ ๋ง‰ํ•˜ ๊ตฌ๊ฐœ์—ด์„ ๊ฐ€์ง€๊ณ  ์žˆ๊ณ  ์–ธ์–ด๋ฐœ๋‹ฌ์˜ ์ง€์—ฐ์„ ๋ณด์ธ๋‹ค. ํ•˜์ง€๋งŒ ๊ฐ€๋ถ€ํ‚ค ์ฆํ›„๊ตฐ์—์„œ์˜ ๊ตฌ๊ฐœ์—ด์˜ ํŠน์ง•์— ๋Œ€ํ•ด์„œ ๋‹ค๋ฃจ๊ณ  ์žˆ๋Š” ๋ฌธํ—Œ์€ ์ œํ•œ์ ์œผ๋กœ, ์ด ์—ฐ๊ตฌ์˜ ๋ชฉ์ ์€ ๊ฐ€๋ถ€ํ‚ค ์ฆํ›„๊ตฐ ํ™˜์ž๋“ค์˜ ๊ตฌ๊ฐœ์—ด์˜ ํŠน์ง•์„ ๋ถ„์„ํ•˜๊ณ  ์ด ํ™˜์ž๋“ค์—๊ฒŒ ์žˆ์–ด ๊ตฌ๊ฐœ์—ด ๋ฐ ์ ๋ง‰ํ•˜ ๊ตฌ๊ฐœ์—ด์˜ ์ง„๋‹จ์˜ ์ค‘์š”์„ฑ ๋ฐ ์ˆ˜์ˆ ์˜ ๊ฒฐ์ •์— ์žˆ์–ด ์ค‘์š”ํ•œ ์ ๋“ค์„ ๊ฐ•์กฐํ•˜๊ณ ์ž ํ•จ์— ์žˆ๋‹ค. 11๋ช…์˜ ์ ๋ง‰ํ•˜ ๊ตฌ๊ฐœ์—ด ํ˜น์€ ๊ตฌ๊ฐœ์—ด๋กœ ๋ณธ์›์—์„œ ์ˆ˜์ˆ  ๋ฐ›์€ ๊ฐ€๋ถ€ํ‚ค ์ฆํ›„๊ตฐ ํ™˜์ž๋“ค์„ ๋Œ€์ƒ์œผ๋กœ ํ›„ํ–ฅ์  ๋ฌธํ—Œ ์—ฐ๊ตฌ๋ฅผ ์‹œํ–‰ํ•˜์˜€๋‹ค. ์ด ์ค‘ 5๋ช…์ด ๊ตฌ๊ฐœ์—ด ํ™˜์ž (45.5%), 6๋ช…์ด ์ ๋ง‰ํ•˜ ๊ตฌ๊ฐœ์—ด ํ™˜์ž (54.5%)์˜€๊ณ  ์ด๋Ÿฌํ•œ ๋ถ„ํฌ๋Š” ๊ธฐ์กด์— ๋ณด๊ณ ๋œ ๊ฒƒ๋ณด๋‹ค ๊ฐ€๋ถ€ํ‚ค ์ฆํ›„๊ตฐ ํ™˜์ž๊ตฐ์—์„œ ์ ๋ง‰ํ•˜ ๊ตฌ๊ฐœ์—ด์˜ ๋ฐœํ˜„ ๋น„์œจ์ด ๋†’์„ ์ˆ˜ ์žˆ์Œ์„ ์‹œ์‚ฌํ–ˆ๋‹ค. ๊ทธ๋ฆฌ๊ณ  ๊ธฐ์กด์— ๋ณธ์›์—์„œ ์‹œํ–‰ํ•œ ๊ตฌ๊ฐœ์—ด ๋ฐ ์ ๋ง‰ํ•˜ ๊ตฌ๊ฐœ์—ด ํ™˜์ž๋“ค์— ๋น„ํ•ด์„œ ๊ฐ€๋ถ€ํ‚ค ์ฆํ›„๊ตฐ ํ™˜์ž๋“ค์˜ ์ˆ˜์ˆ  ํ›„ ๊ฒฐ๊ณผ์˜ ์ƒ๊ด€๊ด€๊ณ„๋ฅผ ๋ถ„์„ํ•˜์˜€๋‹ค. ๋‘ ๊ตฐ ๊ฐ„์— ํ†ต๊ณ„์ ์œผ๋กœ ์œ ์˜ํ•œ ์ฐจ์ด๋ฅผ ๋ณด์˜€๊ณ  ์ด๋Š” ํƒ€ ์ฆํ›„๊ตฐ์„ ๋™๋ฐ˜ํ•˜์ง€ ์•Š์€ ํ™˜์ž๋“ค์˜ ๊ตฌ๊ฐœ์—ด ๋ฐ ์ ๋ง‰ํ•˜ ๊ตฌ๊ฐœ์—ด์— ๋น„ํ•ด์„œ ํ†ต๊ณ„์ ์œผ๋กœ ๋งŒ์กฑ์Šค๋Ÿฝ์ง€ ๋ชปํ•œ ๊ฒฐ๊ณผ๋ฅผ ๋ณด์˜€๋‹ค. ์ €์ž๋“ค์€ ์ด๋Ÿฌํ•œ ๊ฒฐ๊ณผ๋“ค๊ณผ ๊ฐ€๋ถ€ํ‚ค ์ฆํ›„๊ตฐ ํ™˜์ž๋“ค์˜ ๊ตฌ๊ฐœ์—ด ์ˆ˜์ˆ  ๊ฒฝํ—˜์„ ํ†ตํ•ด ๊ธฐ์กด์˜ ๋น„์ฆํ›„๊ตฐ ํ™˜์•„๋“ค์˜ ๊ตฌ๊ฐœ์—ด ์ˆ˜์ˆ ์— ๋น„ํ•ด์„œ ๊ตฌ๊ฐœ์ธ๋‘๋ถ€์ „์˜ ๊ฐœ์„ ํšจ๊ณผ๊ฐ€ ๋งŒ์กฑ์Šค๋Ÿฝ์ง€ ์•Š์Œ์„ ํ™•์ธํ•  ์ˆ˜ ์žˆ์—ˆ๊ณ  ์ด ํ™˜์ž๋“ค์—๊ฒŒ ๊ฐœ์ธ์— ๋งž๋Š” ํ›„๋ฐฉ ์ธ๋‘ ํ”ผํŒ์ˆ ์„ ์‹œํ–‰ํ•จ์œผ๋กœ์จ ๊ตฌ๊ฐœ์ธ๋‘๋ถ€์ „์„ ํšจ๊ณผ์ ์œผ๋กœ ๊ฐœ์„ ์‹œ์ผฐ๋‹ค. ๊ฒฐ๋ก ์ ์œผ๋กœ, ์ด ์—ฐ๊ตฌ์—์„œ ๊ฐ€๋ถ€ํ‚ค ์ฆํ›„๊ตฐ ํ™˜์ž๋“ค์˜ ๊ตฌ๊ฐœ์—ด ์ˆ˜์ˆ ์— ์žˆ์–ด ๊ธฐ์กด์˜ ๊ตฌ๊ฐœ๋งŒ์„ ์ˆ˜์ˆ ํ•˜๋Š” ๋ฐฉ๋ฒ•์œผ๋กœ ์ˆ˜์ˆ ์„ ์‹œํ–‰ํ–ˆ์„ ๋•Œ ๊ฒฐ๊ณผ๊ฐ€ ์ข‹์ง€ ์•Š์„ ์ˆ˜ ์žˆ์Œ์„ ์ˆ ์ž๊ฐ€ ํ•ญ์ƒ ์ธ์ง€ํ•˜๊ณ  ์žˆ์–ด์•ผ ํ•˜๋ฉฐ, ์ตœ์ข…์ ์œผ๋กœ๋Š” ์ ์ ˆํ•œ ์–ธ์–ดํ‰๊ฐ€ ๋ฐ ๋น„์ธ๋‘ ๋‚ด์‹œ๊ฒฝ์„ ํ†ตํ•ด ๊ณ„ํš๋œ ํ›„๋ฐฉ ์ธ๋‘ ํ”ผํŒ์ˆ ์„ ํ†ตํ•ด์„œ ๋งŒ์กฑ์Šค๋Ÿฌ์šด ๊ฒฐ๊ณผ๋ฅผ ์–ป์„ ์ˆ˜ ์žˆ์Œ์„ ๊ฐ•์กฐํ•˜๊ณ ์ž ํ•œ๋‹ค.Abstract (English) List of Tables List of Figures List of Abbreviations I. Introduction. 1 II. Materials and method 3 III. Result 5 IV. Discussion. 15 V. Conclusion 19 VI. References. 20 Abstract (Korean) 24Maste

    ํ•œ๊ตญ ์˜จ๋Œ€ ์‚ฐ๋ฆผ์˜ ์‹๋ฌผ ๊ณ„์ ˆ ๋ณ€ํ™” ๋ถ„์„

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    ํ•™์œ„๋…ผ๋ฌธ(์„์‚ฌ)--์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› :ํ™˜๊ฒฝ๋Œ€ํ•™์› ํ™˜๊ฒฝ๊ณ„ํšํ•™๊ณผ,2019. 8. ์ •์ˆ˜์ข….์‹๋ฌผ๊ณ„์ ˆ ํ˜„์ƒ์€ ๊ธฐ์˜จ๊ณผ ๊ฐ•์ˆ˜์™€ ๊ฐ™์€ ๊ธฐ์ƒ์ธ์ž์— ๋ฏผ๊ฐํ•˜๊ฒŒ ๋ฐ˜์‘ํ•˜๊ธฐ ๋•Œ๋ฌธ์— ๊ธฐํ›„๋ณ€ํ™”์˜ ์ง€ํ‘œ๋กœ ๋„๋ฆฌ ์ด์šฉ๋˜๊ณ  ์žˆ๋‹ค. ์‹๋ฌผ๊ณ„์ ˆ๊ณผ ๊ธฐํ›„๊ฐ„์˜ ์ดํ•ด๋ฅผ ์œ„ํ•œ ์—ฐ๊ตฌ๋“ค์— ๋”ฐ๋ฅด๋ฉด ์„ธ๊ณ„ ๊ฐ์ง€์—์„œ ๊ฐœ์—ฝ์ผ์ด ๋นจ๋ผ์ง€๋Š” ํ˜„์ƒ์„ ๋ณด์ด๊ณ  ์žˆ์œผ๋ฉฐ, ์ด๋Ÿฌํ•œ ๊ฐœ์—ฝ์ผ์€ ์ง€์—ญ๋ณ„๋กœ ์„œ๋กœ ๋‚˜ํƒ€๋‚˜๋Š” ๋ฐ˜์‘์˜ ์ •๋„๊ฐ€ ๋‹ฌ๋ž๋‹ค. ๋ด„์ฒ  ๊ฐœ์—ฝ ๋ฟ๋งŒ ์•„๋‹ˆ๋ผ ๊ฐ€์„์ฒ  ๋‚™์—ฝ๊ณผ ์‹๋ฌผ์ƒ์žฅ๊ธฐ๊ธธ์ด๊ฐ€ ์‹๋ฌผ๊ณ„์ ˆ์„ ์ดํ•ดํ•˜๋Š”๋ฐ ์ค‘์š”ํ•œ ๋ถ€๋ถ„์ด๋ผ๊ณ  ๋ณด๊ณ ๋˜๊ณ  ์žˆ์ง€๋งŒ ๊ฐœ์—ฝ์ผ์— ๊ด€ํ•œ ์—ฐ๊ตฌ์— ๋น„ํ•ด ๋ถ€์กฑํ•œ ์‹ค์ •์ด๋‹ค. ํ•œ๊ตญ์—์„œ๋„ ์—ญ์‹œ ์‹๋ฌผ๊ณ„์ ˆ ์—ฐ๊ตฌ๊ฐ€ ์‹œ๋„๋˜์—ˆ์œผ๋‚˜ ๋„์‹œ์ง€์—ญ์œผ๋กœ ํ•œ์ •๋˜์–ด์žˆ๋‹ค. ๋˜ํ•œ, ์žฅ๊ธฐ์ ์œผ๋กœ ์ง€์ƒ๊ด€์ธกํ•œ ์ž๋ฃŒ๋ฅผ ์ด์šฉํ•œ ์—ฐ๊ตฌ์˜ ๋ถ€์žฌ๋กœ ์ธํ•ด ์ „์ฒด์ ์ธ ํ•œ๊ตญ์˜ ์‹๋ฌผ๊ณ„์ ˆ์„ ์ดํ•ดํ•˜๋Š”๋ฐ ์–ด๋ ค์›€์ด ์žˆ๋‹ค. ๊ทธ๋Ÿฌ๋ฏ€๋กœ ํ•œ๊ตญ์—์„œ๋„ ์ „ ์ง€์—ญ์„ ํฌํ•จํ•˜์—ฌ ์žฅ๊ธฐ์ ์ธ ์‹๋ฌผ์˜ ์ƒ์žฅ ์ฃผ๊ธฐ ๋ณ€ํ™”๋ฅผ ํ†ตํ•ด ์‹๋ฌผ๊ณ„์ ˆ์„ ์ดํ•ดํ•˜๋Š” ๊ฒƒ์ด ํ•„์š”ํ•˜๋‹ค. ๋”ฐ๋ผ์„œ, ๋ณธ ์—ฐ๊ตฌ๋Š” ๊ตญ๋ฆฝ์ˆ˜๋ชฉ์›์—์„œ 2009๋…„๋ถ€ํ„ฐ 2017๋…„๊นŒ์ง€ ๊ด€์ธก๋œ ๊ฐœ์—ฝ์ผ, ๋‚™์—ฝ์ผ, ์‹๋ฌผ์ƒ์žฅ๊ธธ์ด๋ฅผ ํฌํ•จํ•œ ์‹๋ฌผ๊ณ„์ ˆ์ž๋ฃŒ๋ฅผ ์ด์šฉํ•˜์—ฌ ํ•œ๋ฐ˜๋„ ์‚ฐ๋ฆผ์—์„œ์˜ ์‹๋ฌผ๊ณ„์ ˆ ๋ณ€ํ™”๋ฅผ ์—ฐ๊ตฌํ•˜์˜€๋‹ค. ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ์ด 10๊ฐœ ์ˆ˜๋ชฉ์›์„ ํฌํ•จํ•œ 50๊ฐœ ๊ด€์ธก์ง€์—์„œ ์ˆ˜์ง‘๋œ ์‚ฐ๋ฆผ์ง€์—ญ ์‹๋ฌผ๊ณ„์ ˆ ์ž๋ฃŒ๋ฅผ ์ด์šฉํ•˜์˜€๋‹ค. ์ž๋ฃŒ๋Š” ์ด 256์ข…์˜ ์‹๋ฌผ์„ 2009๋…„๋ถ€ํ„ฐ 2017๋…„๊นŒ์ง€ 12๋‹จ๊ณ„์˜ ์‹๋ฌผ๊ณ„์ ˆ์ƒ์„ ๊ตฌ๋ถ„ํ•˜์—ฌ 72,187๊ฐœ๋กœ ์ด๋ฃจ์–ด์ ธ ์žˆ๋‹ค. ์ด์ค‘ ๋ชจ๋“  ์ง€์—ญ์—์„œ ๊ณตํ†ต์ ์œผ๋กœ 6๋…„ ์ด์ƒ ๊ด€์ธก๋œ ๋‚™์—ฝ์ˆ˜ 7์ข…(์ง„๋‹ฌ๋ž˜, ์ƒ๊ฐ•๋‚˜๋ฌด, ์‚ฐ์ฒ ์ญ‰, ๋‹น๋‹จํ’๋‚˜๋ฌด, ๊ฐœ๋‚˜๋ฆฌ, ์‚ฐ์ˆ˜์œ ๋‚˜๋ฌด, ๋ฐฑ๋ชฉ๋ จ)์˜ ๊ฐœ์—ฝ์ผ๊ณผ ๋‚™์—ฝ์ˆ˜ 2์ข…(์ง„๋‹ฌ๋ž˜, ์ƒ๊ฐ•๋‚˜๋ฌด)์˜ ๋‚™์—ฝ์ผ์„ ์„ ์ •ํ•˜์—ฌ ํ•œ๊ตญ์˜ ์‚ฐ๋ฆผ์—์„œ ๋ฐœ์ƒํ•˜๊ณ  ์žˆ๋Š” ์‹๋ฌผ๊ณ„์ ˆ์˜ ๋ณ€ํ™”๋ฅผ ํŒŒ์•…ํ•˜๊ณ  ์ง€์—ญ๋ณ„ ๊ธฐ์˜จ ์ž๋ฃŒ๋ฅผ ์ด์šฉํ•˜์—ฌ ์‹๋ฌผ๊ณ„์ ˆ๊ณผ ๊ธฐ์˜จ ๊ฐ„์˜ ๋ณ€ํ™” ๊ด€๊ณ„๋ฅผ ๋ถ„์„ํ–ˆ๋‹ค. ์ข…๊ณผ ์ง€์—ญ์„ ๊ณ ๋ คํ•˜์—ฌ ๊ฐœ์—ฝ์ผ๊ณผ ๋‚™์—ฝ์ผ ๊ทธ๋ฆฌ๊ณ  ์‹๋ฌผ์ƒ์žฅ๊ธธ์ด๋ฅผ ๋ถ„์„ํ•˜์˜€๋‹ค. 40๊ฐœ ๊ด€์ธก์ง€์—์„œ 6๋…„ ์ด์ƒ ๊ด€์ธก๋œ 143๊ฐœ์˜ ์ž๋ฃŒ ์ค‘ 139๊ฐœ๋Š” ๊ฐœ์—ฝ์ผ์ด ํ‰๊ท  1.37์ผ์”ฉ ๋นจ๋ผ์ง€๊ณ  ์žˆ๋Š” ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ์ข…๋ณ„๋กœ ๋ณด์•˜์„ ๋•Œ ์‚ฐ์ˆ˜์œ ๋‚˜๋ฌด๊ฐ€ ๊ฐ€์žฅ ๋ฏผ๊ฐํ•˜๊ฒŒ ๋ฐ˜์‘ํ•˜์—ฌ 1.82์ผ์”ฉ ์‹๋ฌผ๊ณ„์ ˆ์ด ๋นจ๋ผ์กŒ๊ณ , ์žŽ์ด ๋‚˜๋Š” ๋ฐฑ๋ชฉ๋ จ์€ 1.07์ผ ์”ฉ ๋นจ๋ผ์ ธ ๋ณ€ํ™”๊ฐ€ ์ด๋“ค ์ค‘ ๊ฐ€์žฅ ๋‘”ํ•˜๊ฒŒ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ๋‚™์—ฝ์ผ์˜ ๊ฒฝ์šฐ 34๊ฐœ์˜ ๊ด€์ธก์ง€์—์„œ 6๋…„ ์ด์ƒ ๊ด€์ธก๋œ 52๊ฐœ์˜ ์ž๋ฃŒ ์ค‘ 38๊ฐœ๋Š” ๋‚™์—ฝ์ผ์ด ํ‰๊ท  0.34์ผ์”ฉ ๋Šฆ์–ด์ง€๊ณ  ์žˆ๋Š” ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ๋‚™์—ฝ์ผ์€ ์ƒ๊ฐ•๋‚˜๋ฌด๊ฐ€ 0.44์ผ์”ฉ ๋Šฆ์–ด์ง€๊ณ  ์žˆ๋Š” ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚˜ 0.28์ผ์”ฉ ๋Šฆ์–ด์ง€๊ณ  ์žˆ๋Š” ์ง„๋‹ฌ๋ž˜๋ณด๋‹ค ๋” ๋ฏผ๊ฐํ•˜๊ฒŒ ๋ฐ˜์‘ํ–ˆ๋‹ค. ๊ฐœ์—ฝ์ผ๊ณผ ๋‚™์—ฝ์ผ์ด ๋ชจ๋‘ ๊ด€์ธก๋œ ์ด 32๊ฐœ์˜ ๊ด€์ธก์ง€์—์„œ 49๊ฐœ์˜ ์ž๋ฃŒ ์ค‘ 41๊ฐœ๋Š” ์‹๋ฌผ์ƒ์žฅ๊ธธ์ด๊ฐ€ ํ‰๊ท  1.77์ผ ๋Š˜์–ด๋‚˜๋Š” ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ์ด์ค‘ ์ƒ๊ฐ•๋‚˜๋ฌด์˜ ํ‰๊ท ์ด 1.99์ผ๋กœ 1.60์ผ์ธ ์ง„๋‹ฌ๋ž˜๋ณด๋‹ค ์ƒ์žฅ๊ธธ์ด๊ฐ€ ๊ธธ์–ด์ง„ ๊ฒƒ์„ ํ™•์ธํ•  ์ˆ˜ ์žˆ์—ˆ๋‹ค. ์ˆ˜๋ชฉ์›๋ณ„๋กœ ์‹๋ฌผ๊ณ„์ ˆ๊ณผ ์œ„์„ฑ๊ด€์ธก์ž๋ฃŒ๋ฅผ ๋น„๊ตํ•ด๋ณธ ๊ฒฐ๊ณผ ์ˆ˜๋ชฉ์›์—์„œ ์—ฐ๋„๋ณ„๋กœ ๊ด€์ธก๋œ ๊ฐœ์—ฝ์ผ ์ค‘ ๊ฐ€์žฅ ๋น ๋ฅธ ๊ฐœ์—ฝ์ผ๊ณผ ์œ„์„ฑ์ž๋ฃŒ๊ฐ€ ๋†’์€ ์ƒ๊ด€๊ด€๊ณ„๋ฅผ ๋ณด์—ฌ์คฌ๋‹ค. ์ด๋Š” ๊ฒฝ๊ด€๋‹จ์œ„๋กœ ์ ‘๊ทผํ•˜๋Š” ์œ„์„ฑ์ž๋ฃŒ๊ฐ€ ์‹๋ฌผ ์ค‘ ๊ด€๋ชฉ๋ฅ˜์—์„œ ์žŽ๋ˆˆ์ด ๋‚˜์™€ ์„ฑ์žฅํ•˜๋Š” ์‹œ์ ์„ ์‹๋ฌผ์ƒ์žฅ๊ธฐ๊ฐ„์˜ ์‹œ์ž‘์ผ๋กœ ํŒ๋‹จํ•˜๋Š” ๊ฒƒ์œผ๋กœ ๋ณด์ธ๋‹ค. ๋‹ค์Œ์œผ๋กœ ๊ฐœ์—ฝ์ผ๊ณผ ๋‚™์—ฝ์ผ์˜ ๋ณ€ํ™”๋ฅผ ์ดํ•ดํ•˜๊ธฐ ์œ„ํ•ด ๊ธฐ์ƒ์ฒญ์—์„œ ๊ด€์ธกํ•œ ์ง€์—ญ๋ณ„ ๊ธฐ์ƒ์ž๋ฃŒ์™€ ๋น„๊ตํ•˜์—ฌ ์ƒ๊ด€์„ฑ์„ ๋ณด์•˜๋‹ค. ๊ฐœ์—ฝ์ผ๊ณผ ๋‚™์—ฝ์ผ ๋ชจ๋‘ ์„ ํ–‰๋˜๋Š” ๊ณ„์ ˆ๊ณผ ๊ฐ€์žฅ ๋†’์€ ์ƒ๊ด€์„ฑ์„ ๋ณด์˜€์œผ๋ฉฐ, ๊ฐœ์—ฝ์ผ์˜ ๊ฒฝ์šฐ ๋ด„ ํ‰๊ท ๊ธฐ์˜จ์ด 1โ„ƒ ์ƒ์Šนํ•จ์— ๋”ฐ๋ผ 4.20์ผ์”ฉ ๊ฐœ์—ฝ์ผ์ด ๋นจ๋ผ์ง€๋Š” ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ๋‚™์—ฝ์ผ์˜ ๊ฒฝ์šฐ 10์›”์˜ ํ‰๊ท  ๊ธฐ์˜จ์ด 1โ„ƒ ์ƒ์Šนํ•จ์— ๋”ฐ๋ผ 2.78์ผ์”ฉ ๋‚™์—ฝ์ผ์ด ๋Šฆ์–ด์ง€๋Š” ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ์ด๋ฅผ ๊ธฐ๋ฐ˜์œผ๋กœ ์‹๋ฌผ๊ณ„์ ˆ ํ˜„์ƒ์ด ๋ฐœ์ƒํ•˜๊ธฐ ์ „๊นŒ์ง€์˜ ๋ˆ„์ ๋œ ๊ธฐ์˜จ๊ณผ์˜ ์ƒ๊ด€๊ด€๊ณ„๋ฅผ ๋ณด๊ธฐ ์œ„ํ•ด ๊ฐœ์—ฝ์ผ๊ณผ GDD(Growing Degree Days), ๋‚™์—ฝ์ผ๊ณผ CDD(Cooling Degree Days)๋ฅผ ๊ตญ๋ฆฝ์ˆ˜๋ชฉ์›์˜ ๊ด€์ธก์ž๋ฃŒ์— ์ ์šฉํ•˜์—ฌ ๋น„๊ตํ•˜์˜€๋‹ค. ์ข…๋ณ„ ํ‰๊ท  GDD๋Š” ๊ฐœ์—ฝ์ผ์ด ๋น ๋ฅธ ๊ฐœ๋‚˜๋ฆฌ๊ฐ€ 173.08์œผ๋กœ ๊ฐ€์žฅ ์ž‘์•˜๊ณ , ๊ฐœ์—ฝ์ผ์ด ๋Šฆ์€ ๋ฐฑ๋ชฉ๋ จ์ด 203.06์œผ๋กœ ๊ฐ€์žฅ ํฌ๊ฒŒ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ์ด๋ฅผ ๊ธฐ๋ฐ˜์œผ๋กœ 2009๋…„๋ถ€ํ„ฐ 2017๋…„๊นŒ์ง€ ์˜ˆ์ธก๊ฐ’์„ ์‚ฐ์ •ํ•˜์—ฌ ๊ด€์ธก์ž๋ฃŒ์™€ ๋น„๊ตํ•œ ๊ฒฐ๊ณผ 70.63%์˜ ์„ค๋ช…๋ ฅ์„ ๊ฐ€์ ธ ๋ˆ„์ ๋œ ๊ธฐ์˜จ์ด ์‹๋ฌผ์˜ ๊ฐœ์—ฝ์— ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ๊ฒƒ์„ ํ™•์ธํ•  ์ˆ˜ ์žˆ์—ˆ๋‹ค. ์ด๋Š” ๊ฒจ์šธ์ฒ  ํ‰๊ท ๊ธฐ์˜จ์ด ์ƒ์Šนํ•˜๊ฒŒ ๋˜๋ฉด ๋ˆ„์  ์˜จ๋„ ์กฐ๊ฑด์ธ GDD๋ฅผ ๋น ๋ฅด๊ฒŒ ์ถฉ์กฑ์‹œํ‚ค๊ฒŒ ๋˜์–ด ๊ฐœ๋‚˜๋ฆฌ์™€ ๊ฐ™์ด GDD๊ฐ’์ด ์ž‘์•„ ๊ฐœ์—ฝ์ผ์— ํฐ ์˜ํ–ฅ์„ ์ค„ ์ˆ˜ ์žˆ์„ ๊ฒƒ์œผ๋กœ ๋ณด์ธ๋‹ค. ๊ฐ€์„์ฒ  ๋‚™์—ฝ์˜ ๊ฒฝ์šฐ ์ง„๋‹ฌ๋ž˜์™€ ์ƒ๊ฐ•๋‚˜๋ฌด์˜ ํ‰๊ท  CDD๋Š” 174.24๋กœ ๋‚™์—ฝ์ผ์ด ๋Šฆ์€ ์ง„๋‹ฌ๋ž˜์˜ 203.52๋ณด๋‹ค ์ž‘์€ ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ํ•˜์ง€๋งŒ CDD๋ฅผ ์ด์šฉํ•œ ์˜ˆ์ธก์€ ํญ์—ผ์ด ์žˆ๋˜ 2014๋…„๊ณผ 2016๋…„์— ์กฐ๊ธฐ๋‚™์—ฝ์˜ ๋ฐœ์ƒ์œผ๋กœ ์ธํ•˜์—ฌ ์ƒ๊ด€๊ด€๊ณ„๊ฐ€ ๋‚ฎ์•˜์ง€๋งŒ, ์กฐ๊ธฐ๋‚™์—ฝ์˜ ๊ฒฝ์šฐ๋ฅผ ์ œ์™ธํ•˜๊ณ  ์•ฝ 38% ์ •๋„์˜ ์„ค๋ช…๋ ฅ์„ ๊ฐ€์ง€๊ณ  ์žˆ์—ˆ๋‹ค. ๊ทธ๋ ‡๊ธฐ ๋•Œ๋ฌธ์— ๋‚™์—ฝ์„ ์ดํ•ดํ•˜๊ธฐ ์œ„ํ•ด ํญ์—ผ, ๊ฐ€๋ญ„๊ณผ ๊ฐ™์€ ๊ทนํ•œ๊ธฐ์ƒํ˜„์ƒ์ด ๊ธฐ์˜จ์˜ ๋ณ€ํ™”์™€ ํ•จ๊ป˜ ๊ณ ๋ ค๋˜์–ด์•ผ ํ•œ๋‹ค. ์ข…ํ•ฉ์ ์œผ๋กœ ์•„์ง๊นŒ์ง€ ์—ฐ๊ตฌ๊ฐ€ ์ด๋ฃจ์–ด์ง€์ง€ ์•Š์€ ํ•œ๊ตญ์˜ ์‚ฐ๋ฆผ์„ ๋Œ€์ƒ์œผ๋กœ ์‹๋ฌผ๊ณ„์ ˆ ๋ณ€ํ™”๋ฅผ ์„ค๋ช…ํ•˜๊ณ , ์‹๋ฌผ๊ณ„์ ˆ๊ณผ ๊ธฐ์˜จ๊ฐ„์˜ ์ƒ๊ด€๊ด€๊ณ„๋ฅผ ๋ณด์—ฌ์ฃผ์—ˆ๋‹ค. ํŠนํžˆ ๊ฐœ์—ฝ์ผ์ด ๋น ๋ฅธ ์‹๋ฌผ๋“ค์ด ๊ฒจ์šธ์ฒ  ์˜จ๋„๋ณ€ํ™”์— ๋ฏผ๊ฐํ•˜์˜€์œผ๋ฉฐ, ๋‚™์—ฝ์ผ์€ ๊ทนํ•œ ๊ธฐ์ƒํ˜„์ƒ์— ์˜ํ–ฅ์„ ๋ฐ›๋Š” ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ๋ณธ ์—ฐ๊ตฌ๋Š” ํ•œ๊ตญ ์‚ฐ๋ฆผ์˜ ์‹๋ฌผ๊ณ„์ ˆ์„ ํญ๋„“๊ฒŒ ์ดํ•ดํ•˜๋Š” ๊ธฐ์ดˆ ์ž๋ฃŒ๋ฅผ ์ œ๊ณตํ•˜๋ฉฐ, ์ง€์†์ ์ธ ์‹๋ฌผ๊ณ„์ ˆ ๊ด€์ธก์˜ ํ•„์š”์„ฑ๊ณผ ์‹๋ฌผ๊ณ„์ ˆ๊ณผ ๊ธฐํ›„์™€์˜ ๊ด€๊ณ„์—์„œ ๊ธฐ์˜จ๋ฟ๋งŒ ์•„๋‹ˆ๋ผ ๊ทนํ•œ ๊ธฐ์ƒ๊ณผ ํ•จ๊ป˜ ์—ฐ๊ตฌ๋˜์–ด์•ผ ํ•œ๋‹ค๋Š” ์ƒˆ๋กœ์šด ์‹œ์‚ฌ์ ์„ ๋„์ถœํ•˜์˜€๋‹ค.Phenology is widely used as an indicator of climate change because it is sensitive to meteorological factors such as temperature and precipitation. Previous phenology studies have shown that leaf unfolding is accelerating around the world though the magnitude depends on the area. Furthermore, it is reported that not only the leaf unfolding but also the leaf fall is important for in the growing season length(GSL) of vegetation. However, the study of leaf fall and GSL are scarce compared to that of leaf unfolding. Also in Korea, phenology research is mostly focused on the leaf unfolding only in the urban areas with short-term observations. Due to the lack of long-term observations in forest regions, there is a lack of research in the overall phenology that include all the regions of South Korea. In this study, phenological data of the forest area collected from 50 observation sites in 10 arboretums were used. 72,187 data was collected from 2009 to 2017 with 12 level phenophases for 256 species. 7 species were selected for leaf unfolding(Rhododendron mucronulatum, Lindera optusiloba, Rhododendron yedoense, Acer pseudosienboldianum, Cornus officinalis, Forsynthia koreana, Magnolia denudata), and 2 species were selected for leaf fall(Rhododendron mucronulatum, Lindera optusiloba). These species have been observed for more than 6 years in all Arboretums. The changes of phenology in temperate forest of South Korea and the relationship between phenology and temperature using regional temperature were analyzed. Leaf unfolding, leaf fall, and GSL were analyzed by regions and species. Early leaf unfolding was observed in 139 samples out of 143 and had an average of 1.37 earlier leaf unfolding by year. In terms of species, the most sensitive species was Lindera which had 1.82 earlier days by year. The leaf unfolding of Magnolia were the least sensitive among the 7 species which had 1.07 earlier days by year. 52 samples of leaf fall, observed over six years in 34 sites, have 38 delayed cases with a delay of 0.34 days per year. GSL had an 41 samples, observed over 6 years in 32 observations 41 data out of 49 data from 32 observations where both leaf unfolding and leaf fall were observed showed an average increase in plant growth length of 1.77 days. The average length of Lindera was 1.99 days, which was longer than that of the Rhododendron. As a result of comparing ground-based leaf unfolding observation by arboretum to satellite derived start of growing season(SOS), the fastest leaf unfolding among 7 species showed a high correlation with SOS. It seems that the point of SOS may relate to the time between dormancy and leaf unfolding of early unfolding shrubs. To understand the reason of changes of the leaf unfolding and leaf falls, temperature data was compared to the regional meteorological data observed by the Korea Meteorological Administration(KMA). Both leaf unfolding and leaf fall showed the highest correlation with the mean temperature of the preceding season. The timing of the leaf unfolding becomes 4.20 days per year with the increased 1โ„ƒ in average spring temperature. The timing of the leaf falls becomes 2.78 days delayed per increased 1โ„ƒ in the mean temperature in October. To see the precise correlation between phenology and accumulated temperature, till the observation dates, the Growing Degree-Days(GDD), and the Cooling Degree-Days(CDD) were calculated by the observations from the Pocheon National Arboretum. The smallest mean GDD was that of Forsynthia by 173.08, and the biggest mean GDD was that of Magnolia by 203.06 among 7 selected species. Based on the GDD, the predicted dates of unfolding were calculated and compared with observed data from 2009 to 2017. The high correlation coefficient was calculated by 70.63%, which signify that accumulated temperature affect leaf unfolding. Increase in mean temperature of winter can affect the species unfolding which has small GDD. The mean CDD of Lindera, 174.24, was smaller than that of Rhododendron, 203.52. However, the predictions using CDD showed a low correlation because of early leaves fall in 2014, 2016 when there was a heat wave, and the explanatory power was 38% excluding early leaves fall. This means that extreme weather such as heat wave and drought should be considered with temperature to understand the leaf fall. Phenological changes from 2009 to 2017 in the temperate forest of South Korea were proven, and the phenological responses was correlated to temperature. Early leaf unfolding species were more sensitive to the temperature of winter, and leaf falls were affected by extreme weather. This study provides the basic understanding of the phenology of forest region, and implications for further studies include not only temperature but also extreme weather to understand autumn senescence with continuous observation.โ… . ์„œ๋ก  1 1. ์—ฐ๊ตฌ์˜ ๋ฐฐ๊ฒฝ ๋ฐ ๋ชฉ์  1 2. ์—ฐ๊ตฌ์˜ ๋ฒ”์œ„ 4 โ…ก. ์„ ํ–‰์—ฐ๊ตฌ 5 1. ๊ธฐํ›„ ๋ณ€ํ™”์— ๋”ฐ๋ฅธ ์‹๋ฌผ ๊ณ„์ ˆ์˜ ๋ณ€ํ™” ์—ฐ๊ตฌ 5 2. ์‹๋ฌผ ๊ณ„์ ˆ ์ž๋ฃŒ์™€ ์ง€์—ญ๋ณ„ ์ˆ˜์ข…๋ณ„ ์ฐจ์ด 6 3. ํ•œ๊ตญ์—์„œ ์‹๋ฌผ ๊ณ„์ ˆ์— ๊ด€ํ•œ ์—ฐ๊ตฌ 9 โ…ข. ๋ถ„์„ ์ž๋ฃŒ์™€ ์—ฐ๊ตฌ ๋ฐฉ๋ฒ• 10 1. ํ•œ๊ตญ ์‚ฐ๋ฆผ์˜ ์‹๋ฌผ ๊ณ„์ ˆ ์ž๋ฃŒ 10 2. ํ™˜๊ฒฝ๋ณ€์ˆ˜๋กœ์„œ์˜ ์˜จ๋„ 15 3. ๋ถ„์„ ๋ฐฉ๋ฒ• 18 โ…ข. ์—ฐ๊ตฌ ๊ฒฐ๊ณผ ๋ฐ ํ† ์˜ 21 1. ํ•œ๊ตญ์˜ ์ข…๋ณ„ ์‹๋ฌผ๊ณ„์ ˆ ๋ถ„ํฌ ํŠน์„ฑ 21 2. 2009~2017๋…„๊นŒ์ง€ ํ•œ๊ตญ์˜ ์‹๋ฌผ๊ณ„์ ˆ ๋ณ€ํ™” 24 3. ๊ธฐ์˜จ๋ณ€ํ™”์— ๋”ฐ๋ฅธ ํ•œ๊ตญ์˜ ์‹๋ฌผ๊ณ„์ ˆ ๋ณ€ํ™” 29 4. ๊ธฐ์˜จ์„ ์ด์šฉํ•œ ํ•œ๊ตญ์˜ ์‹๋ฌผ๊ณ„์ ˆ ์˜ˆ์ธก 32 โ…ฃ. ๊ฒฐ๋ก  36 โ–  ์ฐธ๊ณ ๋ฌธํ—Œ 39 โ–  ๋ถ€๋ก 44Maste

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    ํ•™์œ„๋…ผ๋ฌธ (๋ฐ•์‚ฌ) -- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ์‚ฌ๋ฒ”๋Œ€ํ•™ ์ฒด์œก๊ต์œก๊ณผ,๊ธ€๋กœ๋ฒŒ์Šคํฌ์ธ ๋งค๋‹ˆ์ง€๋จผํŠธ์ „๊ณต, 2021. 2. ๊น€๊ธฐํ•œ.๋ณธ ์—ฐ๊ตฌ์˜ ๋ชฉ์ ์€ ์œ ํŠœ๋ธŒ ํ”Œ๋žซํผ ์ƒ์˜ ์Šคํฌ์ธ  ๋ฏธ๋””์–ด ์‹œ์žฅ์— ๋Œ€ํ•œ ์ „๋ฐ˜์ ์ธ ๋ถ„์„๊ณผ ํ•จ๊ป˜ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ  ์†Œ๋น„์— ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ์†Œ๋น„๊ฒฐ์ •์š”์ธ์˜ ์˜ํ–ฅ๋ ฅ์„ ํŒŒ์•…ํ•˜๊ธฐ ์œ„ํ•จ์— ์žˆ์—ˆ๋‹ค. ์Šคํฌ์ธ  ๋ฏธ๋””์–ด ์ฝ˜ํ…์ธ ์˜ ์ƒ์‚ฐ๊ณผ ์†Œ๋น„๋Š” ์ŠคํŠธ๋ฆฌ๋ฐ(Streaming) ํ™˜๊ฒฝ์— ๋”ฐ๋ผ ๋งค์šฐ ์ƒ์ดํ•œ ์–‘์ƒ์„ ๋ณด์ธ๋‹ค. ํŠนํžˆ ์œ ํŠœ๋ธŒ๋Š” ์†Œ์…œ ๋ฏธ๋””์–ด ์„œ๋น„์Šค์™€ OTT(Over the top)์„ ์œตํ•ฉํ•˜์—ฌ ๋””์ง€ํ„ธ ํ™˜๊ฒฝ์—์„œ ๋ฏธ๋””์–ด ์‹œ์žฅ์„ ์„ ๋„ํ•ด ๋‚˜๊ฐ€๊ณ  ์žˆ๋‹ค. ๊ตฌ์ฒด์ ์œผ๋กœ ์œ ํŠœ๋ธŒ ํ”Œ๋žซํผ์€ ์—… ์ŠคํŠธ๋ฆผ(Up stream)์—์„œ์˜ ์ƒ์‚ฐ๊ณผ ๋‹ค์šด ์ŠคํŠธ๋ฆผ(Down Stream)์—์„œ์˜ ์œ ํ†ต์ด ํ†ตํ•ฉ๋œ ํ˜•ํƒœ๋กœ ์ด๋ค„์ง€๊ณ  ์žˆ์œผ๋ฉฐ, ๋ˆ„๊ตฌ๋‚˜ ์ƒ์‚ฐ์ž๋กœ์„œ ์ฐธ์—ฌํ•  ์ˆ˜ ์žˆ๊ณ  ์–ธ์ œ ์–ด๋””์„œ๋‚˜ ์œ ํ†ต์ด ๊ฐ€๋Šฅํ•œ ๊ตฌ์กฐ๋ฅผ ๊ฐ€์ง€๊ณ  ์žˆ๋‹ค. ์ด๋Ÿฌํ•œ ์œ ํŠœ๋ธŒ ํ”Œ๋žซํผ์—์„œ์˜ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ  ์‹œ์žฅ์€ ๊ทธ ํ™˜๊ฒฝ์  ํŠน์„ฑ์— ๋”ฐ๋ผ ๊ธฐ์กด์˜ ๋ฏธ๋””์–ด ์‹œ์žฅ์˜ ํŠน์„ฑ๊ณผ ๋””์ง€ํ„ธ ๋ฏธ๋””์–ด ์‹œ์žฅ์˜ ํŠน์„ฑ์ด ํ˜ผ์žฌ๋˜์–ด ๋‚˜ํƒ€๋‚˜๊ณ  ์žˆ๋‹ค. ์˜ˆ๋ฅผ ๋“ค์–ด ์ „ํ†ต ์Šคํฌ์ธ  ์ฑ„๋„์˜ ์„ธ์ปจ ๋งˆ์ผ“์œผ๋กœ ํ™œ์šฉ์—์„œ๋ถ€ํ„ฐ ๊ฐœ์ธ ํฌ๋ฆฌ์—์ดํ„ฐ์˜ ์ฝ˜ํ…์ธ  ์ œ์ž‘๊นŒ์ง€ ๋‹ค์–‘ํ•œ ํ˜•ํƒœ์˜ ์ƒ์‚ฐ์ด ์ด๋ค„์ง€๊ณ  ์žˆ๋‹ค. ์ด๋Š” ๊ณผ๊ฑฐ ์Šคํฌ์ธ  ๋ฏธ๋””์–ด๋Š” ์ค‘๊ณ„๋ฐฉ์†ก์„ ์ค‘์‹ฌ์œผ๋กœ ํ•œ ์ฝ˜ํ…์ธ  ์ƒ์‚ฐ๊ณผ ์†Œ๋น„๊ฐ€ ์ „ํ†ต๋งค์ฒด๋ฅผ ์ค‘์‹ฌ์œผ๋กœ ์ด๋ค„์ ธ ์˜จ ๊ฒƒ๊ณผ๋Š” ๋งค์šฐ ํฐ ์ฐจ์ด๋ฅผ ๋ณด์ธ๋‹ค. ๋”ฐ๋ผ์„œ ๋ณธ ์—ฐ๊ตฌ๋Š” ๋ณ€ํ™”ํ•˜๋Š” ์Šคํฌ์ธ  ๋ฏธ๋””์–ด ํ™˜๊ฒฝ์— ์ ์ ˆํžˆ ๋Œ€์ฒ˜ํ•˜๊ธฐ ์œ„ํ•ด ์œ ํŠœ๋ธŒ ํ”Œ๋žซํผ์—์„œ์˜ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ  ํ™˜๊ฒฝ์„ ์—ฐ๊ตฌ๋Œ€์ƒ์œผ๋กœ ์„ค์ •ํ•˜๊ณ  ์ƒ์‚ฐ๊ณผ ์†Œ๋น„์˜ ๊ด€์ ์—์„œ ์‹œ์žฅ์„ ๋ถ„์„ํ•˜๊ณ ์ž ํ•˜์˜€๋‹ค. ํŠนํžˆ ๋ณธ ์—ฐ๊ตฌ๋Š” ์œ ํŠœ๋ธŒ ๋ฏธ๋””์–ด ํ”Œ๋žซํผ์—์„œ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ  ์‹œ์žฅ์˜ ํŠน์ˆ˜์„ฑ์„ ํŒŒ์•…ํ•˜๊ณ  ์†Œ๋น„๋ฅผ ์ฆ์ง„์‹œํ‚ค๋Š” ์š”์ธ๋“ค์„ ๋ถ„์„ํ•˜์—ฌ ์‹œ์žฅ ์ฐธ์—ฌ์ž๋“ค์—๊ฒŒ ๋งˆ์ผ€ํŒ… ์ „๋žต์ˆ˜๋ฆฝ์„ ์œ„ํ•œ ๊ธฐ์ดˆ์ ์ธ ์ •๋ณด๋ฅผ ์ œ๊ณตํ•˜๊ณ ์ž ํ•œ๋‹ค. ์ด๋ฅผ ์œ„ํ•ด ์ตœ์‹ ์˜ ์Šคํฌ์ธ  ๋ฏธ๋””์–ด ์—ฐ๊ตฌ ๋ฐ ์ „ํ†ต ์ปค๋ฎค๋‹ˆ์ผ€์ด์…˜ ์—ฐ๊ตฌ๋“ค์„ ๊ณ ์ฐฐํ•˜์—ฌ ์†Œ๋น„ ๊ฒฐ์ • ์š”์ธ์„ ๋„์ถœํ•˜๊ณ  ์‹œ์ฒญ ๋ชจํ˜•์„ ์ž‘์„ฑํ•˜์˜€๋‹ค. ๊ทธ๋ฆฌ๊ณ  ์œ ํŠœ๋ธŒ ํ”Œ๋žซํผ ์ƒ์— ๊ฒŒ์‹œ๋œ ์ฝ˜ํ…์ธ ๋“ค์„ ์œ ํ˜•ํ™”ํ•˜๊ณ  ์†Œ๋น„๊ฒฐ์ •์š”์ธ๋“ค์ด ์„ฑ๊ณผ์ง€ํ‘œ์— ๋ฏธ์น˜๋Š” ์˜ํ–ฅ๋ ฅ์„ ์‹ค์ฆ์ ์œผ๋กœ ๊ฒ€์ฆํ•˜๊ธฐ ์œ„ํ•ด 150๊ฐœ์˜ ์Šคํฌ์ธ  ๊ด€๋ จ ์œ ํŠœ๋ธŒ ์ฑ„๋„์—์„œ ์•ฝ 10๋งŒ๊ฐœ์˜ ์ฝ˜ํ…์ธ ๋ฅผ ์—ฐ๊ตฌ๋Œ€์ƒ์œผ๋กœ ์„ค์ •ํ•˜์˜€๋‹ค. ์›น์ƒ์— ๊ฒŒ์‹œ๋œ ์—ฐ๊ตฌ๋Œ€์ƒ์˜ ์„ฑ๊ณผ์ง€ํ‘œ์™€ ์†Œ๋น„ ๊ฒฐ์ •์š”์ธ๊ณผ ๊ด€๋ จ๋œ ๋ณ€์ˆ˜๋ฅผ ์ˆ˜์ง‘ํ•˜๊ธฐ ์œ„ํ•ด ํŒŒ์ด์ฌ ์–ธ์–ด๋ฅผ ์‚ฌ์šฉํ•˜์—ฌ ๋ฐ์ดํ„ฐ ํฌ๋กค๋ง(Crawling) ๋ฐ ๋งˆ์ด๋‹(Mining)๊ธฐ๋ฒ•์„ ํ™œ์šฉํ•˜์˜€๋‹ค. ๋˜ํ•œ ์ •๋Ÿ‰์ ์œผ๋กœ ์ธก์ •๋˜๊ธฐ ์–ด๋ ค์šด ๋ณ€์ˆ˜์˜ ๊ฒฝ์šฐ ๋‚ด์šฉ๋ถ„์„ ๊ธฐ๋ฒ•์„ ํ™œ์šฉํ•˜์—ฌ ์ธก์ •ํ•˜๊ธฐ๋„ ํ•˜์˜€๋‹ค. ๊ฒฐ๊ณผ์ ์œผ๋กœ ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ์ด์™€ ๊ฐ™์ด ์ˆ˜์ง‘๋œ ์ž๋ฃŒ๋ฅผ ๊ทผ๊ฑฐ๋กœ ์ด 2๊ฐ€์ง€์˜ ์—ฐ๊ตฌ๋ฌธ์ œ๋ฅผ ํ•ด๊ฒฐํ•˜์˜€๋‹ค. ์šฐ์„  ์ฒซ ๋ฒˆ์งธ ์—ฐ๊ตฌ๋ฌธ์ œ์—์„œ๋Š” ์กฐํšŒ์ˆ˜, ์ถ”์ •๋œ ์ฝ˜ํ…์ธ  ์ˆ˜์ต๊ณผ ๊ฐ™์€ ๊ฒฝ์ œ์  ์„ฑ๊ณผ์ง€ํ‘œ์™€ ๋Œ“๊ธ€์ˆ˜์™€ ๊ฐ™์€ ์‚ฌํšŒ์  ์„ฑ๊ณผ์ง€ํ‘œ์— ๋ฏธ์น˜๋Š” ์†Œ๋น„ ๊ฒฐ์ •์š”์ธ๋“ค์˜ ์˜ํ–ฅ๋ ฅ์„ ๋‹ค์ธต๋ชจํ˜• ํšŒ๊ท€๋ถ„์„์„ ํ†ตํ•ด ๊ฒ€์ฆํ•˜์˜€๋‹ค. ๊ฒ€์ฆ ๊ฒฐ๊ณผ ์„ฑ๊ณผ์ง€ํ‘œ์— ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ์†Œ๋น„ ๊ฒฐ์ •์š”์ธ์€ ์ฝ˜ํ…์ธ  ์ˆ˜์ค€๊ณผ ์ฑ„๋„์ˆ˜์ค€์— ํ•จ๊ป˜ ์กด์žฌํ•˜์˜€์œผ๋ฉฐ, ์Šคํฌ์ธ ์— ํŠนํ™”๋œ ์ข…๋ชฉ, ๋ฏธ๋””์–ด ์Šคํฌ์ธ  ์„ฑ๊ฒฉ, ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ  ์œ ํ˜•์ด ๊ฐ€์žฅ ํฐ ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ๊ฒƒ์œผ๋กœ ๋„์ถœ๋˜์—ˆ๋‹ค. ๋˜ํ•œ ์˜์ƒ์—์„œ ์ œ๊ณต๋˜๋Š” ์ •๋ณด์˜ ํ˜•ํƒœ์™€ ์–‘์— ๋”ฐ๋ผ ์„ฑ๊ณผ์ง€ํ‘œ๊ฐ€ ์ฐจ์ด๋ฅผ ๋ณด์˜€์œผ๋ฉฐ, ํŠนํžˆ ์˜์ƒ์„ ๋Œ€ํ‘œํ•˜๋Š” ์ด๋ฏธ์ง€์ธ ์ธ๋„ค์ผ์˜ ์„ ์ •์„ฑ๊ณผ ํญ๋ ฅ์„ฑ์ด ๋†’์„์ˆ˜๋ก ์„ฑ๊ณผ์ง€ํ‘œ๊ฐ€ ๋†’์•„์ง€๋Š” ๊ฒƒ์œผ๋กœ ๊ฒฐ๊ณผ๊ฐ€ ๋„์ถœ๋˜์—ˆ๋‹ค. ๊ทธ๋ฆฌ๊ณ  ์ฑ„๋„ ์šด์˜์ž์˜ ์šด์˜ ํ˜•ํƒœ์™€ ๊ธฐ๊ฐ„์— ๋”ฐ๋ผ ์„ฑ๊ณผ์ง€ํ‘œ๊ฐ€ ์ฐจ์ด๋ฅผ ๋ณด์ด๊ธฐ๋„ ํ•˜์˜€๋‹ค. ํ•œํŽธ ์ฝ˜ํ…์ธ ๋ฅผ ์ œ์ž‘ํ•˜๋Š” ์ œ์ž‘์ž์˜ ์„ฑ๋ณ„๊ณผ ์œ ํ˜•์— ๋”ฐ๋ผ์„œ๋„ ์„ฑ๊ณผ์ง€ํ‘œ๊ฐ€ ์ฐจ์ด๋ฅผ ๋ณด์˜€์ง€๋งŒ ์ „๋ฌธ์„ฑ๊ณผ ์‹ ๋ขฐ์„ฑ๊ณผ ๊ฐ™์€ ๊ณต์‹ ๋ ฅ ๋ชจํ˜•์€ ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ์„ฑ๊ณผ์ง€ํ‘œ์— ์œ ์˜๋ฏธํ•œ ์˜ํ–ฅ์„ ๋ฏธ์น˜์ง€ ์•Š๋Š” ๊ฒƒ์œผ๋กœ ๋„์ถœ๋˜์—ˆ๋‹ค. ์ด์–ด์„œ ๋‘ ๋ฒˆ์งธ ์—ฐ๊ตฌ๋ฌธ์ œ์—์„œ๋Š” ์†Œ๋น„ ์˜ํ–ฅ์š”์ธ๋“ค์„ ๊ธฐ์ค€๋ณ€์ˆ˜๋กœ ํˆฌ์ž…ํ•˜์—ฌ 2๋‹จ๊ณ„ ๊ตฐ์ง‘๋ถ„์„์„ ์‹ค์‹œํ•˜์—ฌ ์œ ํŠœ๋ธŒ ์ƒ์— ๊ฒŒ์‹œ๋œ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ ๋“ค์„ ์œ ํ˜•ํ™”ํ•˜๊ณ  ๊ทธ ํŠน์„ฑ์„ ํŒŒ์•…ํ•˜์˜€๋‹ค. ๋ถ„์„ ๊ฒฐ๊ณผ ์ด 5๊ฐœ ์œ ํ˜•์˜ ๊ตฐ์ง‘์œผ๋กœ ์œ ํ˜•์ด ๋ถ„๋ฅ˜๋˜์—ˆ๋‹ค. ์ข…๋ชฉ๊ณผ ๋ฏธ๋””์–ด ์Šคํฌ์ธ  ์„ฑ๊ฒฉ ๊ทธ๋ฆฌ๊ณ  ์ฝ˜ํ…์ธ  ์œ ํ˜•์ด ๊ตฐ์ง‘์„ ๊ตฌ๋ถ„ํ•˜๋Š”๋ฐ ๊ฐ€์žฅ ๋†’์€ ์˜ˆ์ธก๋ ฅ์„ ๊ฐ€์ง„ ๋ณ€์ˆ˜๋กœ ์‚ฌ์šฉ ๋˜์—ˆ์œผ๋ฉฐ, ์ด์–ด์„œ ์ธ๋„ค์ผ์˜ ์„ ์ •์„ฑ๊ณผ ํญ๋ ฅ์„ฑ์ด ๊ตฐ์ง‘์„ ๊ตฌ๋ถ„ํ•˜๋Š” ๊ธฐ์ค€๋ณ€์ˆ˜๋กœ ์‚ฌ์šฉ๋˜์—ˆ๋‹ค. ๋ถ„๋ฅ˜๋œ ๊ตฐ์ง‘์€ ๊ฐ๊ฐ โ€˜์ž๊ทน์ ์ธ ์˜์—ญํ˜• ์—”ํ„ฐํ…Œ์ธ๋จผํŠธ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ , โ€˜ํ•„๋“œํ˜• ๋ถ„์„ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ , ์˜์—ญํ˜• ๋ถ„์„ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ , โ€˜๊ธฐ๋ก ๋ฐ ํˆฌ์Ÿํ˜• ๋ถ„์„ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ , โ€˜์ž๊ทน์ ์ธ ๋‹จ๋ จํ˜• ๋ ˆ์Šจ ๋ฐ ์ •๋ณดํ˜• ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ โ€™์˜ ํŠน์„ฑ์„ ๋ณด์˜€๋‹ค. ๋ฏธ๋””์–ด ์Šคํฌ์ธ  ์„ฑ๊ฒฉ์„ ๊ธฐ์ค€์œผ๋กœ ๊ตฐ์ง‘ 1,2,3๊ณผ 4,5๋กœ ์–‘๋ถ„๋˜์—ˆ์œผ๋ฉฐ, ๊ตฐ์ง‘ 1,2,3์™€ 4,5๋Š” ๊ฐ๊ฐ ์„ธ๋ถ€ ์ข…๋ชฉ๊ณผ ์ฝ˜ํ…์ธ  ์œ ํ˜•์— ๋”ฐ๋ผ ๋ถ„๋ฅ˜๋˜์–ด์กŒ๋‹ค. ๊ทธ๋ฆฌ๊ณ  5๊ฐœ์˜ ๊ตฐ์ง‘ ์ค‘ ๊ฐ€์žฅ ๋†’์€ ์„ฑ๊ณผ์ง€ํ‘œ๋ฅผ ๋ณด์ด๋Š” ์œ ํ˜•์€ ์ฒซ ๋ฒˆ์งธ โ€˜์ž๊ทน์ ์ธ ์˜์—ญํ˜• ์—”ํ„ฐํ…Œ์ธ๋จผํŠธ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ โ€™์˜€์œผ๋ฉฐ, ๋‘ ๋ฒˆ์งธ๋กœ ๋†’์€ ์„ฑ๊ณผ์ง€ํ‘œ๋ฅผ ๋ณด์ด๋Š” ์œ ํ˜•์€ โ€˜์ž๊ทน์ ์ธ ๋‹จ๋ จํ˜• ๋ ˆ์Šจ ๋ฐ ์ •๋ณดํ˜• ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ โ€™์˜€๋‹ค. ์ด์™€ ๊ฐ™์€ ๊ฒฐ๊ณผ๋ฅผ ํ†ตํ•ด ํŠน์ • ์ข…๋ชฉ์˜ ์œ ํ˜•์—์„œ ๋†’์€ ์„ฑ๊ณผ๋ฅผ ๋‹ฌ์„ฑํ•œ ์ฝ˜ํ…์ธ ๋“ค์˜ ํŠน์„ฑ์„ ํŒŒ์•…ํ•  ์ˆ˜ ์žˆ์—ˆ๋‹ค. ๋ณธ ์—ฐ๊ตฌ์˜ ๊ฒฐ๊ณผ๋Š” ๋””์ง€ํ„ธ ๋ฏธ๋””์–ด ํ™˜๊ฒฝ์—์„œ์˜ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ ์˜ ์ƒ์‚ฐ๊ณผ ์†Œ๋น„์˜ ํŠน์„ฑ์„ ํŒŒ์•…ํ•  ์ˆ˜ ์žˆ๋Š” ์ •๋ณด๋ฅผ ์ œ๊ณตํ•˜์—ฌ ๋‹ค์–‘ํ•œ ์ดํ•ด๊ด€๊ณ„์ž๋“ค์—๊ฒŒ ์‹œ์žฅ์ „๋žต์„ ์ˆ˜๋ฆฝํ•˜๋Š”๋ฐ ๊ธฐ์ดˆ์ ์ธ ์ •๋ณด๋ฅผ ์ œ๊ณตํ•˜์˜€๋‹ค๋Š” ์ ์—์„œ ์˜๋ฏธ๊ฐ€ ์žˆ์—ˆ๋‹ค. ๋˜ํ•œ ๋น…๋ฐ์ดํ„ฐ ์ž๋ฃŒ ์ˆ˜์ง‘ ๊ธฐ๋ฒ•์˜ ๋„์ž…๊ณผ ๊ณ ๊ธ‰ํ†ต๊ณ„๊ธฐ๋ฒ•์˜ ์ ์šฉ์„ ํ†ตํ•ด ๋””์ง€ํ„ธ ๋ฏธ๋””์–ด ์†Œ๋น„ ํ™˜๊ฒฝ์˜ ๋งฅ๋ฝ์— ์ ํ•ฉํ•œ ์—ฐ๊ตฌ๋ฐฉ๋ฒ•์„ ์ œ์‹œํ•˜์˜€๋‹ค๋Š” ์ ์—์„œ๋„ ํ•™์ˆ ์  ์˜๋ฏธ๊ฐ€ ์žˆ๋‹ค. ์ข…ํ•ฉํ•˜์ž๋ฉด ์Šคํฌ์ธ  ๋ฏธ๋””์–ด ์ฝ˜ํ…์ธ ๋ฅผ ์‹œ์ •ํ•˜๋Š” ๋™๊ธฐ์™€ ์ฆ๊ฑฐ์›€์€ ๋ณ€ํ™”ํ•˜์ง€ ์•Š์„ ์ˆ˜ ์žˆ์ง€๋งŒ, ๋‹ค์–‘ํ•œ ๋™๊ธฐ์™€ ์ฆ๊ฑฐ์›€์€ ์‹œ์žฅ์˜ ํ™˜๊ฒฝ์— ๋”ฐ๋ผ ์ƒ์ดํ•˜๊ฒŒ ๋ฐœํ˜„๋  ์ˆ˜ ์žˆ๊ธฐ์—, ๋ฏธ๋””์–ด ํ™˜๊ฒฝ๊ณผ ์ „ํ†ต ๋ฏธ๋””์–ด ์ด๋ก ์„ ๊ณ ๋ คํ•˜๊ณ , ์ƒˆ๋กœ์šด ํ™˜๊ฒฝ์„ ์กฐ์‚ฌํ•  ์ˆ˜ ์žˆ๋Š” ์—ฐ๊ตฌ๋ฐฉ๋ฒ•์„ ๋„์ž…ํ•˜์˜€๋‹ค๋Š” ์ ์—์„œ ๋ณธ ์—ฐ๊ตฌ๋Š” ์˜๋ฏธ๋ฅผ ๊ฐ€์ง„๋‹ค.The purpose of this study was to identify the influence of consumption determinants factors on consuming YouTube sports content, along with an overall analysis of the sports media market on the YouTube platform. The production and consumption of sports media content varies depending on the media streaming environment. In particular, YouTube is leading the media market in the digital environment by combining social media services and OTT Service(over the top). Specifically, production on Upstream and distribution on Downstream are integrated in the YouTube, and it makes special environment that anyone can participate as a producer and distribute anytime, anywhere. For example, various forms of contents production are being carried out from using it as a second market for traditional sports channels to personal producing content for individual creators. This is very different from the past when sports mediaโ€™s production have been centered by broadcasting company. Therefore, this study aimed to analyze the media market by sports content environment on the YouTube platform as a research target. In particular, this study provide market participants with basic information for establishing marketing strategies by identifying the specificity of the sports content market on the YouTube media platform and analyzing factors that promote consumption. To this end, this study contemplate the latest sports media studies and traditional communication studies to derive consumption determinant factors and create a Youtube sports consuming model. In order to classify the sports contents posted on the YouTube platform and empirically verify the impact of consumption determinant factors on performance indicators(view count, estimated content Revenue, reply count),about 100,000 contents were collected as research subjects on 150 sports related YouTube channels. To measure performance indicators and collect variables related to consumption determinant factors on the web, programing data crawling program and mining programs using Python language. And content analysis techniques also used to measure variables that are difficult to measure quantitatively too. As a result, this study solved two research questions based on these collected data. First of all, in the first study, the influence of consumption determinant factors on economic performance indicators such as view count and estimated content revenues are verified through multi-level model regression analysis. And also social performance indicators such as reply count was verified too. As a result of the verification, consumption determinant factors effect were presented not only at the content level but also channel level. And among consumption determinant factors, sports related factors such as sports-specific events, media sports characteristics, and sports content types were having the greatest impact. In addition, the performance indicators differed depending on the form and amount of information provided in the contents, in particular, the higher the sensitivity and the violence of the thumbnail brings the higher the performance indicators. Performance indicators also differed depending on the type and duration of operation of the channel operator. On the other hand, although performance indicators differed depending on the gender and type of content creators, source credibility models such as professionalism and reliability were not derived to have a significant impact on performance indicators in this study. In the second study, the consumption determinent factors were used as reference variables to conduct a two-steps clustering analysis to classify and identify the characteristics of sports contents posted on the YouTube. The analysis results showed that the types were classified into clusters of five types. Specific sports events, media sports characteristics, and content types were used as the most predictable variables to classify clusters, and followed by thumbnail sensitivity and violence variables. Each classified clusters showed the characteristics that "stimulating, area type, entertainment sports content, "field type, analysis, sports contentโ€œ, โ€œarea type, analysis, sports content, "record and struggle type, analysis, sports contentโ€, and "stimulating, lessons and information type, sports content." Specifically, clusters 1,2,3 and 4,5 were divided based on the characteristics of media sports, and clusters 1,2 and 3,4,5 were classified according to the specific sports events and content types, respectively. Getting the highest performance indicator among the five clusters was "stimulating area-type entertainment sports content", followed by "stimulating training lessons and information-type sports content", which achieved the second highest performance index. These kinds of results helped to identify the characteristics of content that achieved high performance in a particular types of sports contents. The results of these two studies were meaningful in that it provided information to understand the characteristics of the production and consumption of sports content in the digital media environment, providing fundamental information to various stake-holders in establishing market strategies. It is also academic in that it presents research methods suitable for the context of digital media consumption environment through the introduction of big-data collection techniques and the application of advanced statistical techniques. Various motives and pleasures of watching sports media content can be expressed differently depending on the environment of the market. Therefore, from a comprehensive perspective, this study is meaningful in that it considers the media environment and traditional media theory and introduces research methods to investigate new environments.โ… . ์„œ ๋ก  1. ์—ฐ๊ตฌ์˜ ๋ฐฐ๊ฒฝ 1 2. ์—ฐ๊ตฌ์˜ ํ•„์š”์„ฑ 3 3. ์—ฐ๊ตฌ์˜ ๋ชฉ์  5 โ…ก. ์ด๋ก ์  ๋ฐฐ๊ฒฝ 1. ์Šคํฌ์ธ ์™€ ๋ฏธ๋””์–ด 7 1) ์Šคํฌ์ธ ๋ฏธ๋””์–ด์˜ ๊ฐœ๋…๊ณผ ์œ ํ˜• 7 โ‘  ์Šคํฌ์ธ  ๋ฏธ๋””์–ด์˜ ๊ฐœ๋… 7 โ‘ก ์Šคํฌ์ธ  ๋ฏธ๋””์–ด ์ƒํƒœ๊ณ„ 9 โ‘ข ์Šคํฌ์ธ  ๋ฏธ๋””์–ด ์ฝ˜ํ…์ธ  ์œ ํ˜• 12 2) ์Šคํฌ์ธ  ๋ฏธ๋””์–ด ์†Œ๋น„์™€ ์ด์šฉ ์ด๋ก  20 โ‘  ๋ฏธ๋””์–ด ํšจ๊ณผ์ด๋ก ๊ณผ ์Šคํฌ์ธ  ๋ฏธ๋””์–ด20 โ‘ก ์Šคํฌ์ธ  ๋ฏธ๋””์–ด ์†Œ๋น„ ๋™๊ธฐ 24 โ‘ข ์Šคํฌ์ธ  ๋ฏธ๋””์–ด ์ฝ˜ํ…์ธ ์˜ ๊ด€๋žŒ ์ฆ๊ฑฐ์›€ 42 โ‘ฃ ์Šคํฌ์ธ  ๋ฐฉ์†กํ”„๋กœ๊ทธ๋žจ์˜ ์‹œ์ฒญ ๊ฒฐ์ • ์š”์ธ 48 2. ๋ฏธ๋””์–ด ์†Œ๋น„ ํ™˜๊ฒฝ์˜ ๋ณ€ํ™”์™€ ์œ ํŠœ๋ธŒ์˜ ๋“ฑ์žฅ 59 1) ๋ฏธ๋””์–ด ๋ฐœ์ „๊ณผ ๋ฏธ๋””์–ด ์†Œ๋น„ ํ–‰๋™์˜ ๋ณ€ํ™” 59 โ‘  ๋ฏธ๋””์–ด ๊ธฐ์ˆ ์˜ ์ง„ํ™”์™€ ๋ฏธ๋””์–ด ์†Œ๋น„ 59 โ‘ก ์ธํ„ฐ๋„ท ํ™˜๊ฒฝ๊ณผ ๋””์ง€ํ„ธ ๋ฏธ๋””์–ด 62 โ‘ข OTT์„œ๋น„์Šค์˜ ๋“ฑ์žฅ๊ณผ ๋ฏธ๋””์–ด ์†Œ๋น„ํ–‰๋™ 68 โ‘ฃ ์†Œ์…œ ๋ฏธ๋””์–ด์™€ ์†Œ๋น„ํ–‰๋™ 70 โ‘ค ๋””์ง€ํ„ธ ๋ฏธ๋””์–ด ์‹œ๋Œ€์˜ ์Šคํฌ์ธ  ๋ฏธ๋””์–ด 79 2) ์œ ํŠœ๋ธŒ ๋ฏธ๋””์–ด ํ™˜๊ฒฝ๊ณผ ์†Œ๋น„ํ–‰๋™์˜ ๋ณ€ํ™” 83 โ‘  ์œ ํŠœ๋ธŒ์˜ ๊ฐœ๋…๊ณผ ์†Œ๋น„ ์ƒํƒœ๊ณ„ 83 โ‘ก ์œ ํŠœ๋ธŒ ์ฝ˜ํ…์ธ  ํŠน์„ฑ๊ณผ ์œ ํ˜• 90 โ‘ข ์œ ํŠœ๋ธŒ ํฌ๋ฆฌ์—์ดํ„ฐ์˜ ํŠน์„ฑ๊ณผ ์œ ํ˜• 99 โ‘ฃ ์œ ํŠœ๋ธŒ ์†Œ๋น„์ž์™€ ์‹œ์ฒญํ–‰๋™์˜ ํŠน์„ฑ 110 3. ์œ ํŠœ๋ธŒ ์Šคํฌ์ธ ์˜ ์†Œ๋น„ 116 1) ์œ ํŠœ๋ธŒ ์Šคํฌ์ธ ์˜ ํŠน์„ฑ 116 โ‘  ์œ ํŠœ๋ธŒ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ ์˜ ๊ฐœ๋…๊ณผ ์œ ํ˜• 116 โ‘ก ์œ ํŠœ๋ธŒ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ  ์†Œ๋น„์ž 125 โ‘ข ์œ ํŠœ๋ธŒ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ ์˜ ์ œ์ž‘์ž 131 2) ์œ ํŠœ๋ธŒ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ  ๊ด€๋ จ ์„ ํ–‰์—ฐ๊ตฌ 140 โ‘  ์œ ํŠœ๋ธŒ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ  ํŠน์„ฑ ๋ฐ ์†Œ๋น„ ๊ด€๋ จ ์—ฐ๊ตฌ 140 โ‘ก ์œ ํŠœ๋ธŒ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ ๋ฅผ ํ™œ์šฉํ•œ ๋งˆ์ผ€ํŒ… ๊ด€๋ จ ์—ฐ๊ตฌ 144 โ‘ข ๋””์ง€ํ„ธ ๊ธฐ์ˆ  ํ™˜๊ฒฝ๊ณผ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ  ์†Œ๋น„์ž ํ–‰๋™ ๊ด€๋ จ ์—ฐ๊ตฌ 147 3) ์œ ํŠœ๋ธŒ ์Šคํฌ์ธ  ์‹œ์ฒญ ์„ฑ๊ณผ์ง€ํ‘œ 150 โ‘  ์œ ํŠœ๋ธŒ ์„ฑ๊ณผ ์ง€ํ‘œ 150 โ‘ก ๊ฒฝ์ œ์  ์„ฑ๊ณผ๋กœ์„œ ์กฐํšŒ์ˆ˜ ๊ธฐ๋ฐ˜ ์„ฑ๊ณผ ์ง€ํ‘œ 153 โ‘ข ์‚ฌํšŒ์  ์„ฑ๊ณผ๋กœ์„œ ์‚ฌํšŒ์  ์†Œํ†ต ์ง€ํ‘œ 160 4) ์œ ํŠœ๋ธŒ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ  ์†Œ๋น„ ๊ฒฝํ—˜ ๋ชจ๋ธ 164 โ‘  ์ปค๋ฎค๋‹ˆ์ผ€์ด์…˜ ๋ชจ๋ธ๊ณผ ์œ ํŠœ๋ธŒ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ  ์†Œ๋น„ 164 โ‘ก ์œ ํŠœ๋ธŒ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ  ์‹œ์ฒญ ๊ฒฝํ—˜ ๋ชจ๋ธ๊ณผ ์†Œ๋น„ํ–‰๋™ 170 5) ์œ ํŠœ๋ธŒ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ  ์†Œ๋น„ ์˜ํ–ฅ์š”์ธ 180 โ‘  ์Šคํฌ์ธ  ์š”์ธ 181 โ‘ก ์ฝ˜ํ…์ธ  ์š”์ธ 188 โ‘ข ์ฑ„๋„ ์š”์ธ 198 โ‘ฃ ์ ‘๊ทผ์„ฑ ์š”์ธ 207 โ…ข. ์—ฐ๊ตฌ๋ฌธ์ œ 1. ์—ฐ๊ตฌ๋ฌธ์ œ ๋„์ถœ ๋ฐฐ๊ฒฝ 211 2. ์„ธ๋ถ€ ์—ฐ๊ตฌ๋ฌธ์ œ 212 1) ์—ฐ๊ตฌ๋ฌธ์ œ 1 212 2) ์—ฐ๊ตฌ๋ฌธ์ œ 2 213 โ…ฃ ์—ฐ๊ตฌ ๋ฐฉ๋ฒ• ๋ฐ ์ ˆ์ฐจ 1. ์ž๋ฃŒ 215 1) ๋ถ„์„ ๋Œ€์ƒ 215 2) ์ž๋ฃŒ์˜ ๊ตฌ์„ฑ 216 3) ์ž๋ฃŒ์ˆ˜์ง‘ ์ ˆ์ฐจ 220 4) ์ž๋ฃŒ ์ˆ˜์ง‘ ๋„๊ตฌ 222 โ‘  ํŒŒ์ด์ฌ ํ”„๋กœ๊ทธ๋ž˜๋ฐ์„ ์ด์šฉํ•œ ๋ฐ์ดํ„ฐ ์ˆ˜์ง‘ ๋ฐ ์ „์ฒ˜๋ฆฌ 222 โ‘ก ๊ฐœ๋ณ„ ์˜์ƒ ์ž๋ฃŒ ์ถ”๊ฐ€ ์ˆ˜์ง‘: ์œ ๋ฃŒ ๋ฐ์ดํ„ฐ ํ™œ์šฉ 225 โ‘ข ๋‚ด์šฉ๋ถ„์„: ์ฝ˜ํ…์ธ  ๋‚ด์šฉ ๋ฐ ์ฑ„๋„ ๊ด€๋ จ ์ž๋ฃŒ ์ˆ˜์ง‘ 227 2. ์ž๋ฃŒ ๋ถ„์„ 231 1) ๊ธฐ์ˆ  ํ†ต๊ณ„ 231 2) ์—ฐ๊ตฌ ๋ฌธ์ œ 1์˜ ๋ถ„์„๋ฐฉ๋ฒ•: ๋‹ค์ธต๋ชจํ˜• ํšŒ๊ท€๋ถ„์„ 232 โ‘  ์—ฐ๊ตฌ๋ชจํ˜•์˜ ์„ค์ •: ํ™•๋ฅ  ์ ˆํŽธ(Random intercept) ๋‹ค์ธต๋ชจํ˜• 232 โ‘ก ์—ฐ๊ตฌ๋ชจํ˜•์˜ ๋ถ„์„ 236 3) ์—ฐ๊ตฌ ๋ฌธ์ œ 2์˜ ๋ถ„์„๋ฐฉ๋ฒ•: ๊ตฐ์ง‘๋ถ„์„ 240 โ‘  ๋ถ„์„๋ฐฉ๋ฒ•์˜ ์„ ํƒ ๋ฐ ์ ์šฉ: 2๋‹จ๊ณ„ ๊ตฐ์ง‘ ๋ถ„์„ 240 โ‘ก 2๋‹จ๊ณ„ ๊ตฐ์ง‘๋ถ„์„์˜ ์ ์šฉ 244 โ…ค. ์—ฐ๊ตฌ๊ฒฐ๊ณผ 1. ์ž๋ฃŒ์ฒ˜๋ฆฌ ๋ฐ ์ฃผ์š”๋ณ€์ˆ˜์˜ ๊ธฐ์ˆ ํ†ต๊ณ„ 247 1) ๊ฒฐ์ธก์น˜ ๋ฐ ์ด์ƒ๊ฐ’(Outlier) ์ฒ˜๋ฆฌ 247 2) ์ฃผ์š”๋ณ€์ˆ˜์˜ ๊ธฐ์ˆ ํ†ต๊ณ„ ๋ถ„์„ 248 โ‘  ์„ฑ๊ณผ์ง€ํ‘œ์˜ ๊ธฐ์ˆ ํ†ต๊ณ„๋Ÿ‰ 248 โ‘ก ์Šคํฌ์ธ  ์š”์ธ์˜ ๊ธฐ์ˆ ํ†ต๊ณ„๋Ÿ‰ 250 โ‘ข ์ฝ˜ํ…์ธ  ์š”์ธ์˜ ๊ธฐ์ˆ ํ†ต๊ณ„๋Ÿ‰ 253 โ‘ฃ ์ ‘๊ทผ์„ฑ ์š”์ธ์˜ ๊ธฐ์ˆ ํ†ต๊ณ„๋Ÿ‰ 255 โ‘ค ์ฑ„๋„ ์š”์ธ ๊ธฐ์ˆ  ํ†ต๊ณ„๋Ÿ‰ 256 โ‘ฅ ํ†ต์ œ๋ณ€์ˆ˜์˜ ๊ธฐ์ˆ  ํ†ต๊ณ„๋Ÿ‰ 258 2. ์—ฐ๊ตฌ๋ฌธ์ œ 1 ๊ฒ€์ฆ 260 1) ์กฐํšŒ์ˆ˜์— ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ์†Œ๋น„์˜ํ–ฅ์š”์ธ ๋ถ„์„ 260 โ‘  ๊ธฐ์ดˆ๋ชจํ˜• ๋ถ„์„ 260 โ‘ก ์กฐํšŒ์ˆ˜์— ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ์˜์ƒ์ˆ˜์ค€(1์ˆ˜์ค€) ์š”์ธ ๊ฒ€์ฆ 262 โ‘ข ์กฐํšŒ์ˆ˜์— ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ์ฑ„๋„์ˆ˜์ค€(2์ˆ˜์ค€) ์š”์ธ ๊ฒ€์ฆ 267 2) ์ถ”์ •๋œ ์ฝ˜ํ…์ธ  ์ˆ˜์ต์— ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ์†Œ๋น„์˜ํ–ฅ์š”์ธ ๋ถ„์„ 269 โ‘  ๊ธฐ์ดˆ๋ชจํ˜• ๋ถ„์„ 269 โ‘ก ์ถ”์ •๋œ ์ฝ˜ํ…์ธ  ์ˆ˜์ต์— ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ์˜์ƒ์ˆ˜์ค€(1์ˆ˜์ค€) ์š”์ธ ๊ฒ€์ฆ 271 โ‘ข ์ถ”์ •๋œ ์ฝ˜ํ…์ธ  ์ˆ˜์ต์— ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ์ฑ„๋„์ˆ˜์ค€(2์ˆ˜์ค€) ์š”์ธ ๊ฒ€์ฆ 275 3) ๋Œ“๊ธ€์ˆ˜์— ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ์†Œ๋น„์˜ํ–ฅ์š”์ธ ๋ถ„์„ 277 โ‘  ๊ธฐ์ดˆ๋ชจํ˜• ๋ถ„์„ 277 โ‘ก ๋Œ“๊ธ€์ˆ˜์— ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ์˜์ƒ์ˆ˜์ค€(1์ˆ˜์ค€) ์š”์ธ ๊ฒ€์ฆ 278 โ‘ข ๋Œ“๊ธ€์ˆ˜์— ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ์ฑ„๋„์ˆ˜์ค€(2์ˆ˜์ค€) ์š”์ธ ๊ฒ€์ฆ 284 3. ์—ฐ๊ตฌ๋ฌธ์ œ 2 ๊ฒ€์ฆ: ์œ ํŠœ๋ธŒ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ  ๊ตฐ์ง‘๋ถ„์„ 287 1) ๋ถ„์„ ๋Œ€์ƒ ๋ฐ ๊ธฐ์ค€๋ณ€์ˆ˜ ์„ ์ • 289 2) ์œ ํŠœ๋ธŒ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ  ๊ตฐ์ง‘ ๋ถ„๋ฅ˜ ๋ฐ ํŠน์„ฑ ๋ถ„์„ 289 โ‘  ๊ตฐ์ง‘ ๋ถ„๋ฅ˜ ๋ฐ ํ’ˆ์งˆ ๊ฒ€์ฆ 289 โ‘ก ์œ ํŠœ๋ธŒ ์Šคํฌ์ธ  ์ฝ˜ํ…์ธ  ๊ตฐ์ง‘ ๋ถ„ํฌ 290 โ‘ข ๊ตฐ์ง‘ ํŠน์„ฑ ๋ถ„์„: ๊ธฐ์ค€๋ณ€์ˆ˜๋ฅผ ํ™œ์šฉํ•œ ํ”„๋กœํŒŒ์ผ๋ง(Profiling) 291 โ‘ฃ ๊ตฐ์ง‘์˜ ์ •์˜ 295 3) ๊ตฐ์ง‘๋ณ„ ์†Œ๋น„ ์˜ํ–ฅ์š”์ธ ํŠน์„ฑ ๋ถ„์„ 298 โ‘  ๊ตฐ์ง‘๋ณ„ ์„ธ๋ถ€ ์ข…๋ชฉ ํŠน์„ฑ 298 โ‘ก ๊ตฐ์ง‘๋ณ„ ์ฝ˜ํ…์ธ  ์š”์ธ ํŠน์„ฑ 301 โ‘ข ๊ตฐ์ง‘๋ณ„ ํฌ๋ฆฌ์—์ดํ„ฐ ์š”์ธ ํŠน์„ฑ302 4) ๊ตฐ์ง‘๋ณ„ ์„ฑ๊ณผ์ง€ํ‘œ ํŠน์„ฑ ๋ถ„์„ 304 โ…ฅ. ๋…ผ์˜ ๋ฐ ๊ฒฐ๋ก  1. ์—ฐ๊ตฌ ๊ฒฐ๊ณผ ์š”์•ฝ 307 2. ์ฃผ์š” ์—ฐ๊ตฌ ๊ฒฐ๊ณผ ๋…ผ์˜ 309 1) ์—ฐ๊ตฌ๋ฌธ์ œ 1์˜ ์—ฐ๊ตฌ๊ฒฐ๊ณผ ๋…ผ์˜ 309 2) ์—ฐ๊ตฌ๋ฌธ์ œ 2์˜ ์—ฐ๊ตฌ๊ฒฐ๊ณผ ๋…ผ์˜ 315 3. ์—ฐ๊ตฌ์˜ ์˜์˜ ๋ฐ ๊ธฐ์—ฌ๋„ 321 4. ์—ฐ๊ตฌ์˜ ์ œํ•œ์  ๋ฐ ํ–ฅํ›„ ์—ฐ๊ตฌ ๋ฐฉํ–ฅ ์ œ์‹œ 325 โ…ฆ. ์ฐธ๊ณ ๋ฌธํ—Œ โ…ง. ๋ถ€๋กDocto

    Clinical studies on the acute suppurative cholangitis

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    ์˜ํ•™๊ณผ/์„์‚ฌ[ํ•œ๊ธ€]๊ธ‰์„ฑ ํ™”๋†์„ฑ ๋‹ด๊ด€์—ผ์€ ๋‹ด๊ด€๋‚ด์˜ ํ™”๋†์„ฑ ๋‹ด์ฆ™ ๋•Œ๋ฌธ์— ์—ฌ๋Ÿฌ ์ฆ์ƒ์ด ์•ผ๊ธฐ๋œ ์งˆํ™˜์ด๋ฉฐ, ์ด๊ฒƒ์ด ๋” ์ง„ํ–‰๋˜๋ฉด ์ €ํ˜ˆ์•• ๋ฐ ์ค‘์ถ”์‹ ๊ฒฝ ์ฆ์ƒ์ด ๋‚˜ํƒ€๋‚˜๋Š” ์งˆํ™˜์ด๋‹ค. ๋ฌธํ—Œ์„ ๊ณ ์ฐฐํ•˜์—ฌ ๋ณด๋ฉด, ๋ณธ ์งˆํ™˜์— ์žˆ์–ด์„œ ๋‹ด๋„๊ณ„์˜ ์ ์ ˆํ•œ ์‘๊ธ‰ ๊ฐ์••์ˆ˜์ˆ ์„ ์‹œํ–‰ํ•˜์ง€ ์•Š์œผ๋ฉด ๋ชจ๋‘ ์‚ฌ๋งํ•˜์˜€์Œ์„ ๋ณด๊ณ ํ•˜๊ณ  ์žˆ๋‹ค. ๋ณธ ๋…ผ๋ฌธ์€ ์—ฐ์„ธ์˜๋ฃŒ์› ์™ธ๊ณผ์—์„œ ๊ฒฝํ—˜ํ•œ 40์˜ˆ์˜ ํ™”๋†์„ฑ ๋‹ด๊ด€์—ผ ํ™˜์ž์˜ ๊ฒฝ๊ณผ ๋ฐ ์น˜๋ฃŒ ๊ฒฐ๊ณผ์— ๋Œ€ํ•ด์„œ ๊ณ ์ฐฐํ•œ ๊ฒƒ์ด๋‹ค. ์ฆ‰ 1966๋…„ 1์›”๋ถ€ํ„ฐ 1976๋…„ 12์›”๊นŒ์ง€ ์—ฐ์„ธ์˜๋ฃŒ์› ์™ธ๊ณผ์—์„œ ๊ฒฝํ—˜ํ•œ 40์˜ˆ๋ฅผ ๋Œ€์ƒ์œผ๋กœ ํ•˜์˜€์œผ๋ฉฐ ํ™˜์ž๋ฅผ ๋‘ ๊ตฐ์œผ๋กœ ๋‚˜๋ˆ„์–ด ๋น„๊ต ๊ด€์ฐฐ์„ ํ•˜์˜€๋‹ค. ์ œ1๊ตฐ์€ ๊ธ‰์„ฑ ํ™”๋†์„ฑ ๋‹ด๊ด€์—ผ ํ™˜์ž๋“ค๋กœ์จ, ๋ณตํ†ต,๋ฐœ์—ด ๋ฐ ์˜คํ•œ, ํ™ฉ๋‹ฌ ๋ฐ ์ˆ˜์ˆ ์‹œ ๋‹ด๋„๋‚ด์— ํ™”๋†์„ฑ ๋‹ด์ฆ™์ด ์กด์žฌํ•œ ์˜ˆ๋กœ ๋˜์—ˆ๊ณ , ์ œ2๊ตฐ์€ ๊ธ‰์„ฑ ํ์‡„์„ฑ ํ™”๋†์„ฑ ๋‹ด๊ด€์—ผ ํ™˜์ž๋กœ์จ, ์ƒ๊ธฐ ์ฆ์ƒ์—๋‹ค ์ค‘์ถ”์‹ ๊ฒฝ ์†์ƒ, ํŒจํ˜ˆ์ฆ์œผ๋กœ ์ดํ•œ shock ๋ฐ ๋‹ด๋„์˜ ์™„์ „ํ์‡„์™€ ๊ฐ„์ข…์–‘์ด ๋™๋ฐ˜๋œ ์˜ˆ๋กœ ๋˜์—ˆ๋‹ค. ์ œ1๊ตฐ์€ 23๋ช…์ด์—ˆ๊ณ , ์ œ2๊ตฐ์€ 17๋ช…์ด์—ˆ๋‹ค. ๋ณธ ์—ฐ๊ตฌ์˜ ๊ฒฐ๊ณผ๋Š” ๋‹ค์Œ๊ณผ ๊ฐ™๋‹ค. 1. ๋‚จ์ž๊ฐ€ 19๋ช…, ์—ฌ์ž๊ฐ€ 21๋ช…์ด์—ˆ๊ณ , 50-59์„ธ์— ํ˜ธ๋ฐœํ–ˆ์œผ๋ฉฐ, ๋ณธ ์กฐ์‚ฌ๊ธฐ๊ฐ„ ์ค‘์— ๋‹ด๋„์งˆํ™˜์œผ๋กœ ์ˆ˜์ˆ ๋ฐ›์€ ํ™˜์ž๋Š” 884๋ช…์œผ๋กœ์จ, ๊ทธ์ค‘์—์„œ 4.5%์˜ ๋นˆ๋„๋ฅผ ๋ณด์—ฌ์ฃผ๊ณ  ์žˆ๋‹ค. 2. ์ฆ์ƒ์˜ ์‹œ์ž‘์€ ๋น„๊ต์  ๋นจ๋ผ์„œ 1์ฃผ์ผ ์ด๋‚ด๊ฐ€ 24๋ช…(60%)์ด์—ˆ์œผ๋ฉฐ ๊ณผ๊ฑฐ๋ ฅ์ƒ๋‹ด๋„ ์งˆํ™˜์˜ ์ฆ์ƒ์„ ๊ฐ€์ง„ ์˜ˆ๋Š” 19๋ช…(48%)์ด์—ˆ๊ณ , ๋‹ด๋„๊ณ„ ์ˆ˜์ˆ ์„ ๋ฐ›์€ ์˜ˆ๋Š” 8๋ช…(20%)์ด์—ˆ๋‹ค. 3. ์ „ ์˜ˆ์—์„œ ๋ณตํ†ต์ด ์žˆ์—ˆ์œผ๋ฉฐ, ํ™ฉ๋‹ฌ(75%) ๋ฐ ๋ฐœ์—ด(75%)์ด ๊ฐ€์žฅ ํ”ํ•œ ์ดํ•™์  ์†Œ๊ฒฌ์ด์—ˆ๋‹ค. 4. ์–‘๊ตฐ ๊ณตํžˆ ๋ฐฑํ˜ˆ๊ตฌ ์ฆ๊ฐ€๋ฅผ ๋ณด์ด๊ณ  ์žˆ๋‹ค. ๋ฐฑํ˜ˆ๊ตฌ์น˜๊ฐ€ 20,000/mm**3 ์ด์ƒ์ธ ๊ฒƒ์€ ์ œ1๊ตฐ์—์„œ 4์˜ˆ(17%), ์ œ2๊ตฐ์—์„œ๋Š” 10์˜ˆ(59%)์ด์—ˆ๋‹ค. ๋นŒ๋ฆฌ๋ฃจ๋นˆ์น˜๋„ ์–‘๊ตฐ ๊ณตํžˆ ์ƒ์Šน๋˜์–ด ์žˆ์—ˆ๋Š”๋ฐ, ์ œ2๊ตฐ(11.0ใŽŽ/dl)์ด ์ œ1๊ตฐ(4.5ใŽŽ/dl)๋ณด๋‹ค ํ›จ์”ฌ ๋†’์€ ์น˜๋ฅผ ๋ณด์—ฌ์ฃผ๊ณ  ์žˆ๋‹ค. SGOT๋Š” ์ œ1 ๊ตฐ๊ณผ ์ œ2๊ตฐ์ด ๊ฐ๊ฐ 68Unit ๋ฐ 160Unit์ด์—ˆ๊ณ , alkaline phosphatase์น˜๋Š” ๊ฐ๊ฐ 7 Somogyi unit ๋ฐ 5.8 Somogyi unit์ด์—ˆ๋‹ค. ๋‹ด์ฆ™์˜ ์„ธ๊ท ๋ฐฐ์–‘์ƒ ์ œ1๊ตฐ์—์„œ๋Š” 65%์˜ ์–‘์„ฑ์œจ์„ ๋‚˜ํƒ€๋‚ด์—ˆ๊ณ , ์ œ2๊ตฐ์€ 87%์˜ ์–‘์„ฑ์œจ์„ ๋ณด์˜€๋‹ค. ํ˜ˆ์•ก์˜ ์„ธ๊ท ๋ฐฐ์–‘์ƒ ์ œ1๊ตฐ์€ 29%์˜ ์–‘์„ฑ์œจ์„ ๋‚˜ํƒ€๋‚ธ ๋ฐ˜๋ฉด์— w-2๊ตฐ์€ 53%์˜ ์–‘์„ฑ์œจ์„ ๋ณด์˜€๋‹ค. ๋‹ด์ฆ™์˜ ์„ธ๊ท ๋ฐฐ์–‘์ƒ ๊ฐ€์žฅ ๋งŽ์ด ์ž๋ž€ ๊ท ์€ Escherichia coli(47%)์ด์—ˆ๊ณ , ํ˜ˆ์•ก์˜ ์„ธ๊ท ๋ฐฐ์–‘์—์„œ๋„ Escherichia coli(26%)๊ฐ€ ๊ฐ€์žฅ ๋งŽ์ด ๋ณด์˜€๋‹ค. 5. ์ˆ˜์ˆ ์ „์˜ ์ง„๋‹จ์ด ์ •ํ™•ํ•˜๊ฒŒ ๋งž์€ ๊ฒƒ์€ 40%์ด์—ˆ๋‹ค. ์ฆ‰ ์ œ1๊ตฐ์—์„œ ๊ฐ€์žฅ ๋งŽ์€ ์ˆ˜์ˆ ์ „ ์ง„๋‹จ์€ ๊ธ‰์„ฑ ํ™”๋†์„ฑ ๋‹ด๊ด€์—ผ(9d))์ด์—ˆ๊ณ , ์ œ2๊ตฐ์—์„œ๋Š” ๊ธ‰์„ฑ ํ์‡„์„ฑ ํ™”๋†์„ฑ ๋‹ด๊ด€์—ผ(7์˜ˆ)์ด์—ˆ๋‹ค. 6. ์ˆ˜์ˆ ์„ ํ•œ 38์˜ˆ ์ค‘ 35์˜ˆ(92%)์—์„œ ์ด์ˆ˜๋‹ด๊ด€ ๋‹ด์„์ด ๋ฐœ๊ฒฌ๋˜์—ˆ์œผ๋ฉฐ, 36์˜ˆ(95%)์—์„œ ์ด์ˆ˜๋‹ด๊ด€ ์ ˆ๊ฐœ์ˆ ์„ ์‹œํ–‰ํ•˜์˜€๋‹ค. ์ˆ˜์ˆ  ํ•ฉ๋ณ‘์ฆ์€ ์ œ1๊ตฐ์—์„œ 6๋ช…, ์ œ2๊ตฐ์—์„œ๋Š” 9๋ช…์ด ๋ณ‘๋ฐœํ•ด์„œ ์ด 40%์ด์—ˆ๊ณ , ์‚ฌ๋ง์ž๋Š” ์ œ1๊ตฐ์—์„œ 1๋ช…์ด๋ฉฐ, ์ œ2๊ตฐ์—์„œ๋Š” 9๋ช…์œผ๋กœ ์ด ์‚ฌ๋ง๋ฅ ์€ 25%์ด์—ˆ๋‹ค. ํŠนํžˆ ์ œ2๊ตฐ์—์„œ ์ˆ˜์ˆ ์„ ์•ˆํ•œ 2์˜ˆ๋Š” ๋ชจ๋‘ ์‚ฌ๋งํ–ˆ๊ณ , 24์‹œ๊ฐ„์—์„œ 72์‹œ๊ฐ„๊นŒ์ง€ ์ˆ˜์ˆ ์ด ์ง€์—ฐ๋œ ์˜ˆ๋Š” 80%์˜ ์‚ฌ๋ง๋ฅ ์„ ๋‚˜ํƒ€๋‚ด์—ˆ๋‹ค. ์ฆ‰ ์ด์ƒ์˜ ๊ฒฐ๊ณผ๋ฅผ ์ข…ํ•ฉํ•ด ๋ณด๊ฑด๋ฐ, ๋ณธ ์งˆํ™˜์€ ๋น ๋ฅธ ์‹œ๊ฐ„๋‚ด์— ์ •ํ™•ํ•œ ์ง„๋‹จ์„ ๋‚ด๋ ค์„œ, ์ ์ ˆํ•œ ๋‹ด๋„๊ณ„์˜ ๊ฐ์••์ˆ ์„ ์‹œํ–‰ํ•ด ์ฃผ๋ฉด ์‚ฌ๋ง๋ฅ ์ด ํ˜„์ €ํžˆ ๊ฐ์†Œ๋จ์„ ์•Œ ์ˆ˜ ์žˆ๋‹ค๊ณ  ํ•˜๊ฒ ๋‹ค. [์˜๋ฌธ]Acute suppurative cholangitis is a clinical disease of varying degree of severity, caused by frank pus in the biliary tree. An advanced form of this disease is termed acute obstructive suppurative cholangitis and frequently characterized by hypotension, depressed mental function, and impending death. All previously reported patients with this disease have died unless the biliary system was adequately decompressed and drained. The purpose of this study was to examine the course and outcome of forty patients with suppurative cholangitis treated at Yonsei Medical Center. Forty patients were treated at Yonsei Medical Center between 1966 and 1976. For purpose of comparision the cases were divided into two groups: groupโ…  includes 23 patients with acute suppurative cholangitis (ASC) and groupโ…ก includes 17 patients with acute obstructive suppurative cholangitis(AOSC). The essential features for diagnosis in groupโ…  were: abnominal pain, fever, chills, and leucocytosis, obstructive jaundice and purulence in the bile ducts at surgery. Essentials for diagnosis in groupโ…ก were: added features of central nervous system depression and bacteremia with hypotension and complete biliary obstruction, common duct pus under pressure, and liver abscess st surgery. The results of this study are summarized as follows: 1. The incidence of this disease was 4.5% of 884 patients who were undergone biliary surgery in the same period. There were 19 males and 21 females and the incidence of peak age was 50 to 59 of age. 2. The onset of the illness was usually rapid and over a span of less than one week in 60% of the patients. Nineteen patients (48%) gave a history of previous biliary tract disease and eight patients (20%) gave a history of previous operation on the biliary tract. 3. All patients had the abdominal pain. Jandice(75%) and fever(75%) were the most common physical findings. 4. Both groups show leucocytosis. Four patients (17%) in groupโ…  and ten patients (59%) in groupโ…ก bad WBC count of over 20,000/cubic mm. Bilirubin level were elevated in both groups. In groupโ…ก, the bilirubin level (11.0ใŽŽ/dl) was much more elevated than groupโ… (4.5ใŽŽ/dl). The SGOT were 68 Unit and 160 Unit and alkaline phosphatase were 7 Somogyi unit and 5.8 Somogyi unit respectively. Bile culture for the infections bacteria in groupโ…  showed positive rate of 65% and 87% in groupโ…ก. Blood culture for infectious bacteria in groupโ…  showed positive rate of 29% and 53% in groupโ…ก. The most commonly cultured organism in the bile was Escherichia coli(47%) and in the blood was also Escherichia coli(26%). 5. The accuracy of the diagnosis in the preoperative period was 40%. The most common preoperative diagnosis in groupโ…  was acute suppurative cholangitis(9 cases) and in groupโ…ก was acute obstructive suppurative cholangitis(7 cases). 6. The common duct stones were found in 35 patients(92%) and common duct was explored in 36 patients(95%). The operative complications in groupโ…  were 6 cases and in group โ…ก were 9 cases. The overall operative complication rate was 40%. And one patient in groupโ…  and nine patients in groupโ…ก were expired. The overall mortality rate was 25 percent. In groupโ…ก, the two cases who were not explored had all died. And cases whose operations were delayed 24 to 72 hours showed 80% mortality rate. In this study, the patient's survival depended on entirely recognition of this disease, immediate adequate drainage of biliary system, and intense medical therapy.restrictio

    ํ†ตํ•ฉํ™˜๊ฒฝ๊ด€๋ฆฌ๋ฅผ ์œ„ํ•œ GIS๊ธฐ๋ฐ˜์˜ ๋ฐ์ดํ„ฐ๋งˆ์ด๋‹ ๊ธฐ๋ฒ• ๋ฐ 3D ๋‹ค์ค‘๋งค์งˆ๋ชจ๋ธ ๊ฐœ๋ฐœ

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    Thesis(doctors) --์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› :ํ™”ํ•™์ƒ๋ฌผ๊ณตํ•™๋ถ€, 2009.2.Docto

    (A) study of perception on critical success factors for the successful development of military hospital information systems

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    ๋ณด๊ฑดํ•™๊ณผ/์„์‚ฌ[ํ•œ๊ธ€] ์ด ์—ฐ๊ตฌ๋Š” ๊ตฐ๋ณ‘์›์ •๋ณด์‹œ์Šคํ…œ์˜ ์„ฑ๊ณต์  ๊ฐœ๋ฐœ๊ณผ ์‹คํ–‰์„ ์œ„ํ•˜์—ฌ ๋ฐ˜๋“œ์‹œ ์ž˜ ๊ด€๋ฆฌํ•ด์•ผ ํ•˜๋Š” ๊ฒƒ์œผ๋กœ ์ธ์‹๋˜๋Š” ์ค‘์š”์„ฑ๊ณต์š”์ธ์ด ๋ฌด์—‡์ธ์ง€๋ฅผ ๋ฐœ๊ฒฌํ•˜๊ณ , ๊ตฐ๋ณ‘์› ์กฐ์ง์„ ๊ตฌ์„ฑํ•˜๋Š” ์ „๋ฌธ ์ง‘๋‹จ์ธ ๊ตฐ์˜(์น˜์˜ ํฌํ•จ), ๊ฐ„ํ˜ธ, ์˜์ •, ๊ตฐ๋ฌด์›/ํ•˜์‚ฌ๊ด€ ๋“ฑ 4๊ฐœ ๋ณ‘๊ณผ๋ณ„ ์ค‘์š”์„ฑ๊ณต์š”์ธ์— ๋Œ€ํ•œ ์šฐ์„ ์ˆœ์œ„ ์ธ์‹์— ์ฐจ์ด๊ฐ€ ์กด์žฌํ•˜๋Š”์ง€๋ฅผ ๊ฒ€ํ† ํ•˜๋Š”๋ฐ ์žˆ๋‹ค. ์—ฐ๊ตฌ๋ฅผ ์ˆ˜ํ–‰ํ•˜๊ธฐ ์œ„ํ•˜์—ฌ ๊ตฐ๋ณ‘์›์— ๊ทผ๋ฌดํ•˜๊ณ  ์žˆ๋Š” ๊ด€๋ฆฌ์ž๋“ค์„ ๋Œ€์ƒ์œผ๋กœ 204๋ช…์˜ ํ‘œ๋ณธ์„ ์ถ”์ถœํ•˜๊ณ  1993๋…„ 9์›”์— ์ž๊ธฐ๊ธฐ์ž…์‹ ์„ค๋ฌธ์ง€๋ฅผ ์‚ฌ์šฉํ•˜์—ฌ ์—ฐ๊ตฌ ์กฐ์‚ฌ๋ฅผ ํ•˜์˜€๋Š”๋ฐ ๊ทธ ์—ฐ๊ตฌ ๊ฒฐ๊ณผ๋Š” ๋‹ค์Œ๊ณผ ๊ฐ™๋‹ค. ์ฒซ์งธ, ์ด ์—ฐ๊ตฌ์—์„œ๋Š” ๊ตฐ๋ณ‘์›์ •๋ณด์‹œ์Šคํ…œ์˜ ์„ฑ๊ณต์ ์ธ ๊ฐœ๋ฐœ์„ ์œ„ํ•œ ์ค‘์š”์„ฑ๊ณต์š”์ธ์œผ๋กœ 20๊ฐœ์˜ ์š”์ธ๋“ค์„ ๋„์ถœํ•˜์˜€๋‹ค. ์ด๋“ค ์ค‘์š”์„ฑ๊ณต์š”์ธ์˜ ์ƒ์œ„ 5์œ„๊ถŒ์„ ์‚ดํŽด๋ณด๋ฉด, 1์œ„๋Š” '๋ถ€๋Œ€์ง€ํœ˜๊ด€์˜ ์ ๊ทน์ ์ธ ์ดํ•ด์™€ ์ง€์›'์ด์—ˆ์œผ๋ฉฐ ๋‹ค์Œ์œผ๋กœ '์šฐ์ˆ˜ํ•œ ์ „์‚ฐ ์ธ๋ ฅ์˜ ํ™•๋ณด ๋ฐ ๊ฐœ๋ฐœ', '๋ถ€ ๋Œ€๊ด€๋ฆฌ์™€ ์ •๋ณด๊ธฐ์ˆ ์— ๋Šฅํ•œ ์ „์‚ฐ๊ด€๋ฆฌ์ž์˜ ์œก์„ฑ', '์‹œ์Šคํ…œ ๊ฐœ๋ฐœ์„ ์œ„ํ•œ ์žฅ๊ธฐ์ „๋žต ๊ณ„ํš ์ˆ˜๋ฆฝ', '์˜๋ฌด ์ „์‚ฐ๋ง ๊ตฌ์ถ•(์˜ˆํ•˜ ๋ณ‘์›๊ฐ„ On-Line๊ตฌ์ถ•)'๋“ฑ์˜ ์ˆœ์„œ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ์ค‘์š”์„ฑ๊ณต์š”์ธ ์ค‘ ์ƒ์œ„ 5์œ„๊ถŒ์—๋Š” ๋“ค์ง€ ์•Š์•˜์œผ๋‚˜ ๊ตฐ๋ณ‘์›ํ™˜๊ฒฝ๊ณผ ๊ด€๋ จ๋œ ํ•ญ๋ชฉ์ธ '๋ณ‘์› ์‹ , ๊ฐœ์ถ•์‹œ ์ „์‚ฐํ„ฐ๋ฏธ๋„์˜ ์—ฐ๊ฒฐ์„ ๊ณ ๋ คํ•œ ์„ค๊ณ„', '์ •ํ™•ํ•œ ์ž๋ฃŒ์˜ ์ž…๋ ฅ์— ์˜ํ•œ ์˜๋ฌดํ†ตํ•ฉ๋ฐ์ดํƒ€๋ฒ ์ด์Šค ๊ตฌ์ถ•', '์˜๋ฃŒ์žฅ๋น„์™€์˜ ์—ฐ๊ฒฐ์„ ๊ณ ๋ คํ•œ ์ •๋ณด์‹œ์Šคํ…œ ๊ตฌ์ถ•', '๊ตฐ์˜๊ด€์˜ ์ฐธ์—ฌ์˜์‹ ๊ณ ์ทจ'๋“ฑ 4๊ฐœ ํ•ญ๋ชฉ์ด ์ค‘์š”์„ฑ๊ณต์š”์ธ์œผ๋กœ ํ‰๊ฐ€๋˜์—ˆ๋‹ค. ๋‘˜์งธ, ์ค‘์š”์„ฑ๊ณต์š”์ธ์— ๋Œ€ํ•œ ๋ณ‘๊ณผ๋ณ„ ์ธ์‹์— ์ฐจ์ด๊ฐ€ ์žˆ๋Š”์ง€๋ฅผ ๋ถ„์„ํ•œ ๊ฒฐ๊ณผ ๊ฐ„ํ˜ธ์™€ ์˜์ •, ๊ตฐ์˜์™€ ๊ฐ„ํ˜ธ๊ฐ„์—๋Š” ์ˆœ์œ„๊ฐ€ ๋น„์Šทํ•œ ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ์œผ๋ฉฐ ๊ทธ์™ธ์˜ ๋ณ‘๊ณผ๋“ค๊ฐ„(๊ตฐ์˜-ํ•˜์‚ฌ๊ด€, ๊ตฐ์˜-์˜์ •, ๊ฐ„ํ˜ธ-ํ•˜์‚ฌ๊ด€, ํ•˜์‚ฌ๊ด€-์˜์ •)์—๋Š” ํ†ต๊ณ„์ ์œผ๋กœ ์ƒ๊ด€์„ฑ์„ ๋ณด์ด์ง€ ์•Š์•˜๋‹ค. ์…‹์งธ, ๊ฐœ๋ณ„ ์ค‘์š”์„ฑ๊ณต์š”์ธ์„ ๊ฐœ๋…์ ์œผ๋กœ ํ†ตํ•ฉํ•œ 5๊ฐœ์˜ ์š”์ธ ๋ฒ”์ฃผ๋“ค์€ ๋Œ€์ฒด์ ์œผ๋กœ ํƒ€๋‹น์„ฑ์ด ์žˆ์Œ์ด ์ž…์ฆ๋˜์—ˆ์œผ๋ฉฐ ์š”์ธ๋ฒ”์ฃผ๋ณ„ ์šฐ์„  ์ˆœ์œ„๋ฅผ ๋ณด๋ฉด ์ „์ˆ ์  ๊ด€๋ฆฌ์š”์ธ, ์ธ๋ ฅ ๊ต์œก ๋ฐ ๊ฐœ๋ฐœ ์š”์ธ, ์ „๋žต์  ๊ด€๋ฆฌ ์š”์ธ, ์‘์šฉ ๊ฐœ๋ฐœ ์š”์ธ, ์ •๋ณด ๊ธฐ์ˆ ๊ด€๋ฆฌ ์š”์ธ์˜ ์ˆœ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ์ด์ƒ์˜ ๊ฒฐ๊ณผ๋ฅผ ์ •๋ฆฌํ•ด ๋ณผ ๋•Œ, ๊ตฐ๋ณ‘์›์˜ ์„ฑ๊ณต์ ์ธ ์ •๋ณด์‹œ์Šคํ…œ ๊ฐœ๋ฐœ์„ ์œ„ํ•ด ๊ตฐ๋ณ‘์›์กฐ์ง์˜ ํŠน์„ฑ๊ณผ ๊ธฐ์ˆ ์ ์ธ ์ธก๋ฉด, ์‘์šฉ๊ฐœ๋ฐœ ๋ฐ ๊ด€๋ฆฌ์  ์ธก๋ฉด์ด ์ถฉ๋ถ„ํžˆ ๊ณ ๋ ค๋œ ์žฅ๊ธฐ์ „๋žต๊ณ„ํš์ˆ˜๋ฆฝ์ด ์ด๋ฃจ์–ด์ ธ์•ผ ํ•˜๊ณ  ๋ถ€๋Œ€ ์ง€ํœ˜๊ด€์˜ ์‹œ์Šคํ…œ ๊ฐœ๋ฐœ์— ๋Œ€ํ•œ ์ง€์‹๊ณผ ์ดํ•ด ๊ทธ๋ฆฌ๊ณ  ์ถฉ๋ถ„ํ•œ ์ง€์›์ด ์ด๋ฃจ์–ด์ ธ์•ผ ํ•œ๋‹ค. ๊ทธ๋ฆฌ๊ณ  ์‚ฌ์šฉ์ž์˜ ๊ด€์‹ฌ๊ณผ ์ฐธ์—ฌ๋ฅผ ์œ ๋„ํ•˜๊ณ  ์ ๊ทน์ ์œผ๋กœ ์‹œ์Šคํ…œ์„ ์ด์šฉํ•  ์ˆ˜ ์žˆ๋„๋ก ์‚ฌ์šฉ์ž ์ค‘์‹ฌ์˜ ์‹œ์Šคํ…œ ๊ฐœ๋ฐœ์ด ์ด๋ฃจ์–ด์ ธ์•ผ ํ•˜๋ฉฐ ์‹œ์Šคํ…œ์— ๋Œ€ํ•œ ์‚ฌ์šฉ์ž๋“ค์˜ ์š”๊ตฌ์‚ฌํ•ญ์„ ์ถฉ๋ถ„ํžˆ ์ง€์›ํ•ด ์ค„ ์ˆ˜ ์žˆ๋„๋ก ์ „์‚ฐ์ธ๋ ฅ์˜ ๋Šฅ๋ ฅ์ด ๊ฐ•ํ™”๋˜์–ด์•ผ ํ•œ๋‹ค. ๊ธ‰๋ณ€ํ•˜๋Š” ์•ˆ๋ณดํ™˜๊ฒฝ ์†์—์„œ ๊ตฐ๋ณ‘์›์ •๋ณด์‹œ์Šคํ…œ์˜ ๋ณด๋‹ค ํšจ์œจ์ ์œผ๋กœ ๊ฐœ๋ฐœ, ์šด์˜, ์œ ์ง€ํ•˜๊ธฐ ์œ„ํ•ด ์ด ์—ฐ๊ตฌ๋ฅผ ๊ธฐ์ดˆ๋กœ ํ•˜์—ฌ ๊ตฐ๋ณ‘์›์ •๋ณด์‹œ์Šคํ…œ ๊ด€๋ฆฌ์— ๋ณด๋‹ค ๋งŽ์€ ์ •๋ณด๋ฅผ ์ œ๊ณตํ•  ์ˆ˜ ์žˆ๋Š” ์‹ฌ์ธต์ ์ธ ์—ฐ๊ตฌ๋“ค์ด ์žˆ๊ธฐ๋ฅผ ๊ธฐ๋Œ€ํ•œ๋‹ค. A Study of perception on Critical Success Factors for the successful Development of Military Hospital Information Systems Jong Ho Kim Department of Public Health The Graduate School Yonsei University (Directed by professor Young Moon Chae, Ph. D) The purposes of this study were to explore the Critical Success Factor(CSF) for the successful development of military hospital information system(MHIS) and to examine the differences in the perception on CSFs among four branches (Surgean, Nurse, Medical Administration and Sergent) using questionaire method. In this study, 204 samples were surveyed from military hospital managers using simple random sampling on September 1993. The results of the study were as follows: First, 20 CSFs were identified as the CSFs for the successful development of MHIS. Top 5 CSFe in the order of importance were as follows: (1) positive understanding and strong support of commander in military hospital, (2) recruitment and development of information system(IS) specialists, (3) development of IS managers, (4) long-term strategic planning, (5) development of medical communication network(local area network within hospital). While they were not being ranked as top 5 CSFs, 4 factors specifically related to military hospital environment were also identified such as 'consideration of computer facility during the design or Modification of hospital','building of integrated medical database','consideration of interface between computer and medical equipments', and 'promotion of surgean's participation'. Second, In comparison of the differences among 4 branches about perception of the importance of the CSF, there were some similarities in ranks for surgean-nurse and nurse-medical administration. But other groups(e.g. surgean-sergent, surgean-medical administration, sergent-nurse and sergent-medical administration) had different ranks. Third, 5 categories of the composite CSFs based on characteristics of CSFs were empirically proved to be valid. The order of the 5 factors categories were : (1) tactical management items (2) development of human resources (3) strategic management items (4) application development (5)information technology management. In conclusion, for the successful development of the MHIS, long-term strategic planning which sufficiently reflects the characteristics of military hospital organization, technology factor, application development and management factor should be developed. In addition, commanders should have knowledges and understanding about MHIS and should strongly support MHIS development. Also, user-oriented system should be developed to increase user's interest and participation by recruiting and training capable IS specialists. [์˜๋ฌธ] The purposes of this study were to explore the Critical Success Factor(CSF) for the successful development of military hospital information system(MHIS) and to examine the differences in the perception on CSFs among four branches (Surgean, Nurse, Medical Administration and Sergent) using questionaire method. In this study, 204 samples were surveyed from military hospital managers using simple random sampling on September 1993. The results of the study were as follows: First, 20 CSFs were identified as the CSFs for the successful development of MHIS. Top 5 CSFe in the order of importance were as follows: (1) positive understanding and strong support of commander in military hospital, (2) recruitment and development of information system(IS) specialists, (3) development of IS managers, (4) long-term strategic planning, (5) development of medical communication network(local area network within hospital). While they were not being ranked as top 5 CSFs, 4 factors specifically related to military hospital environment were also identified such as 'consideration of computer facility during the design or Modification of hospital','building of integrated medical database','consideration of interface between computer and medical equipments', and 'promotion of surgean's participation'. Second, In comparison of the differences among 4 branches about perception of the importance of the CSF, there were some similarities in ranks for surgean-nurse and nurse-medical administration. But other groups(e.g. surgean-sergent, surgean-medical administration, sergent-nurse and sergent-medical administration) had different ranks. Third, 5 categories of the composite CSFs based on characteristics of CSFs were empirically proved to be valid. The order of the 5 factors categories were : (1) tactical management items (2) development of human resources (3) strategic management items (4) application development (5)information technology management. In conclusion, for the successful development of the MHIS, long-term strategic planning which sufficiently reflects the characteristics of military hospital organization, technology factor, application development and management factor should be developed. In addition, commanders should have knowledges and understanding about MHIS and should strongly support MHIS development. Also, user-oriented system should be developed to increase user's interest and participation by recruiting and training capable IS specialists.restrictio

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    ํ•™์œ„๋…ผ๋ฌธ (์„์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ์ฒด์œก๊ต์œก๊ณผ, 2015. 2. ๊น€๊ธฐํ•œ.์—๋ฆญ ๋กœ๋ด๋ถˆ๋Ÿฌ(Eric Rothenbuhler)๋Š” ์ƒํƒœํ•™์—์„œ ๊ฐœ์ฒด๊ตฐ ๊ฐ„ ๊ฒฝ์Ÿ๊ด€๊ณ„๋ฅผ ์„ค๋ช…ํ•˜๊ธฐ ์œ„ํ•ด ๊ฐœ๋ฐœ๋œ ์ด๋ก ์ธ ์ ์†Œ์ด๋ก ์„ ๋ฏธ๋””์–ด ์—ฐ๊ตฌ์— ์ ์šฉํ•˜์—ฌ ๋ฏธ๋””์–ด ๊ฐ„ ๊ฒฝ์Ÿ์„ ๋ถ„์„ํ•˜๋Š” ๋ถ„์„ ๋„๊ตฌ๋กœ์„œ ๋ฏธ๋””์–ด ์ ์†Œ์ด๋ก ์„ ์ œ์ฐฝํ•˜์˜€๋‹ค. ๊ทธ์— ์˜ํ•˜๋ฉด ๋™์ผํ•œ ์ž์›์— ์—ฌ๋Ÿฌ ๊ฐœ์˜ ๋ฏธ๋””์–ด๊ฐ€ ๊ณต์กด ํ•  ๊ฒฝ์šฐ, ๋ฏธ๋””์–ด ๊ฐ„์˜ ์ƒ์กด ๊ฒฝ์Ÿ์€ ์‹ฌํ™”๋  ๊ฒƒ์ด๋ฉฐ ์ด ๊ฐ€์šด๋ฐ ์šฐ์›”ํ•จ๊ณผ ์—ด๋“ฑํ•จ์ด ๋‚˜๋ˆ ์ ธ ํƒˆ๋ฝ๊ณผ ๊ฐ™์€ ํ˜„์ƒ์ด ์ƒ๊ฒจ ๋‚  ๊ฒƒ์ด๋ผ ํ•˜์˜€๋‹ค. (Dimmick, J., & Rothenbuhler, E. 1984) ์ด๋Ÿฌํ•œ ์ƒํ™ฉ์—์„œ ์Šคํฌ์ธ ์˜ ์•„๋ฆ„๋‹ค์›€์„ ์ „๋‹ฌํ•˜๋Š” ์Šคํฌ์ธ  ๋ฐฉ์†ก์€ ์‹œ์ฒญ์ž์˜ ๊ธฐํ˜ธ๋„๊ฐ€ ๋†’์€ ์ฝ˜ํ…์ธ ๋กœ์จ ์ค‘์š”ํ•œ ์œ„์น˜๋ฅผ ์ž๋ฆฌ ์žก๊ณ  ์žˆ๋‹ค. ์ตœ๊ทผ์˜ ๋ฐฉ์†ก๊ธฐ์ˆ ์€ ์ด๋Ÿฌํ•œ ์Šคํฌ์ธ ์˜ ์•„๋ฆ„๋‹ค์šด ์ˆœ๊ฐ„์€ ๋”์šฑ ์‹ค๊ฐ๋‚˜๊ฒŒ ๋”์šฑ ์žฌ๋ฏธ์žˆ๊ฒŒ, ๊ฐ๋™์ ์œผ๋กœ ์ „๋‹ฌํ•˜๊ธฐ ์œ„ํ•ด์„œ ๋ฐœ์ „์„ ๊ฑฐ๋“ญํ•˜๊ณ  ์žˆ๋‹ค. ์Šคํฌ์ธ ์˜ ์•„๋ฆ„๋‹ค์›€์ด๋ผ๋Š” ๊ฐ•๋ ฌํ•œ ์†์„ฑ์„ ์ด์šฉํ•˜์—ฌ ๋ฐฉ์†ก์‹œ์žฅ์„ ์„ ๋„ํ•˜๊ธฐ ์œ„ํ•ด ์„ธ๊ณ„์˜ ๋ฐฉ์†ก์‚ฌ๋“ค์€ ๊ฒฝ์Ÿ์„ ๊ฑฐ๋“ญํ•˜๊ณ  ์žˆ๋‹ค. ๋ณธ ์—ฐ๊ตฌ๋Š” ๊ธ‰๋ณ€ํ•˜๋Š” ๋ฏธ๋””์–ด ํ™˜๊ฒฝ ์†์— ์Šคํฌ์ธ ๊ฐ€ ๋งค๋ ฅ์ ์ธ ์ฝ˜ํ…์ธ ๋กœ์„œ ๋ฐœ์ „ํ•  ์ˆ˜ ์žˆ๋„๋ก, ์Šคํฌ์ธ ์˜ ์ค‘๊ณ„๋ฐฉ์†ก ์˜์ƒ์˜ ๋ฐœ์ „๋ฐฉํ–ฅ์— ๋Œ€ํ•œ ์ด๋ก ์  ๋ฐฐ๊ฒฝ์„ ์ œ์‹œํ•˜๊ธฐ ์œ„ํ•œ ๊ณ ๋ฏผ์œผ๋กœ๋ถ€ํ„ฐ ์‹œ์ž‘ ๋˜์—ˆ๋‹ค. ๊ตฌ์ฒด์ ์œผ๋กœ ์ด๋ฅผ ์œ„ํ•ด ์Šคํฌ์ธ ์˜ ์žฅ๋ฅด์˜ ๋งค์ฒด ํ‘œํ˜„๋ฐฉ์‹๊ณผ ๊ธฐ์ˆ ์˜ ์ ์šฉ์˜ ์ƒ๊ด€๊ด€๊ณ„์— ๋Œ€ํ•˜์—ฌ ์—ฐ๊ตฌํ•˜๊ณ ์ž ํ•˜์˜€๋‹ค. ์ด๋ฅผ ์œ„ํ•ด, ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ์šฐ์„  ์Šคํฌ์ธ ๋ฐฉ์†ก์˜ ๊ฐœ๋…์„ ๋ช…ํ™•ํžˆ ํ•˜๊ณ , ๊ทธ ์žฅ๋ฅด์  ํŠน์„ฑ์„ ์ •์˜ํ•˜์˜€๋‹ค. ์ด์— ๋”ฐ๋ผ ์Šคํฌ์ธ ๋ฐฉ์†ก๊ธฐ์ˆ ์˜ ๋ถ„๋ฅ˜์™€ ํŠน์„ฑ์„ ์ •์˜ํ•˜๊ณ  ๊ทธ ์‹œ์ฒญํšจ๊ณผ์— ๊ด€ํ•œ ์„ ํ–‰์—ฐ๊ตฌ๋ฅผ ์กฐํ•˜ํ•˜์˜€๋‹ค. ์˜์ƒํ‘œํ˜„๊ณผ ์˜์ƒ์‹œ์ฒญ์˜ ์‹œ์ฒญํšจ๊ณผ์— ๊ด€ํ•œ ์„ ํ–‰์—ฐ๊ตฌ๋Š” ๋Œ€๋ถ€๋ถ„ ํ”„๋ ˆ์ฆŒ์Šค(Presence)์ด๋ก ์„ ์ค‘์‹ฌ์œผ๋กœ ํ™œ๋ฐœํžˆ ์—ฐ๊ตฌ๋˜์–ด์ ธ์™”๋‹ค. ๋งˆ์ฐฌ๊ฐ€์ง€๋กœ ๋ณธ ์—ฐ๊ตฌ์—์„œ๋„ ์‹œ์ฒญํšจ๊ณผ์— ๊ด€ํ•˜์—ฌ ์‹ค์žฌ๊ฐ์„ ์ค‘์‹ฌ ์ข…์†๋ณ€์ธ์œผ๋กœ ์—ฐ๊ตฌ ํ•˜์˜€๋‹ค. ํ•˜์ง€๋งŒ, ์ด์ „์˜ ๋Œ€๋ถ€๋ถ„์˜ ์—ฐ๊ตฌ๋“ค์€ ์‹œ์ฒญ๋ฐฉ์‹ ํ˜น์€ ํ‘œํ˜„๋ฐฉ์‹ ํ•œ ๊ฐ€์ง€์— ์ง‘์ค‘ํ•˜์—ฌ ์—ฐ๊ตฌ๋ฅผ ์ง„ํ–‰ํ•˜์˜€์œผ๋ฉฐ, ๋‘ ์š”์†Œ๊ฐ„์˜ ์ƒ๊ด€๊ด€๊ณ„๋ฅผ ๊ฒ€์ฆํ•œ ์—ฐ๊ตฌ๋Š” ๋งค์šฐ ๋“œ๋ฌผ๋‹ค. ๋”ฐ๋ผ์„œ ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ์‹œ์ฒญ๋ฐฉ์‹ ์ค‘ 3D์‹œ์ฒญ๊ณผ ํ‘œํ˜„๋ฐฉ์‹ ์ค‘ ๋‹ค์‹œ์ ์˜์ƒํ•ฉ์„ฑ๋ฒ•์„ ์ค‘์‹ฌ์œผ๋กœ ์‹œ์ฒญ๋ฐฉ์‹๊ณผ ํ‘œํ˜„๋ฐฉ์‹์˜ ์ƒํ˜ธ์ž‘์šฉ์— ๋”ฐ๋ฅธ ์‹œ์ฒญํšจ๊ณผ๋ฅผ ๊ฒ€์ฆํ•˜์˜€๋‹ค. ๋˜ํ•œ ์ถ”๊ฐ€๋กœ ๊ฐ์„ฑ์ด๋ก ์„ ๊ธฐ๋ฐ˜์œผ๋กœ ํ•˜์—ฌ ์‹œ์ฒญ์ž์˜ ๊ฐ์„ฑ ์ˆ˜์ค€์— ๋”ฐ๋ฅธ ์‹ค์žฌ๊ฐ์˜ ํšจ๊ณผ์˜ ์ฐจ์ด๋ฅผ ๊ฒ€์ฆํ•˜์˜€๋‹ค. ๊ฒ€์ฆ์„ ์œ„ํ•ด 20~30๋Œ€ ๋Œ€ํ•™์ƒ์„ ๋Œ€์ƒ์œผ๋กœ 4๊ฐœ์˜ ์‹คํ—˜์ง‘๋‹จ์„ ๊ตฌ์„ฑํ•˜์˜€๋‹ค. ๊ฐ๊ฐ์˜ ์ง‘๋‹จ์— 2D์™€ 3D์˜ ์‹œ์ฒญ๋ฐฉ์‹๊ณผ, ๋‹ค์‹œ์ ์˜์ƒํ•ฉ์„ฑ๋ฒ•์ด ๋“ค์–ด๊ฐ„ ์˜์ƒ๊ณผ ์ผ๋ฐ˜ ์˜์ƒ์œผ๋กœ ๊ตฌ์„ฑ๋œ ์˜์ƒ์„ ์ฒ˜์น˜ํ•˜์˜€๋‹ค. ์ž๊ทน๋ฌผ์€ 2012๋…„ ๋Ÿฐ๋˜์˜ฌ๋ฆผํ”ฝ ์ฒด์กฐ๊ฒฐ์Šน์ „์œผ๋กœ ์„ ์ •ํ•˜์˜€์œผ๋ฉฐ, ๋‹น์‹œ ์‚ฌ์šฉ๋œ ๋‹ค์‹œ์ ์˜์ƒํ•ฉ์„ฑ๊ธฐ์ˆ ์„ ํŽธ์ง‘ํ•˜์—ฌ ์‚ฌ์šฉํ•˜์˜€๋‹ค. ์˜์ƒ์„ ์‹œ์ฒญํ•œ ํ›„ ๊ฐ๊ฐ์˜ ์ง‘๋‹จ์€ 7์ ์ฒ™๋„๋กœ ๊ตฌ์„ฑ๋œ ์ž๊ธฐ๊ธฐ์ˆ  ์„ค๋ฌธ์ง€์— ์‘๋‹ตํ•˜๋„๋ก ํ•˜์˜€๋‹ค. ํ”ผํ—˜์ž์˜ ์‘๋‹ต์„ ์ž๋ฃŒ๋กœ ํ•˜์—ฌ SPSS ver21.0์„ ์ด์šฉํ•˜์—ฌ ๊ฐ€์„ค์„ ๊ฒ€์ฆํ•˜์˜€๋‹ค. ๋ณธ ์—ฐ๊ตฌ์˜ ์ฃผ์š” ๊ฒฐ๊ณผ๋Š” ์ฒซ์งธ, ๋‹ค์‹œ์ ์˜์ƒํ•ฉ์„ฑ๋ฒ•(FPV)์˜ ์‚ฝ์ž… ์—ฌ๋ถ€(์˜์ƒ์˜ ํ‘œํ˜„๋ฐฉ์‹ ์ค‘)์— ๋”ฐ๋ฅธ ์‹œ์ฒญ์ž์˜ ์‹ฌ๋ฆฌ์  ๋ฐ˜์‘์ธ ๊ฐ์„ฑ์ˆ˜์ค€์€ ์ฐจ์ด๋ฅผ ๋ณด์ธ๋‹ค. ๋‘˜์งธ, 2D๋กœ ์‹œ์ฒญํ•˜๋Š” ๊ฒƒ ๋ณด๋‹ค 3D๋กœ ์‹œ์ฒญํ•˜๋Š” ๊ฒƒ์ด ๋” ๋†’์€ ๊ฐ์„ฑ์ˆ˜์ค€์„ ๋ณด์ธ๋‹ค. ์…‹์งธ, ๋‹ค์‹œ์ ์˜์ƒํ•ฉ์„ฑ๋ฒ•(FPV)์˜ ์‚ฝ์ž…์—ฌ๋ถ€์™€ 2D/3D์™€ ๊ฐ™์€ ์‹œ์ฒญ๋ฐฉ์‹์˜ ์ฐจ์ด์— ๋”ฐ๋ผ ๊ฐ์„ฑ์ˆ˜์ค€์€ ๊ฐ€์‚ฐ์ (Additive) ํšจ๊ณผ๋ฅผ ๋ณด์ธ๋‹ค. ๋„ท์งธ, ๊ฐ์„ฑ์ˆ˜์ค€๊ณผ ์‹ค์žฌ๊ฐํšจ๊ณผ์— ์—ญU์žํ˜•ํƒœ๋กœ ์ƒ๊ด€๊ด€๊ณ„๋ฅผ ๊ฐ€์ง„๋‹ค. ๋‹ค์„ฏ์งธ, FPV์˜ ์‚ฝ์ž…์—ฌ๋ถ€์™€ 2D/3D์™€ ๊ฐ™์€ ์‹œ์ฒญ๋ฐฉ์‹์˜ ์ƒํ˜ธ์ž‘์šฉ์— ๋”ฐ๋ผ ์‹ค์žฌ๊ฐ์ˆ˜์ค€์€ ์ฐจ์ด๋ฅผ ๋ณด์ธ๋‹ค. ์—ฌ์„ฏ์งธ, ๋‹ค์‹œ์ ์˜์ƒํ•ฉ์„ฑ๋ฒ•(FPV)์˜ ์‚ฝ์ž…์—ฌ๋ถ€์™€ 2D/3D์™€ ๊ฐ™์€ ์‹œ์ฒญ๋ฐฉ์‹์˜ ์ƒํ˜ธ์ž‘์šฉ์— ๋”ฐ๋ผ ์ฆ๊ฑฐ์›€์ˆ˜์ค€์€ ์ฐจ์ด๋ฅผ ๋ณด์ธ๋‹ค. ์ด๋‹ค๋ชฉ ์ฐจ โ… . ์„œ ๋ก 1 1. ์—ฐ๊ตฌ์˜ ๋ฐฐ๊ฒฝ1 2. ์—ฐ๊ตฌ์˜ ํ•„์š”์„ฑ3 3. ์—ฐ๊ตฌ์˜ ๋ชฉ์ 7 โ…ก. ์ด๋ก ์  ๋ฐฐ๊ฒฝ8 1. ์Šคํฌ์ธ  ๋ฐฉ์†ก8 1.1. ์Šคํฌ์ธ  ๋ฐฉ์†ก์˜ ๊ฐœ๋…๊ณผ ๋ฏธ๋””์–ด ์Šคํฌ์ธ 8 1.2. ์Šคํฌ์ธ  ๋ฐฉ์†ก์ œ์ž‘ ํ™˜๊ฒฝ์˜ ๋ณ€ํ™”10 1.2.1. 1960๋…„๋Œ€ (์˜์ƒ๋ฌธํ™”์‹œ๋Œ€)10 1.2.2. 1970๋…„๋Œ€ (3๊ตญ์ฒด์ œ, TV์‹œ๋Œ€์˜ ๋„๋ž˜)11 1.2.3. 1980๋…„๋Œ€ (KBS,MBC 2๋Œ€ ๊ณต์˜๋ฐฉ์†ก์‹œ๋Œ€)13 1.2.4. 1990๋…„๋Œ€ (๊ณต,๋ฏผ์˜ ๋ฐฉ์†ก์‹œ๋Œ€)15 1.2.5. 2000๋…„๋Œ€ (๋‰ด๋ฏธ๋””์–ด ์‹œ๋Œ€)17 2. ์Šคํฌ์ธ ๋ฐฉ์†ก ๊ธฐ์ˆ ๊ณผ ์‹œ์ฒญ๊ฒฝํ—˜24 2.1. ์Šคํฌ์ธ ๋ฐฉ์†ก ๊ธฐ์ˆ 24 2.1.1. ์Šคํฌ์ธ  ๋ฐฉ์†ก๊ธฐ์ˆ ์˜ ๋ฐœ์ „์‚ฌ24 2.1.2. ์˜์ƒํ‘œํ˜„๋ฐฉ์‹(FreePointView, 3์ฐจ์›์˜์ƒํ•ฉ์„ฑ๊ธฐ๋ฒ•)28 2.1.3. ์˜์ƒ์‹œ์ฒญ๋ฐฉ์‹(2D/3D)29 2.2. ์Šคํฌ์ธ ๋ฐฉ์†ก ์‹œ์ฒญ ๊ฒฝํ—˜30 2.2.1. ๊ฐ์„ฑ30 2.2.2. ์‹ค์žฌ๊ฐ(Presence)31 2.2.3. ์ฆ๊ฑฐ์›€33 2.2.4. ๋ฐฉ์†ก๊ธฐ์ˆ ๊ณผ ๊ฐ์„ฑ, ์‹ค์žฌ๊ฐ, ์ฆ๊ฑฐ์›€์˜ ๊ด€๊ณ„34 2.3. ์Šคํฌ์ธ ๋ฐฉ์†ก๊ธฐ์ˆ ์ด ์‹œ์ฒญ๊ฒฝํ—˜์— ๋ฏธ์น˜๋Š” ์˜ํ–ฅ39 2.3.1. ์˜์ƒํ‘œํ˜„๋ฐฉ์‹๊ณผ ์‹œ์ฒญ๊ฒฝํ—˜39 2.3.2. ์˜์ƒ์‹œ์ฒญ๋ฐฉ์‹๊ณผ ์‹œ์ฒญ๊ฒฝํ—˜40 2.3.3. ์˜์ƒํ‘œํ˜„๋ฐฉ์‹๊ณผ ์˜์ƒ์‹œ์ฒญ๋ฐฉ์‹์ด ๊ฐ์„ฑ์ˆ˜์ค€์— ๋ฏธ์น˜๋Š” ๊ฐ€์‚ฐ์ (Additive)ํšจ๊ณผ41 2.3.4. ์˜์ƒํ‘œํ˜„๋ฐฉ์‹๊ณผ ์˜์ƒ์‹œ์ฒญ๋ฐฉ์‹์ด ์‹ค์žฌ๊ฐ๊ณผ ์ฆ๊ฑฐ์›€์— ๋ฏธ์น˜๋Š” ์ƒํ˜ธ์ž‘์šฉ(Interactive)ํšจ๊ณผ43 โ…ข. ๊ฐ€์„ค48 โ…ฃ. ์—ฐ๊ตฌ๋ฐฉ๋ฒ•49 1. ์—ฐ๊ตฌ๋ชจํ˜•49 2. ์‹คํ—˜์„ค๊ณ„49 3. ์‹คํ—˜์ ˆ์ฐจ50 4. ๋ณ€์ธ์ธก์ •52 4.1. ๊ฐ์„ฑ์ธก์ •52 4.2. ์‹ค์žฌ๊ฐ(Presence)์ธก์ •52 4.2. ์ฆ๊ฑฐ์›€ ์ธก์ •53 โ…ค. ์—ฐ๊ตฌ๊ฒฐ๊ณผ54 1. ํ”ผํ—˜์ž ์†์„ฑ54 2. ์ธก์ •๋„๊ตฌ์˜ ํƒ€๋‹น์„ฑ ๋ฐ ์‹ ๋ขฐ์„ฑ ๊ฒ€์ฆ54 3. ๊ฐ€์„ค๊ฒ€์ฆ55 3.1. ์ฐฝ์˜์  ํ‘œํ˜„๋ฐฉ์‹์— ๋”ฐ๋ฅธ ๊ฐ์„ฑํšจ๊ณผ ๊ฒ€์ฆ 55 3.2. ์‹œ์ฒญ๋ฐฉ์‹์— ๋”ฐ๋ฅธ ๊ฐ์„ฑํšจ๊ณผ ๊ฒ€์ฆ56 3.3. ์‹œ์ฒญ๋ฐฉ์‹๊ณผ ์ฐฝ์˜์ ํ‘œํ˜„๋ฐฉ์‹์ด ๊ฐ์„ฑ์— ๋ฏธ์น˜๋Š” ๊ฐ€์‚ฐ์ ํšจ๊ณผ ๊ฒ€์ฆ57 3.4. ๊ฐ์„ฑ๊ณผ ์‹ค์žฌ๊ฐ์˜ ์ƒ๊ด€๊ด€๊ณ„ ๊ฒ€์ฆ60 3.5. ์‹œ์ฒญ๋ฐฉ์‹๊ณผ ์ฐฝ์˜์ ํ‘œํ˜„๋ฐฉ์‹์˜ ์ƒํ˜ธ์ž‘์šฉ์ด ์‹ค์žฌ๊ฐ์— ๋ฏธ์น˜๋Š” ์˜ํ–ฅ๊ฒ€์ฆ61 3.6. ์‹œ์ฒญ๋ฐฉ์‹๊ณผ ์ฐฝ์˜์  ํ‘œํ˜„๋ฐฉ์‹์˜ ์ƒํ˜ธ์ž‘์šฉ์ด ์ฆ๊ฑฐ์›€์— ๋ฏธ์น˜๋Š” ์˜ํ–ฅ๊ฒ€์ฆ64 โ…ฅ. ๊ฒฐ๋ก  ๋ฐ ๋…ผ์˜68 โ…ฆ. Abstract 75 โ…ง. ์ฐธ๊ณ ๋ฌธํ—Œ77Maste
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