45 research outputs found

    Le constructivisme et l'approche actionnelle

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    ํ•™์œ„๋…ผ๋ฌธ (๋ฐ•์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ์™ธ๊ตญ์–ด๊ต์œก๊ณผ(๋ถˆ์–ด์ „๊ณต), 2011.2. ์‹ฌ๋ด‰์„ญ.Docto

    Are currencies coordinating?

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    Thesis(masters) --์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› :๊ฒฝ์ œํ•™๋ถ€(๊ฒฝ์ œํ•™์ „๊ณต),2008. 8.Maste

    (A)Role and implication of apology in reconciliation between Japan and Korea

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    Thesis(masters) --์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› :๊ตญ์ œํ•™๊ณผ(๊ตญ์ œํ˜‘๋ ฅ์ „๊ณต),2008. 8.Maste

    ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€์˜ ๋ฌธํ™”์  ํ™œ์šฉ์— ๊ด€ํ•œ ์—ฐ๊ตฌ

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    ํ•™์œ„๋…ผ๋ฌธ (๋ฐ•์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ๋””์ž์ธํ•™๋ถ€(๋””์ž์ธ ์ „๊ณต), 2016. 2. ๋ฐ•์˜๋ชฉ.์ตœ๊ทผ ์‚ฐ์—…์‚ฌํšŒ์˜ ๋ฐœ๋‹ฌ๊ณผ ํ•จ๊ป˜ ์ƒ๊ฒจ๋‚œ ๊ทผ๋Œ€์‚ฐ์—…์œ ์‚ฐ์— ๊ด€ํ•œ ๊ด€์‹ฌ์ด ๋†’์•„์ง€๊ณ  ์žˆ๋‹ค. ์‚ฐ์—…์œ ์‚ฐ์€ ๋ฌธํ™”์œ ์‚ฐ์˜ ํ•œ ๋ถ€๋ถ„์œผ๋กœ์„œ ๋น„๊ต์  ํ˜„๋Œ€์— ๋“ค์–ด์™€์„œ ๊ทธ ๊ฐ€์น˜๋ฅผ ์ธ์ •๋ฐ›๊ธฐ ์‹œ์ž‘ํ•˜์˜€๋‹ค. ๊ตญ๋‚ด์—์„œ๋„ ์‚ฐ์—…์œ ์‚ฐ์˜ ์ค‘์š”์„ฑ์„ ์ธ์‹ํ•ด๊ฐ€๊ณ  ์žˆ์œผ๋ฉฐ ๋ณด์กด๊ณผ ํ™œ์šฉ์ด๋ผ๋Š” ์ธก๋ฉด์—์„œ ์ ‘๊ทผํ•˜๊ณ  ์žˆ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ๋งŽ์€ ์‚ฐ์—…์œ ์‚ฐ๋“ค์€ ํ˜„์žฌ ๊ฐ€๋™์ค‘์ธ ๊ฒฝ์šฐ ๊ฐ€์น˜๋ฅผ ์ธ์ •๋ฐ›์ง€ ๋ชปํ•˜๋ฉฐ, ์“ธ๋ชจ๊ฐ€ ์—†์–ด์ง„ ํ›„์—์•ผ ๋ณด์กด ๋ฐ ํ™œ์šฉ๋ฐฉ์•ˆ์„ ๋ชจ์ƒ‰ํ•˜๊ณ  ์žˆ๋‹ค. ๊ทธ ๋ฐฉ๋ฒ•์— ์žˆ์–ด์„œ๋„ ๋ณตํ•ฉ๋ฌธํ™”์˜ˆ์ˆ ๊ณต๊ฐ„์ด๋ผ๋Š” ์œ ์‚ฌํ•œ ์ด๋ฆ„์œผ๋กœ ํš์ผ์ ์œผ๋กœ ๊ฐœ๋ฐœ๋˜๊ณ  ์žˆ๋‹ค. ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ๊ตญ๋‚ด ๊ฒฝ์ œ๋ฐœ์ „์˜ ์ค‘์‹ฌ์ธ ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€์˜ ์—ญ์‚ฌ์ , ๋ฌธํ™”์  ๊ฐ€์น˜๋ฅผ ์ธ์‹ํ•˜๊ณ  ํ˜„์žฌ ๊ด€์ ์—์„œ ๋ฌธํ™”์  ํ™œ์šฉ๋ฐฉ์•ˆ์„ ๋ชจ์ƒ‰ํ•˜๊ณ ์ž ํ•˜์˜€๋‹ค. ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€๋“ค์€ ๋Œ€๋ถ€๋ถ„ ์šฐ๋ฆฌ๋‚˜๋ผ ๊ฒฝ์ œ๋ฐœ์ „ ์ดˆ๊ธฐ์— ๊ตญ๊ฐ€์  ์ฐจ์›์—์„œ ์ •์ฑ…์ ์œผ๋กœ ์กฐ์„ฑ๋˜๊ธฐ ์‹œ์ž‘ํ•˜์—ฌ ํ˜„์žฌ๊นŒ์ง€๋„ ์‚ฐ์—…์˜ ํ•ต์‹ฌ์ ์ธ ์—ญํ• ์„ ํ•˜๊ณ  ์žˆ์œผ๋‚˜ ๊ทธ ์—ญ์‚ฌ์  ๊ฐ€์น˜๋Š” ๋†’์ด ํ‰๊ฐ€๋˜๊ณ  ์žˆ์ง€ ์•Š๋‹ค. ์ด์— ๋”ฐ๋ผ ๋ณธ ์—ฐ๊ตฌ๋Š” ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€๋ฅผ ๋Œ€์ƒ์œผ๋กœ ํ˜„์žฌ ์ง€๋‹ˆ๊ณ  ์žˆ๋Š” ์ž ์žฌ์  ์‚ฐ์—…์œ ์‚ฐ์— ๊ด€ํ•˜์—ฌ ์กฐ์‚ฌ๋ฅผ ํ•˜๊ณ  ๋ถ„์„ํ•˜์—ฌ ๋ฌธํ™”์  ํ™œ์šฉ ๊ฐ€๋Šฅ์„ฑ์„ ์ฐพ๊ณ ์ž ํ•˜์˜€๋‹ค. ๋ฌธํ™”์  ํ™œ์šฉ ๋„๊ตฌ๋กœ๋Š” ๋ผํ‚ค๋น„์›€์„ ์ ์šฉํ•˜์˜€๋‹ค. ๋ผํ‚ค๋น„์›€์€ ๋„์„œ๊ด€, ๊ธฐ๋ก๊ด€, ๋ฐ•๋ฌผ๊ด€์ด ํ•ฉ์ณ์ง„ ๊ฐœ๋…์œผ๋กœ ์ธ๋ฅ˜๋ฌธํ™”๋ณด์กด ๋ฐ ๋ฐœ์ „์ด๋ผ๋Š” ๊ณตํ†ต๋œ ๋ชฉ์ ์„ ๊ฐ€์ง€๊ณ  ์žˆ๋‹ค. ๋ผํ‚ค๋น„์›€์ด๋ผ๋Š” ์œต๋ณตํ•ฉ ๊ณต๊ฐ„์—์„œ๋Š” ์†Œ์žฅ์ž๋ฃŒ์˜ ๋ฒ”์œ„๊ฐ€ ํ™•๋Œ€๋˜๊ณ  ๋ณด์กด๊ณผ ํ™œ์šฉ๋ฐฉ๋ฒ•๋„ ๋‹ค์–‘ํ•ด์ง€๋ฉฐ, ์ปค๋ฎค๋‹ˆํ‹ฐ ํ™œ๋™๊ณผ ํ‰์ƒ๊ต์œก์˜ ๊ธฐ๋Šฅ์ด ๋‹ค์–‘ํ•œ ๋ชจ์Šต์ด ๋  ๊ฒƒ์ด๋‹ค. ๋ผํ‚ค๋น„์›€์€ ์ฝ˜ํ…์ธ  ํŠน์„ฑ๊ณผ ๋ฐฉ๋ฌธ๊ฐ์„ ์ค‘์‹ฌ์œผ๋กœ ๋ผํ‚ค๋น„์›€์˜ ์œ ํ˜•์„ ๋ถ„๋ฅ˜ํ•  ์ˆ˜ ์žˆ๋‹ค. ์ฝ˜ํ…์ธ ๋ฅผ ๊ธฐ์ค€์œผ๋กœ ํ•  ๊ฒฝ์šฐ, ๋ณด์กด๊ฐ€์น˜๊ฐ€ ๋†’์€ ์ฝ˜ํ…์ธ ๋ณด์กดํ˜• ๋ผํ‚ค๋น„์›€๊ณผ ํ™œ์šฉ๋„๊ฐ€ ๋†’์€ ์ฝ˜ํ…์ธ ํ™œ์šฉํ˜• ๋ผํ‚ค๋น„์›€์œผ๋กœ ๋ถ„๋ฅ˜ํ•˜๊ณ , ๋ฐฉ๋ฌธ๊ฐ์„ ๊ธฐ์ค€์œผ๋กœ ํ•  ๊ฒฝ์šฐ, ์ง€์—ญ๋ฏผ์˜ ๋น„์ค‘์ด ํฐ ์ง€์—ญ์‚ฌํšŒํ˜• ๋ผํ‚ค๋น„์›€๊ณผ ์™ธ๋ถ€๊ด€๊ด‘๊ฐ์˜ ๋น„์ค‘์ด ํฐ ๊ด€๊ด‘ํ˜• ๋ผํ‚ค๋น„์›€์œผ๋กœ ๋ถ„๋ฅ˜ํ•  ์ˆ˜ ์žˆ๋‹ค. ์ด ๋„ค ๊ฐ€์ง€ ์œ ํ˜•์˜ ๋ผํ‚ค๋น„์›€์€ ์„œ๋กœ ๊ต์ฐจํ•˜์—ฌ ์ฝ˜ํ…์ธ ํ™œ์šฉ-์ง€์—ญ์‚ฌํšŒํ˜•, ์ฝ˜ํ…์ธ ํ™œ์šฉ-๊ด€๊ด‘ํ˜•, ์ฝ˜ํ…์ธ ๋ณด์กด-์ง€์—ญ์‚ฌํšŒํ˜•, ์ฝ˜ํ…์ธ ๋ณด์กด-๊ด€๊ด‘ํ˜• ๋ผํ‚ค๋น„์›€์œผ๋กœ ์œ ํ˜•ํ™”ํ•  ์ˆ˜ ์žˆ์œผ๋ฉฐ ํ˜ผํ•ฉ์  ์„ฑ๊ฒฉ๋„ ๊ฐ€๋Šฅํ•˜๋‹ค. ๋ณธ ์—ฐ๊ตฌ์˜ ์กฐ์‚ฌ๋Œ€์ƒ์€ ํ˜„์žฌ ๊ฐ€๋™์ค‘์ธ ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€ 35๊ณณ์ด๋‹ค. 35๊ฐœ ๋‹จ์ง€๋Š” ํฌ๊ฒŒ ์—…์ข…์„ ์ค‘์‹ฌ์œผ๋กœ ์ผ๋ฐ˜์ œ์กฐ์—…๊ตฐ, ์šด์†กโ€ค์ œ์ฒ ๊ตฐ, ์ž์›โ€ค๋ฐœ์ „๊ตฐ, ์ •๋ณดโ€ค์—ฐ๊ตฌ๊ฐœ๋ฐœ๊ตฐ์œผ๋กœ ๋ถ„๋ฅ˜ํ•˜์˜€๋‹ค. ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€์˜ ์กฐ์‚ฌ๋‚ด์šฉ์€ ์œ ๋ฌดํ˜•์˜ ์‚ฐ์—…์‚ฌ ๋ฐ ์ƒํ™œ์‚ฌ ์ž๋ฃŒ์˜ ํŒŒ์•…์ด๋‹ค. ์‚ฐ์—…์‚ฌ์  ์ฝ˜ํ…์ธ ๋กœ๋Š” ๊ฑด๋ฌผ, ์‹œ์„ค, ์žฅ๋น„, ์ƒ์‚ฐํ’ˆ, ๊ธฐ์ˆ , ๋ฐ์ดํ„ฐ, ์‹œ์Šคํ…œ, ๋…ธ๋™์šด๋™์ด๋ฉฐ, ์ƒํ™œ์‚ฌ์  ์ฝ˜ํ…์ธ ๋กœ๋Š” ์ฃผ๊ฑฐ์‹œ์„ค, ์ปค๋ฎค๋‹ˆํ‹ฐ์‹œ์„ค, ์ƒํ™œ๋ฌธํ™”, ํ™œ๋™ํ”„๋กœ๊ทธ๋žจ, ๋™ํ˜ธํšŒ ๋“ฑ์„ ์กฐ์‚ฌํ•˜์˜€๋‹ค. ์กฐ์‚ฌ๋ฐฉ๋ฒ•์œผ๋กœ๋Š” ๊ธฐ์—…์ž๋ฃŒ, ๋ฐœ๊ฐ„์ž๋ฃŒ, ํ†ต๊ณ„์ž๋ฃŒ, ์‹ ๋ฌธ, ์ธํ„ฐ๋„ท ๋“ฑ์˜ ๋ฌธํ—Œ์กฐ์‚ฌ์™€ ํ˜„์žฅ๋ฐฉ๋ฌธ ๋ฐ ์ธํ„ฐ๋ทฐ ๋“ฑ์„ ์‚ฌ์šฉํ•˜์˜€๋‹ค. ์กฐ์‚ฌ๋‚ด์šฉ์˜ ํ‰๊ฐ€๋Š” ์—ญ์‚ฌ์„ฑ, ๊ธฐ๋ก์„ฑ, ๋Œ€ํ‘œ์„ฑ(์ƒ์ง•์„ฑ), ์œ ์ผ์„ฑ, ์ง‘ํ•ฉ์„ฑ, ์ „๋ฌธ์„ฑ(ํŠน์ˆ˜์„ฑ) ๋“ฑ์„ ๊ธฐ์ค€์œผ๋กœ ํ‰๊ฐ€ํ•˜์˜€๋‹ค. ์กฐ์‚ฌ ๊ฒฐ๊ณผ๋Š” ๋‹ค์Œ๊ณผ ๊ฐ™๋‹ค. ์ฒซ์งธ, ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€๋“ค์€ ๋Œ€๋ถ€๋ถ„ ๊ตญ๋‚ด์‚ฐ์—… ๋ฐ ๊ฒฝ์ œ๋ฅผ ๋Œ€ํ‘œํ•˜๊ฑฐ๋‚˜ ์—ญ์‚ฌ๋ฅผ ํ•จ๊ป˜ ํ•จ์œผ๋กœ์„œ ๊ณผ๊ฑฐ์—์„œ๋ถ€ํ„ฐ ํ˜„์žฌ์— ์ด๋ฅด๊ธฐ๊นŒ์ง€ ๋ฌธํ™”์œ ์‚ฐ์œผ๋กœ์„œ ๊ฐ€์น˜๊ฐ€ ๋†’์€ ๊ฒƒ์œผ๋กœ ํ‰๊ฐ€๋˜์—ˆ๋‹ค. ๋˜ํ•œ ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€์˜ ๊ธฐ์ˆ  ์ˆ˜์ค€์ด ๋งค์šฐ ๋†’๊ณ  ์ „๋ฌธ์ ์ด์–ด์„œ ์ „๋ฌธ์„ฑ, ๊ธฐ๋ก์„ฑ ๋“ฑ์˜ ๋‹ค๋ฅธ ํ•ญ๋ชฉ์—์„œ๋„ ๋†’์€ ๊ฐ€์น˜๋ฅผ ์ง€๋‹ˆ๊ณ  ์žˆ์—ˆ๋‹ค. ๋‘˜์งธ, ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€๊ฐ€ ๊ฐ€์ง€๋Š” ์ฝ˜ํ…์ธ ๋ฅผ ์‚ฐ์—…์‚ฌ์™€ ์ƒํ™œ์‚ฌ๋กœ ๋‚˜๋ˆ„์–ด ์กฐ์‚ฌํ•˜์˜€์„ ๋•Œ ์‚ฐ์—…์‚ฌ์  ์ž๋ฃŒ๋Š” ๋งค์šฐ ํ’๋ถ€ํ•œ ๋ฐฉ๋ฉด, ์ƒํ™œ์‚ฌ์  ์ž๋ฃŒ๋Š” ์ƒ๋Œ€์ ์œผ๋กœ ๋ถ€์กฑํ•˜๊ฒŒ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ๊ทธ ์ด์œ ๋กœ๋Š” ๋‹จ์ง€๋‚ด ์ฃผ๊ฑฐํ™˜๊ฒฝ์ด๋‚˜ ์ƒํ™œํ™˜๊ฒฝ์ด ๋ฐœ๋‹ฌ๋˜์ง€ ์•Š์€ ๊ฒฝ์šฐ๊ฐ€ ๋งŽ์•˜๊ณ , ์ƒํ™œ๋ฌธํ™”๊ฐ€ ๋‹จ์ง€๋ณ„ ํŠน์„ฑ์„ ๋šœ๋ ทํ•˜๊ฒŒ ๋ณด์—ฌ์ฃผ๋Š” ๊ฒฝ์šฐ๊ฐ€ ๋งŽ์ง€ ์•Š์•˜๊ธฐ ๋•Œ๋ฌธ์ด๋‹ค. ์…‹์งธ, 35๊ฐœ์˜ ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€์˜ ์ฝ˜ํ…์ธ ๋ฅผ ์กฐ์‚ฌํ•œ ๊ฒฐ๊ณผ ์—…์ข…๋ณ„๋กœ ์œ ์‚ฌํ•œ ํŠน์„ฑ๊ณผ ํ‰๊ฐ€๊ฐ€ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ์ผ๋ถ€๋ฅผ ์ œ์™ธํ•˜๊ณ ๋Š” ๋ชจ๋‘ ๋ณด์กด๊ณผ ํ™œ์šฉ์ด ๊ฐ€๋Šฅํ•œ ์„ฑ๊ฒฉ์„ ๊ฐ€์ง€๊ณ  ์žˆ๊ณ , ๋‹จ์ง€์ข…์‚ฌ์ž๋ถ€ํ„ฐ ์™ธ๋ถ€๊ด€๊ด‘๊ฐ๊นŒ์ง€๋ฅผ ์•„์šฐ๋ฅผ ์ˆ˜ ์žˆ๋Š” ์ž๋ฃŒ๋ฅผ ๋ณด์œ ํ•˜๊ณ  ์žˆ์—ˆ๋‹ค. ๋„ท์งธ, 35๊ฐœ ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€์˜ ๋ฌธํ™”์  ํ™œ์šฉ์„ ์œ„ํ•˜์—ฌ ๋ผํ‚ค๋น„์›€ ์œ ํ˜•์„ ํ‰๊ฐ€ํ•œ ๊ฒฐ๊ณผ ๋‹ค์„ฏ ๊ฐ€์ง€๋กœ ๋ถ„๋ฅ˜๋˜์—ˆ๋‹ค. โ‘ ์—…์ข…๋Œ€ํ‘œ ์ข…ํ•ฉํ˜• ๋ผํ‚ค๋น„์›€, โ‘ก์ง€์—ญ์ค‘์‹ฌ ํ™œ์šฉํ˜• ๋ผํ‚ค๋น„์›€, โ‘ข์—…์ข…๋Œ€ํ‘œ ๊ธฐ์ˆ ํ˜• ๋ผํ‚ค๋น„์›€, โ‘ฃ์‹œ์„ค ๊ด€๊ด‘ํ˜• ๋ผํ‚ค๋น„์›€, โ‘ค์‚ฐ์—…๋‹จ์ง€ ํ‰์ƒ๊ต์œกํ˜• ๋ผํ‚ค๋น„์›€ ๋“ฑ์ด๋ฉฐ, ํŠน์„ฑ์— ๋”ฐ๋ผ ๋ผํ‚ค๋น„์›€์˜ ์ˆ˜์ง‘์ •์ฑ…์—์„œ๋ถ€ํ„ฐ ์šด์˜ํ”„๋กœ๊ทธ๋žจ๊นŒ์ง€ ๋‹ค๋ฅด๊ฒŒ ์ ์šฉ๋˜์–ด์•ผ ํ•œ๋‹ค.์ œ 1 ์žฅ ์„œ๋ก  12 ์ œ 1 ์ ˆ ์—ฐ๊ตฌ์˜ ๋ฐฐ๊ฒฝ ๋ฐ ๋ชฉ์  12 1. ์—ฐ๊ตฌ์˜ ๋ฐฐ๊ฒฝ 12 2. ์—ฐ๊ตฌ์˜ ๋ชฉ์  16 ์ œ 2 ์ ˆ ์—ฐ๊ตฌ์˜ ๋ฒ”์œ„ ๋ฐ ๋ฐฉ๋ฒ• 17 1. ์—ฐ๊ตฌ์˜ ๋ฒ”์œ„ 17 2. ์—ฐ๊ตฌ์˜ ๋ฐฉ๋ฒ• 19 ์ œ 2 ์žฅ ์‚ฐ์—…์œ ์‚ฐ ๋ฐ ์‚ฐ์—…๋‹จ์ง€์˜ ์ผ๋ฐ˜์  ๊ณ ์ฐฐ 21 ์ œ 1 ์ ˆ ์‚ฐ์—…์œ ์‚ฐ์˜ ์ด๋ก ์  ๊ณ ์ฐฐ 21 1. ์‚ฐ์—…์œ ์‚ฐ์˜ ๊ฐœ๋… 21 2. ์‚ฐ์—…์œ ์‚ฐ ๊ด€๋ จ ์ œ๋„ 28 3. ์‚ฐ์—…์œ ์‚ฐ ๊ด€๋ จ ์„ ํ–‰์—ฐ๊ตฌ 36 ์ œ 2 ์ ˆ ์‚ฐ์—…๋‹จ์ง€์˜ ์ผ๋ฐ˜์  ๊ณ ์ฐฐ 39 1. ์‚ฐ์—…๋‹จ์ง€์˜ ๊ฐœ๋… 39 2. ์‚ฐ์—…๋‹จ์ง€์˜ ์˜๋ฏธ 40 3. ์‚ฐ์—…๋‹จ์ง€์˜ ์ œ๋„ 41 ์ œ 3 ์ ˆ ์‚ฐ์—…์œ ์‚ฐ์˜ ๋ฌธํ™”์  ํ™œ์šฉ ์‚ฌ๋ก€ 43 1. ๋‹จ์ผ๊ณต๊ฐ„ ํ™œ์šฉ์‚ฌ๋ก€ 43 2. ๋‹จ์ง€ ๋ฐ ๋งˆ์„ ํ™œ์šฉ ์‚ฌ๋ก€ 49 3. ๊ตญ๋‚ด ์‚ฐ์—…๋‹จ์ง€ ํ™œ์šฉ์‚ฌ๋ก€ 52 4. ์†Œ๊ฒฐ 55 ์ œ 3 ์žฅ ๋ฌธํ™”์  ํ™œ์šฉ ๋„๊ตฌ๋กœ์„œ์˜ ๋ผํ‚ค๋น„์›€ 56 ์ œ 1 ์ ˆ ๋ผํ‚ค๋น„์›€์˜ ๊ฐœ๋… ๋ฐ ์˜์˜ 56 1. ๋ผํ‚ค๋น„์›€์˜ ๊ฐœ๋… 56 2. ๋ผํ‚ค๋น„์›€์˜ ์˜์˜ 65 3. ๋ผํ‚ค๋น„์›€์˜ ์‚ฌ๋ก€ 67 ์ œ 2 ์ ˆ ๋ผํ‚ค๋น„์›€์˜ ๊ตฌ์„ฑ 71 1. ๋ผํ‚ค๋น„์›€์˜ ๋ชฉ์  71 2. ๋ผํ‚ค๋น„์›€์˜ ์†Œ์žฅ์ž๋ฃŒ 74 3. ๋ผํ‚ค๋น„์›€ ์ „๋ฌธ์ธ๋ ฅ 78 4. ๋ผํ‚ค๋น„์›€์˜ ๊ณต๊ฐ„ 81 ์ œ 3 ์ ˆ ๋ผํ‚ค๋น„์›€ ๋ชจํ˜• ๋ฐ ์œ ํ˜• 87 1. ๋ผํ‚ค๋น„์›€ ๋ชจํ˜• ๊ฐœ๋… 87 2. ๋ผํ‚ค๋น„์›€ ์œ ํ˜• 90 ์ œ 4 ์žฅ ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€์˜ ์ฝ˜ํ…์ธ  ํŠน์„ฑ ๋ฐ ๋ผํ‚ค๋น„์›€ ํ™œ์šฉ 94 ์ œ 1 ์ ˆ ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€์˜ ์กฐ์‚ฌ๊ฐœ์š” 94 1. ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€์˜ ์˜์˜ 94 2. ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€ ์กฐ์‚ฌ๋ฒ”์œ„ ๋ฐ ๋‚ด์šฉ 95 ์ œ 2 ์ ˆ ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€์˜ ์ฝ˜ํ…์ธ  ํŠน์„ฑ 99 1. ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€์˜ ์ฝ˜ํ…์ธ ๋ณ„ ํŠน์„ฑ 99 2. ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€์˜ ๋‹จ์ง€๋ณ„ ํŠน์„ฑ 108 ์ œ 3 ์ ˆ ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€ ์œ ํ˜•๋ณ„ ๋ผํ‚ค๋น„์›€ ํ™œ์šฉ ๋ฐฉํ–ฅ 114 1. ์‚ฐ์—…๋‹จ์ง€๋ฅผ ์ ์šฉํ•œ ๋ผํ‚ค๋น„์›€ ์œ ํ˜• 114 2. ๊ตญ๊ฐ€์‚ฐ์—…๋‹จ์ง€์˜ ์œ ํ˜•๋ณ„ ๋ผํ‚ค๋น„์›€ ํ™œ์šฉ ๋ฐฉํ–ฅ 118 ์ œ 5 ์žฅ ๊ฒฐ๋ก  ๋ฐ ์ œ์–ธ 127 ์ฐธ๊ณ ๋ฌธํ—Œ 131 ๋ถ€๋ก 137 ABSTRACT 204Docto

    Subtype of Postoperative Delirium in Surgical Intensive Care Units: Prevalence, Risk Factors and Clinical Outcomes

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    ํ•™์œ„๋…ผ๋ฌธ(์„์‚ฌ)--์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› :๊ฐ„ํ˜ธ๋Œ€ํ•™ ๊ฐ„ํ˜ธํ•™๊ณผ,2020. 2. ์žฅ์„ ์ฃผ.This study identified the risk factors and the clinical outcomes of the delirium subtypes in Surgical Intensive Care Unit (SICU). Patients data for those admitted to the SICU were collected by retrospective chart review. This study enrolled patients of 18 years and older, who had undergone an operation and been admitted to the SICU. Delirium was diagnosed according to the criteria of the Confusion Assessment Method for ICU. Richmond Agitation Sedation Scale was used to classify delirium subtypes. The variables used for analysis were predisposing factors, precipitating factors and clinical outcomes. Those variables were analyzed using descriptive statistics, ANOVA, chi square test, and multiple regression with the SPSS version 25.0. Among the 4,234 participants who admitted to the SICU during the study period, the prevalence of delirium was 8.7%. Specifically, 44 (12%) cases were hyperactive delirium; 148 (40%) cases were hypoactive delirium and 175 (48%) cases were mixed delirium. As the length of hospitalization in the ICU increased, the incidence of hypoactive and mixed delirium was 1.37 and 1.38 times higher compared to hyperactive delirium, respectively (95% CI= 1.09~1.72, p< .01; 95% CI= 1.10~1.73, p< .01). As the use of CRRT increased, the incidence of hypoactive delirium 29,783,690.17 times increased compared to the incidence of hyperactive delirium (95% CI= 10,162,249.00~87,290,539.72, p< .01). When more restraints were applied, the incidence of hypoactive delirium was 0.20 times decreased (95% CI= 0.08~0.46, p< .01). When the assessed APACHEโ…ก score was higher, the incidence of mixed delirium was 1.08 times higher (95% CI= 1.01~1.15, p< .05). As the number of catheters in patients increased, the occurrence of mixed delirium was 1.50 times higher (95% CI= 1.05~2.16, p< .05). When the serum pH level was lower, the occurrence of hypoactive delirium was 0.006 times more frequent (95% CI= 5.48E-5~0.57, p< .05), and the incidence of mixed delirium occurred 0.001 times more than that of hyperactive delirium (95% CI= 7.571E-6~ .081, p< .01). When the serum potassium level was lower, mixed delirium occurred 0.579 times more frequently ( 95% CI= 0.36~0.93, p< .05). The outcomes after delirium included unplanned removal of catheter (x2= 40.390, p< .01), longer hospitalization in ICU (F= 6.708, p< .01) and hospital mortality(x2= 14.400, p< .01). In conclusion, considering that mixed delirium and hypoactive delirium have a high incidence, have worse clinical outcomes, medical staff should diagnosis delirium regularly. There was a significant difference in the risk factors and clinical outcomes for the delirium subtypes. An intervention should be differentiated from each delirium subtype considering those factors for delirium. Further studies are needed to establish more evidence of delirium subtype. Additionally, future studies to investigate effectiveness of intervention for delirium subtype are necessary.์˜์‹ ์žฅ์• , ์ธ์ง€๊ธฐ๋Šฅ ์žฅ์• ์™€ ์ฃผ์˜์ง‘์ค‘์˜ ๊ฐํ‡ด๋ฅผ ์˜๋ฏธํ•˜๋Š” ์„ฌ๋ง์€ ์ฆ์ƒ์— ๋”ฐ๋ผ ๊ณผํ™œ๋™ํ˜•, ์ €ํ™œ๋™ํ˜•, ํ˜ผ์žฌํ˜• ์„ฌ๋ง์œผ๋กœ ์•„ํ˜•์ด ๋ถ„๋ฅ˜๋œ๋‹ค. ์œ„ํ—˜์š”์ธ๊ณผ ์ž„์ƒ๊ฒฐ๊ณผ๋ฅผ ๊ณ ๋ คํ•œ ์ค‘์žฌ๋ฅผ ํ†ตํ•˜์—ฌ ์„ฌ๋ง์€ ์˜ˆ๋ฐฉ๊ณผ ์น˜๋ฃŒ๊ฐ€ ๊ฐ€๋Šฅํ•˜๊ธฐ ๋•Œ๋ฌธ์—, ํšจ๊ณผ์ ์ธ ์•„ํ˜•๋ณ„ ์„ฌ๋ง ๊ฐ„ํ˜ธ๋ฅผ ์œ„ํ•ด์„œ๋Š” ์•„ํ˜•๋ณ„ ์„ฌ๋ง์˜ ์œ„ํ—˜์š”์ธ๊ณผ ์ž„์ƒ๊ฒฐ๊ณผ๋ฅผ ๊ทœ๋ช…ํ•˜๋Š” ๊ฒƒ์ด ์„ ํ–‰๋˜์–ด์•ผ ํ•œ๋‹ค. ๋ณธ ์—ฐ๊ตฌ๋Š” ์ˆ˜์ˆ  ํ›„ ์™ธ๊ณผ๊ณ„์ค‘ํ™˜์ž์‹ค์— ์ž…์›ํ•œ ์„ฑ์ธ ํ™˜์ž์˜ ์˜๋ฌด๊ธฐ๋ก์„ ํ™œ์šฉํ•œ ํ›„ํ–ฅ์  ์กฐ์‚ฌ์—ฐ๊ตฌ๋กœ, ์•„ํ˜•๋ณ„ ์„ฌ๋ง์˜ ๋ฐœ์ƒ๋ฅ ๊ณผ ์œ„ํ—˜์š”์ธ ๋ฐ ์ž„์ƒ๊ฒฐ๊ณผ๋ฅผ ๊ทœ๋ช…ํ•˜๊ธฐ ์œ„ํ•ด ์‹œํ–‰๋˜์—ˆ๋‹ค. ์—ฐ๊ตฌ์˜ ๋Œ€์ƒ์ž๋Š” ์„œ์šธ์‹œ ์†Œ์žฌํ•œ ๋Œ€ํ•™๋ณ‘์›์—์„œ 2017๋…„ 1์›”๋ถ€ํ„ฐ 2019๋…„ 6์›”๊นŒ์ง€ ์™ธ๊ณผ๊ณ„์ค‘ํ™˜์ž์‹ค์— ์ž…์›ํ•œ ๋งŒ 18์„ธ ์ด์ƒ์˜ ์ˆ˜์ˆ ์„ ๋ฐ›์€ 4,234๋ช…์˜ ํ™˜์ž์ด๋‹ค. ์„ฌ๋ง ์–‘์„ฑ์€ Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)๊ธฐ๋ก๊ณผ ์ •์‹ ๊ณผ ๊ธฐ๋ก์„ ๊ธฐ๋ฐ˜์œผ๋กœ ์ง„๋‹จํ•˜์˜€์œผ๋ฉฐ, Richmond Agitation Sedation Scale (RASS)๋ฅผ ๊ธฐ์ค€์œผ๋กœ ์•„ํ˜•๋ณ„ ์„ฌ๋ง์„ ๋ถ„๋ฅ˜ํ•˜์˜€๋‹ค. SPSS 25.0 ํ†ต๊ณ„ ๋ถ„์„ ํ”„๋กœ๊ทธ๋žจ์„ ์ด์šฉํ•˜์—ฌ ์•„ํ˜•๋ณ„ ์„ฌ๋ง์˜ ์„ ํ–‰ ์š”์ธ, ์ด‰์ง„ ์š”์ธ๊ณผ ์ž„์ƒ๊ฒฐ๊ณผ์— ๋Œ€ํ•œ ์ฐจ์ด๋Š” ANOVA์™€ chi square test๋ฅผ ์ด์šฉํ•˜์—ฌ ๋ถ„์„ํ•˜์˜€์œผ๋ฉฐ, ์œ ์˜ํ•œ ์ฐจ์ด๋ฅผ ๋ณด์ธ ์„ ํ–‰ ์š”์ธ๊ณผ ์ด‰์ง„ ์š”์ธ ๋ฐ ์ˆ˜์ˆ  ๊ด€๋ จ ์š”์ธ์— ๋Œ€ํ•ด์„œ๋Š” ๋‹ค๋ณ€๋Ÿ‰ ๋กœ์ง€์Šคํ‹ฑ ํšŒ๊ท€๋ถ„์„์„ ํ†ตํ•ด ์•„ํ˜•๋ณ„ ์„ฌ๋ง์˜ ์œ„ํ—˜์š”์ธ์„ ์•Œ์•„๋ณด์•˜๋‹ค. ๋ณธ ์—ฐ๊ตฌ์˜ ๊ตฌ์ฒด์ ์ธ ์—ฐ๊ตฌ๊ฒฐ๊ณผ๋Š” ๋‹ค์Œ๊ณผ ๊ฐ™๋‹ค. 1) ๋ณธ ์—ฐ๊ตฌ์˜ ์ด 4,234๋ช… ๋Œ€์ƒ์ž ์ค‘ ์„ฌ๋ง ์–‘์„ฑ ํ™˜์ž๋Š” 367๋ช…์œผ๋กœ 8.7%์˜ ์„ฌ๋ง ๋ฐœ์ƒ๋ฅ ์„ ๋ณด์˜€๋‹ค. ์ด์ค‘ ํ˜ผ์žฌํ˜• ์„ฌ๋ง์€ 48%๋กœ ๊ฐ€์žฅ ๋ฐœ์ƒ๋ฅ ์ด ๋†’์•˜๊ณ , ์ €ํ™œ๋™ํ˜• ์„ฌ๋ง์€ 40%, ๊ณผํ™œ๋™ํ˜• ์„ฌ๋ง์€ 12%์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. 2) ์•„ํ˜•๋ณ„ ์„ฌ๋ง์˜ ์„ ํ–‰ ์š”์ธ์—์„œ๋Š” ๊ณผํ™œ๋™ํ˜• ์„ฌ๋ง์— ๋Œ€๋น„ํ•˜์—ฌ ์ €ํ™œ๋™ํ˜• ์„ฌ๋ง์˜ ๋ฐœ์ƒ๋ฅ ์€ ์ค‘ํ™˜์ž์‹ค ์žฌ์›์ผ์ˆ˜๊ฐ€ 1์ผ ์ฆ๊ฐ€ํ• ์ˆ˜๋ก 1.37๋ฐฐ ์ฆ๊ฐ€ํ•˜์˜€์œผ๋ฉฐ(95% CI=1.09~1.72, p< .01), Continuous Renal Replacement Therapy (CRRT) ์‚ฌ์šฉ์ด 1๋‹จ์œ„ ์ฆ๊ฐ€ํ• ์ˆ˜๋ก ๋ฐœ์ƒ๋ฅ ์ด 29,783,690.17๋ฐฐ ์ฆ๊ฐ€ํ•˜์˜€๋‹ค(95% CI=10,162,249.00~87,290,539.72, p< .01). ๋ฐ˜๋ฉด ๋ณดํ˜ธ๋Œ€ ์‚ฌ์šฉ๋Ÿ‰์ด 1๋‹จ์œ„ ์ฆ๊ฐ€ํ• ์ˆ˜๋ก ์ €ํ™œ๋™ํ˜• ์„ฌ๋ง์˜ ๋ฐœ์ƒ๋ฅ ์€ 0.20๋ฐฐ ๊ฐ์†Œํ•˜์˜€๋‹ค(95% CI=0.08~0.46, p< .01). ํ˜ผ์žฌํ˜• ์„ฌ๋ง์˜ ๋ฐœ์ƒ๋ฅ ์€ ๊ณผํ™œ๋™ํ˜• ์„ฌ๋ง์— ๋น„ํ•ด ์ค‘ํ™˜์ž์‹ค ์žฌ์›์ผ์ˆ˜๊ฐ€ 1์ผ ์ฆ๊ฐ€ํ• ์ˆ˜๋ก 1.38๋ฐฐ ์ฆ๊ฐ€ํ•˜์˜€์œผ๋ฉฐ(95% CI=1.10~1.73, p< .01), ์นดํ…Œํ„ฐ ๊ฐœ์ˆ˜๊ฐ€ 1๊ฐœ ์ฆ๊ฐ€ํ• ์ˆ˜๋ก ๋ฐœ์ƒ๋ฅ ์€ 1.50๋ฐฐ ์ฆ๊ฐ€ํ•˜์˜€๊ณ (95% CI=1.05~2.16, p< .05), Acute Physiology, Age, Chronic Health Evaluation โ…ก (APACHEโ…ก)์—์„œ 1์  ์ฆ๊ฐ€ํ• ์ˆ˜๋ก ๋ฐœ์ƒ๋ฅ ์€ 1.08๋ฐฐ ์ฆ๊ฐ€ํ•˜์˜€๋‹ค(95% CI=1.01~1.15, p< .05). 3) ์•„ํ˜•๋ณ„ ์„ฌ๋ง์˜ ์ด‰์ง„ ์š”์ธ์—์„œ๋Š” pH๊ฐ€ 1๋‹จ์œ„ ์ฆ๊ฐ€ํ•  ๊ฒฝ์šฐ ์ €ํ™œ๋™ํ˜• ์„ฌ๋ง์˜ ๋ฐœ์ƒ๋ฅ ์€ ๊ณผํ™œ๋™ํ˜• ์„ฌ๋ง์— ๋น„ํ•ด 0.006๋ฐฐ(95% CI=5.48E-5~ 0.57, p< .05), ํ˜ผ์žฌํ˜• ์„ฌ๋ง์˜ ๋ฐœ์ƒ๋ฅ ์€ 0.001๋ฐฐ ๊ฐ์†Œํ•˜์˜€๋‹ค(95% CI=7.57E-6~ 0.08, p< .01). Potassium์—์„œ 1๋‹จ์œ„๊ฐ€ ์ฆ๊ฐ€ํ•  ๊ฒฝ์šฐ ํ˜ผ์žฌํ˜• ์„ฌ๋ง์˜ ๋ฐœ์ƒ๋ฅ ์€ ๊ณผํ™œ๋™ํ˜• ์„ฌ๋ง์˜ ๋ฐœ์ƒ๋ฅ ์— ๋น„ํ•ด 0.579๋ฐฐ ๊ฐ์†Œํ•˜์˜€๋‹ค(95% CI= 0.36~ 0.93, p< .05). 4) ์•„ํ˜•๋ณ„ ์„ฌ๋ง์˜ ์ž„์ƒ๊ฒฐ๊ณผ์—์„œ ์ฐจ์ด๋ฅผ ๋ณด์ธ ๋ณ€์ˆ˜๋Š” ์ž๋ฐœ์  ๋„๊ด€ ๋ฐ ์นดํ…Œํ„ฐ ์ œ๊ฑฐ(x2=40.390, p< .01), ์ค‘ํ™˜์ž์‹ค ์žฌ์›์ผ์ˆ˜(F=6.708, p< .01)์™€ ๋ณ‘์›๋‚ด ์‚ฌ๋ง(x2=14.400, p< .01)์ด์—ˆ๋‹ค. ํ˜ผ์žฌํ˜• ์„ฌ๋ง์€ ๋ชจ๋“  ํ•ญ๋ชฉ์—์„œ ๊ฐ€์žฅ ๋ถ€์ •์ ์ธ ๊ฒฐ๊ณผ๋ฅผ ๋ณด์˜€์œผ๋ฉฐ, ๊ณผํ™œ๋™ํ˜• ์„ฌ๋ง์— ๋น„ํ•ด ์ €ํ™œ๋™ํ˜• ์„ฌ๋ง์˜ ์ž„์ƒ๊ฒฐ๊ณผ๊ฐ€ ๋” ๋ถ€์ •์ ์ธ ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ๋ณธ ์—ฐ๊ตฌ๋Š” ์™ธ๊ณผ๊ณ„์ค‘ํ™˜์ž์‹ค ํ™˜์ž์˜ ์„ฌ๋ง ๋ฐ ์•„ํ˜•๋ณ„ ์„ฌ๋ง์˜ ๋ฐœ์ƒ๋ฅ ๊ณผ ์•„ํ˜•๋ณ„ ์„ฌ๋ง์— ๋”ฐ๋ฅธ ์œ„ํ—˜์š”์ธ ๋ฐ ์ž„์ƒ๊ฒฐ๊ณผ๋ฅผ ๋ถ„์„ํ•œ ์—ฐ๊ตฌ๋กœ ์•„ํ˜•๋ณ„ ์„ฌ๋ง์„ ๊ณ ๋ คํ•œ ์ฐจ๋ณ„ํ™”๋œ ์ค‘์žฌ ํ”„๋กœํ† ์ฝœ ๊ฐœ๋ฐœ์„ ์œ„ํ•œ ๊ธฐ์ดˆ์ž๋ฃŒ๋กœ ์ œ๊ณต๋˜๊ณ ์ž ์‹œํ–‰๋˜์—ˆ๋‹ค. ์„ ํ–‰์—ฐ๊ตฌ์™€ ๋‹ฌ๋ฆฌ ์„ฌ๋ง์˜ ์•„ํ˜•์„ ๊ตฌ๋ถ„ํ•˜์—ฌ ๋ฐœ์ƒ๋ฅ ๊ณผ ์œ„ํ—˜์š”์ธ ๋ฐ ์ž„์ƒ๊ฒฐ๊ณผ๋ฅผ ๋น„๊ตํ•˜์˜€์œผ๋ฉฐ, ์™ธ๊ณผ๊ณ„์ค‘ํ™˜์ž์‹ค์— ์ž…์›ํ•œ ํ™˜์ž ์ค‘ ์ˆ˜์ˆ ์„ ๋ฐ›์€ ๋ชจ๋“  ํ™˜์ž๋ฅผ ๋Œ€์ƒ์œผ๋กœ ์ง„ํ–‰ํ•œ ์—ฐ๊ตฌ๋ผ๋Š” ์ ์—์„œ ์˜์˜๊ฐ€ ์žˆ๋‹ค. ์—ฐ๊ตฌ ๊ฒฐ๊ณผ๋ฅผ ์ข…ํ•ฉํ•ด๋ณด์•˜์„ ๋•Œ ํ˜ผ์žฌํ˜•๊ณผ ์ €ํ™œ๋™ํ˜• ์„ฌ๋ง์ด ๋งŽ์œผ๋ฉฐ ์ž„์ƒ๊ฒฐ๊ณผ๋Š” ๋”์šฑ ๋ถ€์ •์ ์ด๋ฏ€๋กœ ์ฃผ๊ธฐ์ ์ธ ์„ฌ๋ง ์‚ฌ์ •์„ ํ†ตํ•˜์—ฌ ํ˜ผ์žฌํ˜• ์„ฌ๋ง๊ณผ ์ €ํ™œ๋™ํ˜• ์„ฌ๋ง์„ ์กฐ๊ธฐ์— ์ง„๋‹จํ•˜๋Š” ๊ฒƒ์ด ์ค‘์š”ํ•˜๋‹ค. ๋˜ํ•œ, ์•„ํ˜•๋ณ„ ์„ฌ๋ง์— ๋”ฐ๋ฅธ ์œ„ํ—˜์š”์ธ๊ณผ ์ž„์ƒ๊ฒฐ๊ณผ์—์„œ ์ฐจ์ด๋ฅผ ๋ณด์ด๋ฏ€๋กœ ์ด์— ๋Œ€ํ•œ ์ดํ•ด๋ฅผ ํ† ๋Œ€๋กœ ๊ฐ„ํ˜ธ๋ฅผ ์ œ๊ณตํ•˜๋Š” ๊ฒƒ์ด ํ•„์š”ํ•˜๋‹ค. ํ›„์†์—ฐ๊ตฌ๋กœ๋Š” ์ง€์†์ ์ธ ์•„ํ˜•๋ณ„ ์„ฌ๋ง์— ๋Œ€ํ•œ ์—ฐ๊ตฌ๋ฅผ ํ†ตํ•ด ๊ทผ๊ฑฐ๋ฅผ ๊ตฌ์ถ•ํ•˜๊ณ , ์ด๋ฅผ ๋ฐ”ํƒ•์œผ๋กœ ์‹œํ–‰๋œ ์•„ํ˜•๋ณ„ ์„ฌ๋ง ๊ฐ„ํ˜ธ์— ๋Œ€ํ•œ ์—ฐ๊ตฌ๋„ ํ•„์š”ํ•  ๊ฒƒ์œผ๋กœ ๋ณด์ธ๋‹ค.โ… . ์„œ ๋ก  1 1. ์—ฐ๊ตฌ์˜ ํ•„์š”์„ฑ 1 2. ์—ฐ๊ตฌ์˜ ๋ชฉ์  3 3. ์šฉ์–ด ์ •์˜ 4 โ…ก. ๋ฌธํ—Œ๊ณ ์ฐฐ 8 1. ์„ฌ๋ง๊ณผ ์•„ํ˜•๋ณ„ ์„ฌ๋ง 8 2. ์„ฌ๋ง๊ณผ ์•„ํ˜•๋ณ„ ์„ฌ๋ง์˜ ์œ„ํ—˜์š”์ธ 13 3. ์„ฌ๋ง๊ณผ ์•„ํ˜•๋ณ„ ์„ฌ๋ง์˜ ์ž„์ƒ๊ฒฐ๊ณผ 15 โ…ข. ์ด๋ก ์  ๊ธฐํ‹€ 17 โ…ฃ. ์—ฐ๊ตฌ ๋ฐฉ๋ฒ• 22 1. ์—ฐ๊ตฌ ์„ค๊ณ„ 22 2. ์—ฐ๊ตฌ ๋Œ€์ƒ 22 3. ์—ฐ๊ตฌ์˜ ์œค๋ฆฌ์  ์ธก๋ฉด 24 4. ์—ฐ๊ตฌ ๋„๊ตฌ 25 5. ์ž๋ฃŒ์ˆ˜์ง‘ ์ ˆ์ฐจ 29 6. ์ž๋ฃŒ๋ถ„์„ ๋ฐฉ๋ฒ• 29 โ…ค. ์—ฐ๊ตฌ ๊ฒฐ๊ณผ 30 1. ์„ฌ๋ง๊ณผ ์•„ํ˜•๋ณ„ ์„ฌ๋ง ๋ฐœ์ƒ๋ฅ  30 2. ์•„ํ˜•๋ณ„ ์„ฌ๋ง์˜ ์„ ํ–‰ ์š”์ธ 31 3. ์•„ํ˜•๋ณ„ ์„ฌ๋ง์˜ ์ด‰์ง„ ์š”์ธ 36 4. ์•„ํ˜•๋ณ„ ์„ฌ๋ง ์ž„์ƒ๊ฒฐ๊ณผ 42 โ…ฅ. ๋…ผ์˜ 43 1. ์„ฌ๋ง๊ณผ ์•„ํ˜•๋ณ„ ์„ฌ๋ง ๋ฐœ์ƒ๋ฅ  43 2. ์•„ํ˜•๋ณ„ ์„ฌ๋ง ์œ„ํ—˜์š”์ธ 46 3. ์•„ํ˜•๋ณ„ ์„ฌ๋ง ์ž„์ƒ๊ฒฐ๊ณผ 53 โ…ฆ. ๊ฒฐ๋ก  ๋ฐ ์ œ์–ธ 56 ์ฐธ๊ณ ๋ฌธํ—Œ 59 ๋ถ€๋ก 71 Abstract 77Maste

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    ํ•™์œ„๋…ผ๋ฌธ (์„์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ์˜๋ฅ˜ํ•™๊ณผ, 2016. 8. ๋ฐ•์ •ํฌ.๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ์‹ค์ œ ์˜๋ฅ˜์‚ฐ์—…์—์„œ ๋ฒ”์šฉ๋˜๋Š” ์•Œ์นผ๋ฆฌ ๊ฐ๋Ÿ‰๊ฐ€๊ณต์„ ์ด์šฉํ•ด ์ €๋†๋„์˜ ์•Œ์นผ๋ฆฌ ์ฒ˜๋ฆฌ๋กœ ์ธ์žฅ๊ฐ•๋„ ๊ฐ์†Œ๋ฅผ ์ค„์ด๊ณ , ์„ฌ์œ ํ‘œ๋ฉด์˜ ๋งˆ์ดํฌ๋กœ-๋‚˜๋…ธ ๊ฑฐ์น ๊ธฐ๋ฅผ ์ •๊ตํ•˜๊ฒŒ ๊ตฌํ˜„ํ•˜์—ฌ ์šฐ์ˆ˜ํ•œ ์ดˆ์†Œ์ˆ˜์„ฑ ๋ฐ ์พŒ์ ์„ฑ์„ ๊ฐ€์ง€๋Š” ํด๋ฆฌ์—์Šคํ„ฐ ์ง๋ฌผ์„ ๊ฐœ๋ฐœํ•˜๊ณ ์ž ํ•˜์˜€๋‹ค. ์ฒซ ๋ฒˆ์งธ ๋‹จ๊ณ„์—์„œ๋Š”, ์•Œ์นผ๋ฆฌ ์ฒ˜๋ฆฌ ์˜จ๋„์™€ ์ฒ˜๋ฆฌ ์‹œ๊ฐ„์„ ์กฐ์ ˆํ•˜์—ฌ ์„ฌ์œ  ํ‘œ๋ฉด์˜ ์ •๊ตํ•œ ๊ฑฐ์น ๊ธฐ๋ฅผ ํ˜•์„ฑํ•˜์˜€๊ณ , ์ธ์žฅ๊ฐ•๋„ ๊ฐ์†Œ์œจ์„ ๊ณ ๋ คํ•˜์—ฌ ์•Œ์นผ๋ฆฌ์ฒ˜๋ฆฌ์˜ ์ตœ์  ์กฐ๊ฑด์„ ์„ ์ •ํ•˜์˜€๋‹ค. ๋‘ ๋ฒˆ์งธ ๋‹จ๊ณ„์—์„œ๋Š” ํŽธ๋ฉด์ฝ”ํŒ…์„ ์œ„ํ•ด, ๋ถˆ์†Œ๊ณ„ ๊ณ ๋ถ„์ž ์šฉ์•ก์— ์ ์ฆ์ œ์˜ ๋†๋„๋ฅผ ์กฐ์ ˆํ•˜์—ฌ ํผ์ฝ”ํŒ… ์•ก์„ ์ œ์กฐํ•˜์˜€๊ณ , ์„ฌ์œ ํ‘œ๋ฉด์˜ ๊ฑฐ์น ๊ธฐ๊ฐ€ ์œ ์ง€๋˜๋„๋ก ์นผ๋‚ ๊ณผ ์ง๋ฌผ๊ฐ„์˜ ๊ฐ„๊ฒฉ์„ ์กฐ์ ˆํ•˜์—ฌ ํŽธ๋ฉด์†Œ์ˆ˜ํ™” ์‹œ์ผฐ๋‹ค. ์•Œ์นผ๋ฆฌ ์ฒ˜๋ฆฌ์˜ ์ตœ์ ์กฐ๊ฑด ์„ ์ •์„ ์œ„ํ•ด, ์ฒ˜๋ฆฌ ์‹œ๊ฐ„ ๋ฐ ์ฒ˜๋ฆฌ ์˜จ๋„์— ๋”ฐ๋ฅธ ์ง๋ฌผ์˜ ๋ฌด๊ฒŒ, ์ธ์žฅ๊ฐ•๋„, ํ‘œ๋ฉด ํ˜•ํƒœ์˜ ๋ณ€ํ™”๋ฅผ ๋น„๊ตยท๋ถ„์„ํ•˜์˜€๊ณ , ํŽธ๋ฉด์†Œ์ˆ˜ํ™” ์ฒ˜๋ฆฌ์˜ ์ตœ์ ์กฐ๊ฑด ์„ ์ •์„ ์œ„ํ•ด ์ •์ ์ ‘์ด‰๊ฐ ๋ฐ shedding angle, ๊ทธ๋ฆฌ๊ณ  ์ด๋ฉด์˜ ์ –์Œ์„ฑ ํ‰๊ฐ€๋ฅผ ํ•จ๊ป˜ ์ง„ํ–‰ํ•˜์˜€๋‹ค. ์•Œ์นผ๋ฆฌ ์ฒ˜๋ฆฌ ์‹œ๊ฐ„ ๋ฐ ์ฒ˜๋ฆฌ ์˜จ๋„๊ฐ€ ์ฆ๊ฐ€ํ• ์ˆ˜๋ก, ์„ฌ์œ ํ‘œ๋ฉด์˜ ๋ฏธ์„ธํ•œ ๊ฑฐ์น ๊ธฐ๋ฅผ ํ˜•์„ฑํ•˜์—ฌ ์ดˆ์†Œ์ˆ˜์„ฑ ํ‘œ๋ฉด ๊ตฌํ˜„์— ์œ ๋ฆฌํ•˜์˜€๊ณ , ํผ ์ฝ”ํŒ…์•ก์˜ ์ ๋„๋Š” ๋‚ฎ์„์ˆ˜๋ก ์œ ๋ฆฌํ•˜์˜€๋‹ค. ์ด์— ๋”ฐ๋ผ, ํ‘œ๋ฉด(face side)์€ ์ •์ ์ ‘์ด‰๊ฐ 162.8ยฐ, SHA๋Š” 5.6ยฐ๋ฅผ ๋‚˜ํƒ€๋‚ด๋Š” ์ดˆ์†Œ์ˆ˜์„ฑ์„ ๊ฐ€์ง€๋ฉด์„œ, ์ด๋ฉด(back side)์€ 109์ดˆ ๋‚ด๋กœ ๋ฌผ๋ฐฉ์šธ์ด ์™„์ „ํžˆ ์Šค๋ฉฐ๋“œ๋Š” ์นœ์ˆ˜์„ฑ์„ ๊ฐ–๋Š” ์กฐ๊ฑด์ธ ์•Œ์นผ๋ฆฌ ์ฒ˜๋ฆฌ์˜จ๋„ 70ยฐC์—์„œ 60๋ถ„๊ฐ„ ๊ฐ๋Ÿ‰๊ฐ€๊ณต ํ›„ ๋ถˆ์†Œ๊ณ„์šฉ์•ก์™€ ์ ์ฆ์ œ์˜ volume ๋†๋„ ๋น„์œจ์„ 40:2๋กœ ์ œ์กฐํ•œ ์ฝ”ํŒ…์šฉ์•ก์„ ํŽธ๋ฉด์—๋งŒ ๋ถ€์—ฌํ•œ 70-E60-C2๋ฅผ ์ตœ์ ์กฐ๊ฑด์œผ๋กœ ์„ ์ •ํ•˜์˜€๋‹ค. ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ์ €๋†๋„์˜ ์•Œ์นผ๋ฆฌ ๊ฐ๋Ÿ‰๊ฐ€๊ณต์„ ์ด์šฉํ•˜์—ฌ ์ธ์žฅ๊ฐ•๋„๋ฅผ ์ตœ์†Œํ™”์‹œํ‚ค๊ณ  ํŽธ๋ฉด์—๋งŒ ์†Œ์ˆ˜ํ™” ์ฒ˜๋ฆฌํ•˜์—ฌ ์พŒ์ ์„ฑ์ด ํ–ฅ์ƒ๋˜๊ณ  ์šฐ์ˆ˜ํ•œ ์ดˆ์†Œ์ˆ˜์„ฑ์„ ๋™์‹œ์— ๊ฐ€์ง€๋Š” ํด๋ฆฌ์—์Šคํ„ฐ ์ง๋ฌผ์„ ๊ฐœ๋ฐœํ•˜์˜€๋‹ค๋Š”๋ฐ ์˜์˜๊ฐ€ ์žˆ๋‹ค.I. ์„œ๋ก  1 1. ์—ฐ๊ตฌ์˜ ํ•„์š”์„ฑ 1 2. ์—ฐ๊ตฌ์˜ ๋ชฉ์  4 II. ์ด๋ก ์  ๋ฐฐ๊ฒฝ 6 1. ์ดˆ์†Œ์ˆ˜์„ฑ ํ‘œ๋ฉด 6 1.1. ์ –์Œ์„ฑ์— ๋Œ€ํ•œ ๊ธฐ๋ณธ ์ด๋ก  6 1.2. ํŽธ๋ฉด ์ดˆ์†Œ์ˆ˜์„ฑ ํ‘œ๋ฉด๊ณผ ์ œ์ž‘ ๋ฐฉ๋ฒ• 11 2. ์•Œ์นผ๋ฆฌ ๊ฐ๋Ÿ‰๊ฐ€๊ณต 15 2.1. ์˜๋ฅ˜์‚ฐ์—…์—์„œ์˜ ์•Œ์นผ๋ฆฌ ๊ฐ๋Ÿ‰๊ฐ€๊ณต 15 2.2. ์•Œ์นผ๋ฆฌ ๊ฐ๋Ÿ‰๊ฐ€๊ณต์— ๋”ฐ๋ฅธ ์„ฌ์œ ํ‘œ๋ฉด ๋ณ€ํ™” 17 III. ์‹คํ—˜ 21 1. ์‹œ๋ฃŒ ๋ฐ ์‹œ์•ฝ 21 1.1. ์‹œ๋ฃŒ 21 1.2. ์‹œ์•ฝ 22 2. ์‹คํ—˜ ๋ฐฉ๋ฒ• 23 2.1. ์‹คํ—˜ ๋ฐฉ๋ฒ• 23 2.2. ํ‘œ๋ฉด ๊ฑฐ์น ๊ธฐ ์ œ์–ด๋ฅผ ์œ„ํ•œ ์•Œ์นผ๋ฆฌ ๊ฐ๋Ÿ‰ 26 2.3. ํŽธ๋ฉด ์†Œ์ˆ˜ํ™” 26 3. ์‹œ๋ฃŒ์˜ ํŠน์„ฑ ํ‰๊ฐ€ ๋ฐ ๋ถ„์„ 30 3.1. ์•Œ์นผ๋ฆฌ ๊ฐ๋Ÿ‰์— ์˜ํ•œ ๋ฌผ๋ฆฌ์  ํŠน์„ฑ 30 3.2. ํŽธ๋ฉด์†Œ์ˆ˜ํ™”์— ์˜ํ•œ ํ™”ํ•™์  ํŠน์„ฑ 32 3.3. ํ‘œ๋ฉด ์ –์Œ์„ฑ 33 3.4. ํˆฌ๊ณผ ์„ฑ๋Šฅ 35 3.5. ์„ธํƒ ๋‚ด๊ตฌ์„ฑ 37 3.6. ์ง๋ฌผ์˜ ํƒœ ๋ณ€ํ™” 38 IV. ๊ฒฐ๊ณผ ๋ฐ ๊ณ ์ฐฐ 42 1. ์•Œ์นผ๋ฆฌ ๊ฐ๋Ÿ‰์— ์˜ํ•œ ๋ฌผ๋ฆฌ์  ํŠน์„ฑ ๋ณ€ํ™” 42 1.1. ์ง๋ฌผ ๋ฌด๊ฒŒ์˜ ๋ณ€ํ™” 42 1.2. ์ธ์žฅ ๊ฐ•๋„์˜ ๋ณ€ํ™” 45 1.3. ํ‘œ๋ฉด ํ˜•ํƒœ์˜ ๋ณ€ํ™” 48 2. ํŽธ๋ฉด์†Œ์ˆ˜ํ™”์— ์˜ํ•œ ๋ฌผ๋ฆฌยทํ™”ํ•™์  ํŠน์„ฑ ๋ณ€ํ™” 52 2.1. ํ‘œ๋ฉด์˜ ํ™”ํ•™ ์กฐ์„ฑ์˜ ๋ณ€ํ™” 52 2.2. ํ‘œ๋ฉด ์ –์Œ์„ฑ 54 2.3. ํˆฌ๊ณผ ์„ฑ๋Šฅ 63 2.4. ์„ธํƒ ๋‚ด๊ตฌ์„ฑ 68 2.5. ์ง๋ฌผ์˜ ํƒœ ๋ณ€ํ™” 70 V. ๊ฒฐ๋ก  73 ์ฐธ๊ณ  ๋ฌธํ—Œ 76Maste

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    ์ˆœ์กฐ~์ฒ ์ข… ์‹œ๊ธฐ์—๋Š” ์‚ฌ์„œ์˜(ๅ››ๆ›ธ็–‘) ์‹œ์ œ์™€ ์ œ๋ฌธ์„ ๋‹ด์€ ์‹œ์ œ์ง‘๊ณผ ๊ณผ๋ฌธ์ง‘์ด ํ™œ๋ฐœํ•˜๊ฒŒ ํŽธ์ฐฌ๋˜์—ˆ๋‹ค. ๋Œ€ํ‘œ ์ „์ ์œผ๋กœ๋Š” ใ€Ž๊ณผ์ œ๊ฐ์ฒด(็ง‘้กŒๅ„้ซ”)ใ€์™€ ใ€Ž์ž„ํ—Œ๊ณต๋ น(่‡จ่ป’ๅŠŸไปค)ใ€์„ ๋“ค ์ˆ˜ ์žˆ์œผ๋ฉฐ, ์ด ์™ธ์— ๊ฐœ์ธ ๋ฌธ์ง‘ ๋ฐ ใ€Ž์‚ฌ๋งˆ๋ฐฉ๋ชฉใ€์„ ํ†ตํ•ด์„œ๋„ ์‚ฌ์„œ์˜ ์‹œ์ œ์˜ ์ผ๋ฉด์„ ๋ณผ ์ˆ˜ ์žˆ์—ˆ๋‹ค. ์ด๋Ÿฌํ•œ ์—ฌ๋Ÿฌ ์ž๋ฃŒ๋“ค์„ ํ†ตํ•ด ์ˆ˜์ง‘ํ•œ ์ด ์‹œ๊ธฐ์˜ ์‚ฌ์„œ์˜ ์‹œ์ œ 382๋ฌธ(ๅ•)์„ ๋ถ„์„ํ•˜์—ฌ ๊ฐ ์ฑ…๋ณ„๋กœ ๋“œ๋Ÿฌ๋‚˜๋Š” ์ถœ์ œ ๊ฒฝํ–ฅ์„ฑ์— ๋Œ€ํ•ด ์‚ดํŽด๋ณด์•˜๋‹ค. ใ€Ž๋…ผ์–ดใ€์˜ ๊ฒฝ์šฐ ๊ฐœ๋…์–ด์˜ ์ •์˜์™€ ์„ ํ›„๊ณ ํ•˜(ๅ…ˆๅŽ้ซ˜ไธ‹)์™€ ๊ด€๋ จํ•œ ๋ฌธ์ œ๋“ค์ด ๋Œ€๊ฑฐ ์ถœ์ œ๋˜์—ˆ๋‹ค. ใ€Ž๋งน์žใ€๋Š” ์ธ๊ฐ„์˜ ๋ณธ์„ฑ ํƒ๊ตฌ์™€ ๊ด€๋ จํ•œ ๋ฌธ์ œ ๋ฐ ์™•์ •(็Ž‹ๆ”ฟ)๊ณผ ์‚ฌํšŒ์ œ๋„์— ๊ด€ํ•œ ๋ฌธ์ œ ๋“ฑ์ด ์ฃผ๋กœ ์ถœ์ œ๋˜์—ˆ๋‹ค. ใ€Ž๋Œ€ํ•™ใ€๊ณผ ใ€Ž์ค‘์šฉใ€์€ ์ค‘๋ณต ์ถœ์ œ๋œ ๋ฌธ์ œ๊ฐ€ ๋งŽ์•˜์œผ๋ฉฐ ํŒ”์กฐ๋ชฉ(ๅ…ซๆข็›ฎ)์˜ ๋ฌธ์žฅ ๊ตฌ์กฐ ๋ฐ ์ฒด์šฉ(้ซ”็”จ)์˜ ๋ถ„์†์— ๊ด€ํ•œ ๋ฌธ์ œ๊ฐ€ ์ฃผ๋กœ ์ถœ์ œ๋˜์—ˆ๋‹ค. ๊ทธ ๋ฐ–์— ์—ฌ๋Ÿฌ ์ฃผ์„๊ฐ€๋“ค์˜ ์„ค์„ ์ธ์šฉํ•œ ๋ฌธ์ œ์™€ 4๊ฐœ์˜ ์ฑ…์„ ํ†ตํ‹€์–ด ๋‚ธ ๋ฌธ์ œ ๋“ฑ๋„ ์žˆ์—ˆ๋‹ค. ์ค‘๋ณต ์ถœ์ œ ๋ฌธ์ œ๋Š” ํ•œ์„ฑ์‹œ(ๆผขๅŸŽ่ฉฆ)๋ณด๋‹ค ํ–ฅ์‹œ(้„•่ฉฆ)์—์„œ ๋‘๋“œ๋Ÿฌ์ง€๊ฒŒ ๋‚˜ํƒ€๋‚ฌ์œผ๋ฉฐ, ์ •์กฐ๋Œ€์™€ ์ธ์ ‘ํ•œ ์ˆœ์กฐ๋Œ€์—๋Š” ์ž ์‹œ ๋ณด์ด์ง€ ์•Š๋‹ค๊ฐ€ ํ—Œ์ข…~์ฒ ์ข…๋Œ€์— ์ด๋ฅด๋Ÿฌ ๋‹ค์‹œ ๋ณด์ด๊ธฐ ์‹œ์ž‘ํ•œ๋‹ค. ์ด๋Š” ๊ณง ์‚ฌ์„œ์˜ ์‹œ์ œ๊ฐ€ ๊ฐ€์ง€๋Š” ์–ด์ฉ” ์ˆ˜ ์—†๋Š” ํ•œ๊ณ„์ ์œผ๋กœ, ์‹œ๊ด€๋“ค์€ ์ด๋ฅผ ๊ทน๋ณตํ•˜๊ธฐ ์œ„ํ•ด ๊ฒฝ๋ฌธ(็ถ“ๆ–‡)์„ ๋ฒ—์–ด๋‚˜ ์„œ๋ฌธ(ๅบๆ–‡) ๋ฐ ์ฃผ์„๊ฐ€๋“ค์˜ ์„ค์„ ๋ฌธ์ œ๋กœ ๋‚ด๋Š” ๋“ฑ ์ถœ์ œ์˜ ์™ธ์—ฐ(ๅค–็ทฃ)์„ ํ™•์žฅํ•˜๊ธฐ ์œ„ํ•ด ๋…ธ๋ ฅํ•˜์˜€๋‹ค

    ํ™œ์„ฑ์‚ฐ์†Œ์ข…๊ณผ ํ™œ์„ฑ์งˆ์†Œ์ข…์„ ์ œ๊ฑฐํ•˜๋Š” ํ•˜์ด๋“œ๋กœ์ ค์„ ์ด์šฉํ•œ ์—ผ์ฆ์„ฑ ์งˆํ™˜ ์น˜๋ฃŒ

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    MasterVarious inflammatory diseases are developed from chronic inflammation. In inflammatory process, reactive oxygen species and reactive nitrogen species play important roles in signaling between immune cells. When inflammation progresses chronically, reactive oxygen species and reactive nitrogen species accumulate excessively in the inflammatory lesions, and they generate chemical species, which are stronger oxidants and damage the surrounding normal tissues, thereby exacerbating inflammation. Therefore, by scavenging overexpressed reactive oxygen/nitrogen species, the oxidative stress caused by them can be reduced, and through this, it is intended to alleviate inflammatory diseases. In this study, moieties that respond to reactive oxygen species and reactive nitrogen species were introduced into biocompatible polymers. And hydrogels formed by the polymers were used to form the injectable scaffold into the inflammatory lesions. Polymerized phenylboronic acid can be combined with polyvinyl alcohol, hydrophilic polymer in which a 1, 3-diol group is present, making phenylboronic ester bond that can scavenges reactive oxygen species. Through this process, phenylboronic esters were formed, and polymers were cross-linked to form a hydrogel. In addition, by introducing an o-phenylene diamine group, a moiety that scavenges reactive nitrogen species, to biocompatible hyaluronic acid, the polymer that scavenges reactive nitrogen species were synthesized. So after all polymers loaded in dual syringe were injected from it, injectable hydrogel was formed. This hydrogel, which can scavenge reactive oxygen/reactive nitrogen species, can be injected locally to the inflammatory area and expected to effectively alleviate inflammation by reducing oxidative stress. In addition, the hydrogel has an excellent ability to load the drug molecules in its porous network. Therefore, if the anti-inflammatory drug is loaded in the hydrogel, the drug will be gradually released and the effect of continuous inflammation treatment will be seen. Through this, it is expected to develop an efficient inflammatory disease treatment system and examine its biological application potential
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