[요약리뷰] 언더스탠딩 - 뇌출혈예방법, 서울대병원 이승훈 교수

 

 

### 한글 요약

이승훈 교수는 뇌출혈의 심각성과 예방 방법에 대해 설명합니다. 뇌출혈은 뇌경색과 함께 뇌졸중의 일종으로, 혈관이 터져서 발생합니다. 뇌는 회복이 어려운 장기이기 때문에 출혈을 예방하는 것이 중요합니다. 주요 예방 방법으로는 고혈압 관리와 담배를 피하는 것이 강조됩니다.

뇌출혈에는 두 가지 유형이 있습니다. 첫 번째는 뇌 실질 출혈로, 고혈압에 의해 작은 혈관이 터져 발생합니다. 두 번째는 지주막하 출혈로, 뇌 바깥 큰 혈관의 동맥류가 파열되어 발생합니다. 특히 지주막하 출혈은 30대에서 60대 사이에 발생할 수 있으며, 갑작스럽게 생겨 치명적일 수 있습니다.

예방을 위해 정기적인 MRI 검진을 통해 동맥류를 발견하고, 필요한 경우 코일 색전술 등의 시술을 받을 수 있습니다. 생활 습관 개선, 즉 규칙적인 운동, 금연, 건강한 식습관 등이 중요합니다.

미국 심장학회에서는 심장과 뇌 건강을 위해 8가지 생활 수칙을 제안합니다: 건강한 식습관 유지, 적정 체중 유지, 규칙적인 운동, 금연, 충분한 수면, 혈압 관리, 혈당 관리, 콜레스테롤 관리입니다. 이를 실천하면 뇌출혈과 같은 중대한 질병을 예방할 수 있습니다.

### English Summary

Professor Seung-Hoon Lee explains the seriousness of cerebral hemorrhage and prevention methods. Cerebral hemorrhage, a type of stroke along with cerebral infarction, occurs when a blood vessel bursts in the brain. As the brain is a difficult organ to recover, prevention is crucial. Key preventive measures include managing high blood pressure and avoiding smoking.

There are two types of cerebral hemorrhages. The first is intracerebral hemorrhage, caused by small blood vessels bursting due to high blood pressure. The second is subarachnoid hemorrhage, caused by the rupture of an aneurysm in the large blood vessels outside the brain. Subarachnoid hemorrhage can occur between the ages of 30 and 60 and can be fatal suddenly.

Prevention includes regular MRI screenings to detect aneurysms, and procedures like coil embolization if necessary. Improving lifestyle habits, such as regular exercise, quitting smoking, and maintaining a healthy diet, is crucial.

The American Heart Association suggests eight essential lifestyle rules for heart and brain health: maintaining a healthy diet, keeping a proper weight, regular exercise, quitting smoking, getting enough sleep, managing blood pressure, controlling blood sugar, and managing cholesterol. Following these can help prevent severe diseases like cerebral hemorrhage.

 

 

매우 치명적인 뇌출혈 예방법은 의외로 간단합니다 (서울대병원 이승훈 교수) - YouTube
https://www.youtube.com/watch?v=kp_Si3brGb4

Transcript:
(00:00) 세상의 모든 지식 언더스탠딩 오늘도 한번 뇌출혈에 대해서 우리가 뭘 모르는지도 몰라서 뭘 여쭤봐야 될지도 잘 모르겠습니다 하여튼 배워보겠습니다 어서 오십시오 안녕하세요네 안녕하세요네 저희의 수준이 딱 정단이 정도입니다 딱요 정도 아니 아주 수준 높은 일반인 수준이죠 아야 그 내추럴 뇌에 피가 나는 건데 그럼 리 뭐가 마비 뭐 이런 거 아닐까 뭐 이런 거 뇌출혈이 뭐예요 비슷한 그니까 그 제가 첫 시간에 뇌졸중 했었잖아요 근데 뇌졸중의 상당 부분 얘기가 허혈성 뇌졸중 뇌경색 그다음에 심근경색 그리고 이런 동맥 경화를 어떻게 치료하고 예방하음 사실 그 얘기에서 뇌출혈은 뺏었어요 뇌졸 중에 한 축입니다음 그러니까 뇌가 관적인 문제로 손상됐을 때 는 거를 뇌졸중이 하는데 혈관이 막히면 뇌경색 내지는 허혈성 뇌졸중
(01:07) 혈관이 터져서 뇌세포가 다치게 될 때를 이제 출혈 출혈성 뇌졸증 이렇게 얘기를 합니다음 뭐 큰 특징은 사망률이 어마어마하고요 기대 예상하시는 것처럼 그리고 생각보다 드물지 않고 그리고 정말 일생일대 사건으로 나타나는 경우가 많습니다 전혀 예상을 못 하다가 갑자기 사망음 갑자기 혼수상태 갑자기 식물인간 그런데음 상당 부분은 조금만 건강에 신경 쓰면 아예 안 생기게 만들 수 아 그래요 예 아예 안 생기게 만들 수가 있다 그게 사실 제가 오늘 얘기하는 거에 가장 중요한 핵심이고 이겠네요 사실 의사 입장에서는 환자가 돼서 치료하면 뭐 이렇게 얘기하면 이상한데 그게 이제 우리 입장에서는 의사의 역할을 하는 거지만 사실 뇌졸중은 뇌 라는 장기의 특성으로 봤을 때음 무조건 안 생기는게 제일 좋거든요 그러니까 어떤 간은 70에서 80% 갑자기 손상이 돼도 원래 형태로 다시 자할 정도로
(02:13) 재생 능력이 우수하고 예 피부나 점막은 뭐 아시는 거 많이 다쳐 보셨겠지만 원래대로 돌아가고 예 뇌는 사실 거의 전혀 회복이 안 된다고 보셔야 됩니다 뇌는 다치면 아무튼 예 그냥 다친 부위가 그냥 흉터가 되 되든지 그러니까음 다치는 순간 나머지 뇌로 살아야 되는 상황이 벌어진다 재생이 안 되는 건 아닌데 예 학술적인 수준이고 너무 미미해서 그냥 얘는 재생이 안 되는 우리 몸에서 가장 가장 재생이 안 되는 장기 중에 하나구나음 그게 이제 수정체 연골 이제 뇌 뭐 이렇게 생각하시면 됩니다 아 아 눈 수정체 무릎 연골 다 그러니까면 교체하는네 걔네들도 다 이제 잘 재생이 안 되는데 외는 이제 큰 장기 중에서 아주 대표적 적 재생이 잘 안 되죠 님 근데 생각해 보니까 뇌에 출혈은 뇌에 출혈이 있는 거잖아요 피가 터 혈관이 터져서 피가 옆으로 세는 거지 않습니까 피가 세는게 문제입니까 아니면 피가 뇌로 가는게 가다가
(03:16) 옆으로 안 가고 딴 데로가 버리는게 문제입니까 아 새서 뇌 조직 안에 혈액이 묻는게 문제죠 혈액이 묻으면 그게 문제가 돼요으면 혈액은 그니까 라는 표현이 조금 더 강하게 표현하면 이제 두 가지 손상 기전이 있는데요 예 강한 압력으로 뇌를 이렇게 혈액이 터져 나오면서 덮치게 되면 물리적인 손상을 받습니다 압력이 뇌압이 커져서 밀리거나 하기 때문에 이제 물리적 손상 첫 번째로 받고요 두 번째는 화학적 손상을 받는데 예음 여러분들이 이제 출혈이 돼서 이제 멍이 들면 뻐근 하잖아요네 사실은 혈액이 조직이 아무런 손상을 주지 않으면 뻐그 날 리가 없는데음 혈 안에서는 너무너무 유용한 물질인데이 적혈구 안에 있는 헤모글로빈 그다음에 혈장에 있는 만들어지는 트롬빈 뭐 이런 물질들이 예 어 신경독성을 가지고 있어요 아 그런게 있어요 혈과 혈액 안에 예 혈액은 그래서 혈관 안에서만 존재해야 되고 혈관 밖으로 터지는 순간 조직
(04:20) 손상을 유발하게 돼요 오 그래요 근데 뇌는 우리 몸에서 제일 약한 장기고 그러다 보니까 압력에도 제일 약하고 화학적으로 약 하다 보니까 출혈이란 문제가 생겼을 때 가장 손상이 쉬운 장기 있는데 문제는 어 출혈이란 말을 흔하게 되는 건 장출혈 정도 들어 보시잖아요 예 그러니까 우리 몸에 신부 장기 중에 고형 장기 약간 그런 장기 중에서 출혈이 문제가 되는 유일한 기관입니다 뇌가 그러니까 심장 출혈 못 들어보셨죠 심장은 원래 피가 왔다 갔다 하는 거니까 심장에 혈관이 터져서 심장이 출혈이 됐다 그런 얘기 못 들었잖아요 예 친근 경색 만 있지 예 사실 신장은 좀 출혈이 생길 수 있지만 거기도 출혈 잘 안 생기거든요 그러니까 출혈이란 문제를 흔한 문제로 생기는 유일한 장기가 뇌요리 뇌가 혈관 아주 많이 발달돼 있는데 조직 압이 너무 약해요 그러니까 조 지갑이 장기에 압력이 약해요 너무 거의 뇌에는 물과 같은 상태라고 보시면 돼 그래가지고 젤리 물컹물컹 거의 물
(05:26) 수준입니다 그래가지고 아주 자유롭게 이동을 할 수 있거든 여러 물질들이 그래서 사실 뇌를 우리가 뭐 카데바 아고 해 가지고 우리가 실제고 고정시킨 다음에 꺼내 봐도 이게 손으로 쭉 누르면 다 들어가요 아 이게 어떤 장애도 손으로 누르다 들어가지 않는데 그냥 주룩 들어갈 정도거든요 근데 고정을 시킨 건데 생체 상태 뇌는 거의 흐물흐물한 상태라서 그래서 이제 혈관이 터지지 않으려면 조직이 압력으로 눌러 줘야 되거든요 심장은 돌 덩어리라서 어마어마한 압력이 누르기 때문에 혈관이 약해졌다 하더라도 터질 엄두를 못 내는데음 음 혈관 력 훨씬 크고 조직 압력이 낮으니까 혈관이 조금만 변성이 되면 터지는 사건이 벌어질 수 있다는 거죠 안에서 혈관이 주변 혈관을 눌러 주는 힘이 별로 없으니 예 주변 조직이 혈관을 누르는 압력이 약하다 보니까 아 그런데 피가 옆으로 세는 것 자체가 독성이 있는 거고 그렇죠 나오면서 그 어마어마한 압력으로 누르는 물리적인 손상 손상 혈액 자체 화학적 상 그러니 뇌 안에 돌아다니는 혈관에 혹시 문제가 생겨서 파열되면 그요 네
(06:30) 그냥 그게 뇌출혈이 그렇죠 예 근데 이제 크게 그거를 오늘 준비한 거는 이제 뇌출혈을 어 두 가지 종류가 있는데 일단은 알기 쉽게 두 가지를 조금 아시면음 일반인들도 이제 이게 무슨 병인지 약간 공포감은 가지셔야 되고음 어 왜냐면 그런 사건들이 뭐 언론에서 가끔씩 나오거든 유명인들이 갑자기 사망하시고 이런 일이 벌어지면 그냥 뇌출혈은 저 사람들만 가끔 생기는거다 그게 아니고 굉장히 흔하고음 그런데 한 3 40대부터 조금 준비하시면 인생에서 그걸 안 생기게 만들 수 있다는게 굉장히 중요한 분이 그러네요 50대는 준비하기 좀 늦었으니까 아니 아니 아니요 아 집중력이 달라질 것 같습니다 아니 그뜻이 아니고 그뜻이 아니고 그러니까 이제 일찍 준비하시면 3 40대 50대인데 아직 본인이 거기에 대한 미리 검진을 안 했다 그 그때라도 하셔야죠 그때까지 사건 안 생겼으니까 예방을 할 수 있다 방하는 건 뭡니까 주사가 예방 주사가 있어요 그걸 이제부터 배워야 되는 거 아니야네 뭐
(07:34) 시술이나 수술을 통해서 없애 버릴 수가 있습니다 문제 근원을 아 그 지금 뭘 뇌를 잠깐 보면 야 너 요거 조금 조심하지 않으면 너 여기서 터지겠다 이게 터진다고 범인이 나오는 거죠 나중에 아 몇 년 안에 터지겠네 이렇게 와 뭘 뭘 한번할 수 있습니까 하 하 MRI 시티를 찍으면 되는데요 예 그래 조금 이게 한번 보여 드리겠습니다 예 예전에 2018년도에 뇌출혈로 쓰러졌다는 뉴스가 크게 나왔었고 예 실제 퍼거슨 감독은 그때 유서를 썼다 그래요 아 난 이제 죽는구나 해가지고 근데 지금 멀쩡하게 활동하시고 근데 아마도 본인은 불편한 걸 느낄 텐데 외부인들 테는 들키지 않을 정도로 회복이 되신 것일 가능성이 높습니다음 근데 퍼거슨 감독이 그때 생겼을 때가 2018년도가 77세 쯤 생기신 거죠 굉장히 고령에 어 이분이 있고 이제 우리가 아까운 인재 중에 이제제 whoo 그 세계 건강 기구의 최고 정점에 계셨던
(08:37) 사무총장으로 계 이종욱 박사님이 있습니다 우리나라에서 처음으로 사실 본인의 실력으로 이제 올라가신 분이기 때문에 대단하신 분인데 실제 업무도 너무 잘하셔서음 2006년도에 스위스에 이제 집무실에서 일하시다가음 두통을 느끼고 쓰러지셨다 바로 옆에는 이제 토날 병원으로 옮겨졌는데 3일 만에 사망하 이분 이분이 때 생기셨다 나이 보시면 61세 어 꽤 젊은 나이 때 생기신 거고 그네 밑에 이제 강수현 씨 같은 경우도 아마 40대 있겠죠 그 이제 뇌출혈 발생하고 이미 뭐 병원에 갔을 때 거의 심정지 상태다 그래고 했었고 돌아가셨죠 그데 이제 또 정치적으로 이제 재작년에 굉장히 유명했던 사건이 아산병원 간호사가음 수술을 해야 되는데 내출혈이 있어요 내출혈이 있고 어 그거를 제 병원 내에 수술할 신경외과 의사가 없다고 해서음 그 서울대 병원으로 이송을 했고 그죠 와서 수술을 했는지 안했지 하튼 돌아가셨죠
(09:41) 그럼 뇌혈관에서 터졌는데 수술을 한다는 건 그걸 꿰매서 터지기 직전 상태로 일단 터진 혈관은 해결을 하고 막아 버리고 꿰매서 막는 건가요 큰 혈관인 경우에는 이제 뭐 일단 나오는데 어떻게든 막습니다 두 가지 방법이 있고 그근데 제가 아까 이미 터진 혈액에의 의한 물리적 화학적 손상은 되돌이킬 수가 없다고 했잖아요네 그러니까 만약에 이제 장에서 출혈이 생겼다 복강내로 출혈이 생겼다 내지는 복강내로 이제 장이 터져 가지고 그렇다 그러면은 사실 이제 배를 열어서 열심히 깨끗하게 빨면 됩니다 배를 표현이 좀 그런데 열심히 이제 불순물들 치우고 출혈도 치우면 돼요 근데 뇌는 아까 얘기한 것처럼 쑥 들어간다고이 만지는 순간 뇌는 손상이 돼요 그러니까 이제 수술 할 때도 어떻게든 뇌는 정상 뇌는 건드리지 않으려고 굉장히 노력을 해야 된다는죠 근데 피가 퍼졌다고 해서 피를 걷어 낸다든지 닦아 낸다든지 하는 시술이 더 안 좋아요 불가능하다는 거 더 안 좋아요 할 수가 없는 거죠 더 손상을 유발하게 돼 하는 과정에서 전 뇌가 밀리면
(10:44) 변형이 온다는 터진 혈액을 어떻게 할 수가 없다라는게 굉장히 큰 문제죠 아 근데 그래서 사실 요게 퍼거슨 감독은 고령이 있다는 차이가 있고 이종욱 박사님과 요쪽은 젊은 나이인데 어떻게 도 없이 갑자기 예고도 없이 퍼거슨 감독가 아마 건강 검지 했던 평상시에 무슨 예고를 받았을 가능성이 있는데요음 오른쪽은 사실은 정말 신경 쓰고 그 검사하지 않으면 이게 그 모르셨을 가능성이 아주 높으신 거죠 야 그래서 이제 뭐 다시 한번 기초적인 제가 처음에 했던 강의를 말씀드리면 뇌졸중은 두 가지 터지 막히거나 터지거나 돼 있는데음 혈관이 막혀서 뇌세포가 산소와 포도당이 없어서 괴사되는 걸 허혈성 뇌졸 증 예 혈액은 혈관이 열려 있지만 터져 버려서이 혈액에 의해서 오염되면서 압력과 오염에 의해서 문제가 되는게 오늘 말씀드린 출혈성 뇌졸중이 됩니다 출혈성 뇌졸중이 뇌출혈 거죠 줄여서 뇌출혈 이렇게 말씀드리는 거고 이게 뇌 출혈성 들
(11:50) 뇌출혈의 두 종류가 있는 겁니다 영어로 I SH 써 놨는데요 두 가지가 합쳐서 전체 뇌졸 중에 30% 차지하고 있어요 30% 실제로는 옛날에는 더 많아서 옛날에는 절반 이상의 출혈성 뇌절 중이었거든요 근데 이제 이게 뇌절 중에 발생률이 올라가면서 워낙 허혈성 뇌절 중에 발생률이 증가하다 보니까 출혈성 뇌절 중은 약간 줄고 많이 줄지 않았습니다 약간 줄고 허혈성 중이 너무 많아지면서 지금 한 30% 정도를 우리나라에서 차지하고 있습니다 지금은 그러니까 막히는 뇌졸중이 좀 더 많다는 훨씬 많죠 그게 아주 서구적인 스타일이거든요 그니까 미국같은 경우는 85% 차지하고 막힌 거 키가 안 통해서 뇌가 그냥 괴사하는 거고 리 예 그게 이제 뭐 햄버거 먹고 고혈압 당뇨 고지혈 등등에서 동맥경화의 전형적인 코스로 가게 되는게 허혈성 뇌절중 출혈성 뇌졸중은 좀 다르다 좀 다르다 어 후진국 형인 것도 있고 후진국형 예 그렇습니다 그 두 가지를 한번 설명을 드릴게요 그러니까 뇌출혈은 훨씬 더 많았는데 지금은
(12:54) 비율은 낮지만 그 비율이 낮다는 것 때문에 줄어들었거나 이렇게 착각하시면 안 된다는 거지 줄었는데 전체 뇌졸 중에 파이가 워낙 커지면서음 줄어든 것처럼 착시를 불러일으키는 거죠 요거는 이제 제가 이게 분류를 했던 건데 이건 뭐 학술적이고 간단히 설명드리면이 뇌출혈의 두 종류가 있다 인트라셀 헤모리지 아고 하는 뇌 실질 출혈 인트라 세레브랄 세레브랄 브레인 안에 뇌 안에 생긴 출혈이다 뜻이고요 서브 아라크노이드 리지는 지주막하 거미막 밑 출혈 이게 어 죠 하여튼요 두 가지 출혈에 대해서 아주 알기 쉽게 좀 얘기를 해보도록 하겠습니다 먼저 이제 뇌실질 출혈은 이게 정상뇌 시고요 예 터지면 그냥 허무하죠이요 상태 이게 하얗게 보이는게 출혈이 저게예요 하얀게 피는 시티에서 하얗게 아주 잘 보입니다 급성 출혈은 그래서 출혈 뇌출혈이 생기신 분들은 거의 처음부터 그 제가 이제 뇌경색 얘기할 때 강조했던 이게
(14:00) 두통을 뇌졸증의 증상이라고 뇌경색의 증상이라고 생각하지 마라 만성 두통을 뇌출혈은 아주 마큼 두통이 제일 중요한 증상이에요 두통이 딱 생겨 두통으로 예 왜냐면 이제 뇌가 갇혀 있는 공간인데 열이 생기면서 없었던게 새로 생기니까 압력이 커져 가지고 그래서 제일 먼저 느끼는게 뇌 막이 이제 그 거기에 텐션이 걸리면서 두통을 느끼게 되는게 맨 처음입니다 아 그래서 대부분 이제이 정도 사실 통이 생 이 정도 뇌출혈이 생기면 이거는 사실은 사망할 지경이고 요건 아마 환자분이 사망했을 가능성이 높고 작은 출혈도 두통이 생기는 경우가 많아서음 전에 없던 새로운 두통이 생겼다 내지는 두통과 함께 팔다리가 약간 마비되는 증상을 느낀다 그 그 바로 내출혈 의심해야 내출혈이 제일 먼저 의심되는 거죠 그리고 응급실에 오면 시티는 굉장히 금방 치을 수 있기 때문에 진단은 굉장히 빠르고요 그 이제 뇌뇌 실질 출혈은 뇌 안에서이 이거 뇌 안에서 터졌죠 뇌 안에서 터졌기 때문에 의 뇌 조직과 영합해 보여 가지고 뇌 조직을 밀어내고 있습니다 양쪽을 정상 조직들
(15:04) 마구 밀어내면서 합니다 그래서 손발도 마비되는 거예요 정상 뇌조직이 파괴됐고 때문에 그 그 위치에 있던 정상 뇌조직이 이제 뭐 신 운동 신경 관련된 부분이 파괴돼서 마디가 되고 그서 평소에 두통이 많아 그렇지 그게 뇌 출을 의심할 수는 없겠죠 많이 아파요 이런 얘기를 하면은 평상시 두통이 있던 분들이 병원으로 많이 오시거든요 근데 되게 두통의 원인은 근육 긴장성 두통이라고 해 가지고 이제 머리뼈를 지탱하고 있는 근육들이 뭉쳐서 생기는 두통이 많고 편두통이라고 해서 이제 머리 안쪽이 혈관의 운동 불안정 때문에 생기는 경우도 있고 근데 그런 것들은 혈관이 막히거나 터지는 것과는 거의 무관하다 아 제가 거 평소의 두통은 느낌은 아 느낌은 사실 모르시겠다 머리가 아프다고만 하지 그 평소에 두통약 먹을 때 두통과 내가 보니까 이거는 진짜 많이 아플 거 같아 많 꽤 많이 아픕니다 그러니까 이제 전에 느껴보지 못한 그리고 두통이 생기면서 이렇게 압력이 높아지면 구토를 하게 되거든요 아 그래서 이제 구토를 하다가 더 심해지면 의식을 잃게 되고 그러니까
(16:06) 사실은 이게 두 전에 없던 두통에가 응급실 오시는 건 좋은 행동입니다 그니까 뭐 그걸 본인이 구별해서 오지 말라는 뜻이 아니고 분명히 내가 평상시 못 넘게본 두통데지는 매우 심한 두통 나 원래 두통 환자가 아니었는데 두통이 생겼다든지 그럼 일단 응급실에서 이제 판별 받는게 좋죠 시티는 우리나라에서 굉장히 저렴하고 빨리 검사를 할 수 있으니까요 일단 뇌실질 출혈을 말씀드리면 예 이게 그 굉장히 중요한 일단 사실이 있습니다 그러니까 뇌로 들어가는 안쪽을 관통하는 뇌로 들어가는 그러니까 뭐 도로로 따진다면 고속도로가 아니라 고속도로 톨게이트 나와서 간선도로 예 그 지역으로 가고 있는 도로에서 터졌다고 보시면 돼요 근데 작은 혈관이 굉장히 작은 혈관 만약에이 혈관이 피부에서 터졌으면 이렇게 누르면 돼요 아 그금 그 정도로 미미한 미미한데 뇌는 압력이 너무 약해서 계속 커져 갑니다 아이 평형이 될 때까지 밀려서 뇌 조직 압이 커져 가지고이 혈압과 평형이 될 때까지 커져요 혈종을 형성하게 되거든요이
(17:10) 뇌실질 출혈은 그래서 뇌가 너무 약하기 때문에 다른 장기에서 생기지도 힘들고 커지지도 않은 혈종이 뇌에서 이게 커질 수 있고 사람이 죽을 수도 있다 사망률이 우리나라는 20에서 30% 전 세계적으로 40% 그래서 질문이 있습니다 뇌가 그 약한 조직이면 우리 몸이 뇌에 있는 혈관도 다른 관하고 좀 다르게 생기지 않겠습니까 어 뇌 혈관은 그니까 보강돼 있는 거는 그 혈관이 물리적인 부분도 약간 보강돼 있지만 화학적으로 많이 그 뇌 혈관 뇌혈액 장벽이라고 해가지고 그런 식으로 이제 다른 장기에서 보기 힘든 그런 보강은 꽤 돼 있습니다 근데 그런 보강이 돼 있다 하더라도 고혈압을 굉장히 방치한다 아니면 선천적으로 조금 약간 문제가 있는 혈관을 태어났는데 그렇다 하더라도 우리가 일반적으로 건강에 사는 건강 수명 한 50세까지 대게는 문제 없어요 예 뇌실질 출혈은 이제 문제가 생기는게 적어도 한 65세 한 70세 넘어가면서 문제가 생깁니다
(18:14) 그래서 요거는 이제 설명을 드리면 고혈압을 조심 해라가 이제 결론이 되지만 예 다시 두 번째로 설명하 지주 마화 출혈은 건강한 사람도 의심 해라가 됩니다 그래서 어떤 사람이 의심해 될지는 얘기를 드릴게요 원래 이제 뇌경색은 당연히 큰 혈관의 동맥경화 이런 문제이지만 예 뇌출혈은 작은 혈관의 동맥 경화가 문제가 되는데이 작은 혈관의 동맥 경화가 원래 고혈압의 중요한 특성이 고혈압 때문에 동맥 경화 생긴 큰 혈관의 동맥 경화도 생기지만음 작은 혈관에 생기는게 더 흔하고 더 심각한데 왜 그러냐 하면 지금 보시는 것처럼 큰 혈관이 가다가 갑자기 옆으로 작은 혈관을 내요 으흠 예 그니까 서서히 변화 가는게 아니라 갑자기 소 혈관으로 변해요 어 빨리 달리다가 그니까 확 좁아지 확 좁아지는 길로가 들어 그 큰 압력으로 혈액이 오다가 그 같은 압력으로 갑자기 소혈관 그걸 받아야 돼요 그러니까 이제 혈압 표를 보게 되면 거의 같은 압력인 혈관 벽은 갑자기 엄청나게 얇아지 그러다 보니까 고혈압이 있을 때이 혈관이
(19:17) 제일 많이 손상되기 시작을 해요 아 이거를 이제 세동맥 경화증이라고 얘기를 하게 되고 그래서 이제 이건 어떻게 보면은 사람이 기본적으로 소혈관이 고혈압에 제일 약할 수밖에 없는 선천적인 이유인 거죠 어떻게 변해 가느냐면 이렇게 혈관 벽이 망가지기도 하고 혈관이 튼튼하다면 혈관벽이 이렇게 춤을 추면서 뇌를 이렇게 밀어내요음 뇌가 밀린 거예요 뇌 조직이 너무 약하기 때문에 작은 혈 이게 막 춤을 추면 밀려요 주변 혈관 주위 공간이 생기기도 하고 이건 큰 병은 아니지만 저런게 생기면 아 고혈압이 있나 보다라고 생각하게 되고 작 작은 동맥 경화가 생기기도 하고 혈관벽이 이렇게 죽어 버리기도 합니다 사실 요런 것들이 생기면 우리가 평상시에 무슨 증상으로 알 수 있냐 전혀 알 방법이 없어요 저런 거는 저렇게 미세하게 나오는 거 그러니까 지금 저나 뭐 대표님이나 뭐 뭐 이프로 님이나 있을지도 몰라요음 고혈압으로 인한 저런 이미 혈관은 많이 손상되고 있을지도 모르는데 고혈압 본인이 이제 많이 치료 안 하고 무시했다면 그 평상시 내가 혈압
(20:22) 재는 걸로 뇌 손상이 어느 정도 있는지 알 방법은 없어요 그 더더 정상 기능을 하고 있다면 대부분 정상 기능을 하죠 예 그런데 이제 우리가 진단 기구가 굉장히 발전되면서 뭐 방귀가 잦으면 화장실 간다라는 담이 있듯이 뭔가 이제이 혈관이 손상돼서 비실비실 혈액이 세워 나온다는 거를 우리가 MRI 볼 수가 있어요음 그걸 이제 미세 출혈이라고 하는데 예 이분이 이제 대표적이 까맣게 보이는게 MRI 그래는 이제 특성에 따라서 혈액이 이제 까맣게 보이는게 일반적인데요 시티는 하얗게 보이지만 그래서이 혈 혈액이 터져서 다 춘 너무 약하게 터져가지고 주변 조직하고 금방 평이 되는 바람에 요만큼 터지고 말아 사이즈가 뭐 2mm 3mm 뭐 이렇게 근데 이제 MRI 굉장히 과장하는 영상이라서 그분을 굉장히 크게 보여줘요 아 저런 걸 미세 출혈이 있는 환자를 보게 되면 혈관이 지금 굉장히 방귀를 많이 끼고 있다 굉장히 위험한 상태군요 예 이분은 꽤 많은 겁니다 굉장히 많은
(21:24) 하나만 있어도 어 이분이 혈관이 왜 터졌지 생각해야 되는데 두 개다 개가 넘어가면 아 고혈압을 너무 관리 안 하고 혈관이 터질 가능성을 굉장히 방치하고 수십개 나오면 이제 이건 굉장히 오랫동안 혈압 문제를 이제 방치했을 가능이 높은 거지 나중에 이제 이렇게 크게 터지기도 한다는 거지 어디가 터진 거예요 아 하얗게 하 시티는 이제 하얗게 그러니까 2단계에서 이걸 진단하는 건 이미 늦으신 거고음 그까 평상시에 이제 요건 이제 고령에 좀 생기니까 뭐 늦은 나이라도 MRI 찍었을 때 저는 미세 출혈이 있다 의사로부터 그런 얘기를 듣는다 하면 아 나는 고해라고 굉장히 방치했나 담배를 많이 폈구나 뭐 이런 거 왜 MRI 항상 찍어야 되겠습니다 그럼 아니 그러니까 한 번 찍 한 번만 찍어 봐도 굉장히 주는 정보가 많아서음이 나라가 헬스케어를 다 책임지고 있는 영국이나 캐나다는 자기가 찍고 싶다 찍을 수가 없잖아요 근데 우리나라는 이제 워낙 그 일반 뭐 외래에서 그 의원에서 mrl 찍을 저렴하게 찍을 수 있는 전 세계 거저 유일한 나라다 보니까 약간만 돈 들여
(22:28) 가지고 이런 정보를음 쉽게 얻을 수 있죠 오 그래서 한번 찍어 보시면 미세 출혈이 있는지를 뭐 지금은 아마 찍으시면 거의 없으실 거고요 이제 한 55세 넘어가고 한 60세 65세 넘어가면 저런 것들이 나오는 분이 있고 안 나오는 분들이 있습니다 안 나오는 분들은 뇌출혈은 그래도 좀 뇌실질 출연은 좀 생기지 않겠구나라는 예상을 할 수 있고 65세에 안 나오면네 그 정도 되면 이제 조금 괜찮 고혈압이 있었어도 관리를 잘 했든지 어음 그렇죠 이제 고혈압 때문에 에 생기는 이게 양면성이 있는데요 그러니까 아까 소혈관 때문에이 문제가 생기는게요 부분은 제가 첫 시간에 뇌졸중 얘기할 때 얘기했던 것 중에 하나예요 소혈관 질환으로 뇌경색이 생기면 가장 작은 뇌경색이 생깁니다 왜냐면 간선도로 하나 막힌 거니까 그 하나에 해당되는 영역의 뇌졸 중만 생겨서 너무 작기 때문에 그 열공성 뇌경색이라고 하고 환자분은 증상이 너무 가벼워서 증상이 한 가지만 생기거나 심 심하자 두 가지 생기고 회복률은 너무 좋아서 거의 대부분 의 환자들이 정상적으로 회복될 3개월
(23:31) 안에 정상적으로 회복될 정도로 매우매우 좋습니다 그런데 이거는 이제 혈관이 망가져서 안쪽으로 탁 덮힌 경우음 이제 혈관이 막 망가진게 똑같은 방식으로 망가지는데 하필 바깥으로 나가요네 그럼 뇌출혈이 되죠 그러니까 무슨 얘기냐면 뇌경색에 가장가 가벼운 타입의 열공성 경색이 생길 수 있는 사람은 응 뇌 출혈도 생길 수가 있습니다 어 죽을 병도 생길 수가 있어요 아 저 가볍게 같은 에 의해서 똑같이 뇌가 망가졌는데 어 가장 행운의 뇌졸중도 생길 수 있지만 사망할 뇌졸중도 생길 수 있다는 거 그 완전 운입니다데 그거를 예전에는 이제 운이라고 생각했는데 이분은 뇌에 열공성 경색 위주로 생기는 사람이구나 고혈압이 있었어도음 아니면 고혈압의 흔적이 별로 없구나 근데 이분은 고혈압이 있어도 추성로 생기는 분이구나라는 걸 이제 MRI 찍으면 이제 볼 수 있게 되는 거죠 어 그거는 뇌가 생긴 모양에 따라서 다른 거예요 아까 미출 같 게 있으면 아 이분은 출혈성 생기는 분이구나 조금 나은 거네요 그러면 그니까 아니요
(24:34) 출혈성 사망률이 높 사망률이 높은 거가 그렇지 예 그러니까 이제 뇌경색에 설명했던 가장 가벼운 형태의 뇌경색이어서 내가 아 나 운이 좋네 그고 하셨다가 그대로 그 고혈압을 방치하시면 나중에 뇌출혈로음 그 한 가지 원인에 의해서 아주 극단적인 형태 천사와 악마 같은 형태의 뇌졸중 두 가지 둘 다 생길 수 있다는 거죠 야 그래 뭐 이게 아주 고혈압에 의한 가장 뇌가 받기 쉬운 결과물이에요 예 고혈압 얘기하면 이제 평상시에 컨디션이 안 좋거나 두통 있거나 이렇게 생각하시는데 제가 고혈압 얘기를 하면서 자각 증상이 없습니다 뭐 증상이 있어도 고혈압과 관련이 없습니다 얘기를 막 수도 없이 했잖아요 예 없다가 그 그 고혈압을 그대로 본인이 이제 고혈압인데 방치하시다가 어쩌다가 저렇게 운이 좋은 뇌경색도 생길 수 있지만 이제음 죽을 뇌 출혈도 생길 수 있다는 거죠 그 고혈압이 얼마나 중요한지를 설명하는 것 중에 최악의 형태가 뇌실질 출혈이다라고 보실 수가 있겠습니다 아
(25:37) 요건 이제 그다음 뇌출혈에 대한 설명이니 그 고혈압이 없는 사람은 특히 젊은 분들이나 안 생겨요 뇌출혈이 어 고혈압의 기여율이 압도적으로 높습니다 뇌실질 출혈은 그래서 이게 후진국병이라고 볼 수 있어요 그러니까 우리나라가 뇌실질 출이 정말 많았다가음 지금은 살짝 줄어들었거든요음 살짝 줄어들었는데 워낙 뇌경색이 많이 생기니까 이제 뇌 뇌실질 출이 많이 줄었거나 생각하는데 건수는 살짝 줄거나 비슷한데 아니면 살짝 늘었거나 그런데 뇌경색이 너무 압도적으로 많이 생겨서 그런 거거든요 근데 이제 이게 왜 후진국병 있냐면 뭐 상상을 해 보시면 이제 시골에 계신 할아버지가 괄호를 하시고 농사를 많이 짓는데 새참으로 막 걸리 드시고 뭐 그리고 돌아와서 이제 근데 집이 이제 그렇게 부여하지 못한 니까 깡소주 드시고 근데 그런 할아버지 분 삐쩍 말하셨죠 근데 이제 옛날에는 이제 보건소가 제대로 활성화되기 전에 본인이 혈압도 잘 모으시고 사셨습니까 그러니까 삐쩍 말랐는데 고혈압 관리는
(26:41) 안 되고 술을 많이 드시고 담배도 피고 이렇게 되면 여기 혈관에 터지는 방향으로 굉장히 크게 가가는 거죠 그래서 사실은음 뚱뚱하고 비만이고 그 혈압 관리하고 당뇨 생계 고지혈증이 있으면 혈관이 막히는 방향으로 주로 가서 이런 선형의 그 경 뇌 경색 쪽으로 많이 가게 되는데 후진국 형태는 고혈압 관리 기본적인 가장 기본적인 고혈압 관리할 사람 그리고 술 담배를 워낙 많이 해서 그 터지는 쪽으로 많이 가게 됩니다 약간 우리나라는 그래서 고혈압에 대한 캠페인이 워낙 잘된 순식간의 선진국 형태로 이제 변한 나라기 때문에 병도 순식간의 뇌경색 쪽으로 갔어요은 별로 없고 예 좀 아니요 별로 없진 않는데 근데 이제 하여튼 예전에는 정말 허 생겨도 정말 험악하게 많이 생겼는데 지금은 그렇게 사망할 만한 뇌출혈을 공격하는 건 혈압이 어떤 형태든 그러니까 혈압이 어떤 선을 넘어서 강력하게 혈압이 정상 혈관인
(27:48) 터질 정도로 올라간다 럼 뇌출혈 생길 수 있어요 어 그러니까 어떤 운동을 하고 뭐 너무 심하게 정말 너무너무 심하게 하면 우리 몸에서 조직 압이 제일 약한 조직은 뇌기 때문에 터질 때 뇌부터 터질 수도 있죠 그러니까 그 근데 그근데 그 선을 넘기라는게 굉장히 어렵고 혈관이 정상이라면 그 혈관의 탄력성도 있기 때문에 그러기 굉장히 힘든데 혈관이 이미 고혈압으로 많이 망가진 상태다 그러면 이제 어느 선을 넘을 정도에 갑작스 혈압 변동이 있을 만한음 굉장한 심리적인 뭐 드라마 볼 때 뭐 내가 그럴 줄이야 뭐 이러면서 기목 잡고 할 때 쓰러지는게 대부분 뇌실질 출혈 이죠 아 아 그때 쓰러지는 건 뇌실질 출혈 그러니까 이제 굉장히 심한 스트레스를 받고 굉장히 심한 괄호를 하고 뭐 몸을 이게 굉장히 학대하거나 심적으로 굉장히 큰 고통을 받고 있을 때 혈압의 변동이 엄청나거든요 낮았다가 이제 심한 혈압에 쾅 칠 때 이미 혈관이어도 망가져 있다 하면 이제 터질 수 제가 그니까 예전에 설명할 때 방아 이원으로
(28:51) 설명드린게 총알을 장전하는 건 평상시에 고해라 이런 관리를 못 하게 되면 이미 총알을 계속 장전하고 계신 거고음 어 한순간에 히 심 호를 하거나 심리적인 그런 고통을 느끼실 때 방세를 당기는 거라고 말씀드렸죠 방만 안 당겨도 장전 돼서도 안 나갈 수 있는데네 그 당시에 이제 어떤 큰 몸에 이제 격동이 있느냐 그게 이제 그 발생할 때 굉장히 중요한게 됩니다 아허 알겠습니다 요건 사실 뇌실질 출혈을 말씀드리는 거는 어떻게 보면 인생 전체를 관통하는 고혈압 술를 관 하라는 측면이 되니까요 이건 이제 본인이 평상시 건강성을 어떻게 열심히 하느냐에 달린 건데 예 예 지금 설명드릴 지주 아카 출혈은 이제 불행한 사건이 됩니다 그러니까 아까 지금 뇌실질 출혈은 알렉스 퍼거슨 감독의 사례이고 평상시 고혈압과 술담배를 잘 관리하면 나이가 들어서도 안 생기게 만들거나 약하게 생기게 할 수 있다 근데 지주 만카 출혈은 내가 건강했는데 어느 날 갑자기 생길 수가 있는 거예요 필 생겼는데 심지어 내가
(29:55) 죽었다 이럴 수도 있다는 거죠 야 실제 그 사례를 제가 아까 처음에 보여 드린 거고 이제네 이종욱 박사님이랑 영화배우 사례나 그다음에 간호사 같은 사건들이 다 발생하자마자 사망한 사례들을 지금 보여 드린 거죠네 그게 이제 지주막하 출혈이란 병입니다 지주막하 출혈은 뭘까요 예 설명을 드리면요이 지주 마카 출혈은 이렇게 출혈이 생기면 아까는 정말 막 혈종이 크게 생겨서 일반인도 보기에도 어 굉장히 못생겼네 뇌가 많이 망가졌나 이게 보이는데 이거는 그냥 봐서는 어디가 문제가 있다는 거지를 잘 모르기도 해요 근데 이제 뭐 의사들은 보면 하는데 그게 이제 혈관이 보이면 안 되는데 티에서 혈관이 다 있는 것처럼 보입니다 이렇게 아 원래 보이면 안 되는데 저 까맣게 보이거든요 저위가 안 보여야 되는데 그냥 조형제 안 쓴 시트인데 혈관이 쫙 보여요음 그럼 혈관 주위 공간으로 혈액이 쫙 셌다 거거든요 아우 예 그럼 혈관 주위 공 왜 혈액이 하얗게 보이는 거지 혈관 체 안 보이 너무
(31:00) 빠른 속도로 지나가고 근데 혈액이 세난다면 거기 그대로 뭐 저류 돼 있기 때문에 저게 하얗게 보이는 건데 저 안에 혈관이 묻혀 있고요 혈관 주위 공간으로 굉 굉장한 압력이 혈액이 세 나오고 있다는 얘기거든요 요거는이 환자는 굉장히 높은 압력으로 이미 혼수 상태일 가능성이 높아요 세상에 그 요거 이렇게 혈관 주의 혈관이 있는 것처럼 보이는 상태 왜 그러냐 하면네 머리로 올라간 그러니까 그 원리를 설명드리면 어떤 장기권음 우리가 부산에서 서울로 이제 집까지 차를 몰고 갈 때 고속도로를 가다가 그 고속도로가 자기 집까지 가진 않잖아요 예 고속도로가 오다가 옆으로 가요 서울 예 외곽순환 고속도로가 돼 가지고 서울을 이렇게 둘러싸게 가는 것처럼 우리 장기도 그래요 그래서 맹렬한 속도로 대동맥이 이제 큰 혈관으로 그 장기를 향해서 가다가 뇌를 만나면 쫙 돌아요 예 외곽순환 곳들처럼이 돌면서이 혈관들이 어디 있느냐 어디에 존 뇌 바깥에 존재하잖아요 그 뇌 바깥에 어디 있냐 뇌 막이이 지금 두 개고리 있고 뇌
(32:05) 막이 이제 듀라라 하는 경막이 있고 예 그 아라크노이드 아고 써 있는 거미막 내지는 옛날 한자로 지주막이라는게 있이 거미줄처럼 생겼다서 거미막 골지 지주 형태로 생겼다 지주막 이렇게 불렀거든요 그 거미막 내진 지주 막은 아래 뇌척수액이 흐르는 공간이 있고 그 공간에 혈관이 묻혀 있어요 외곽 순 고속 들어가 그니까 두 개골 바로 밑에서 피가 돈다네 큰 혈관들은 두 개골 바로 밑에서 이렇게 크게 돌고 있어요 그러면서 뇌를 향해서 관통 동맥이 아까 얘기한 관통 동맥이 작은 혈관 이렇게 가지를 치면서 들어가는 형태로 돼 있는 거죠 그 이제 뇌에 딱 붙어 있는 막을 연질 막이라고 하는데 막이 세 개거 연질막 거미막 경막 중에 경막을 뼈에 붙어 있고 연질막 뇌에 붙어 있어요 근데 거미막이라고 하는이 공간은 굉장히 넓 넓은 공간으로 여기에 굉장히 중요한 뇌에 해당되는 여러 특히 이제 혈관 같은 것들이 흐르는 공간으로 돼 있는 거죠 그러다 보니까 여기이 혈이 큰 혈관이 터지면 거미막 밑 공간은
(33:10) 뇌척수액이 있는 그런 약간 널널한 압력이 낮은 공간이다 보니까 혈액이 뇌 바깥에 쫙 퍼지게 되는 거죠 이게 처음 퍼질 때는 혈관 주위부터 이게 퍼져서 혈관 주위에 있는 이런 혈액들이 보이는 상태가 되고 더 퍼진 뇌를 쫙 다 저거는 굉장히 큰 혈관이 터지는 거 네 그니까 작은관는 아니 아까는 진짜 뭐 조그만한 혈관이 터졌는데 40% 사망하 이랬지만이 혈관이 크게 터지다 보니까 어 발생한 사람의 3분의이 병원에 왔을 때 이미 사망한 채이거나 세상에 오셨는데 사망하시고 1이 어 남은 사람의 1분이 중중 장애자가 됩니다 아 그요 거미막 밑 출혈은 생기는 거 자체가 불행이 그래서 근데 또 정말 어이가 없는 거 아까는 70세 넘어야 뇌실질 출혈이 생긴다고 했는데 예 지주 아카 출혈은 30대에서 60세까지 호발 연령이 그냥 걸리는 건네요 열심히 일할 때 열심히 직장 생활할 때네 한 순간에 딱 인생이 끝나는 거죠 왜 원인이
(34:16) 뭡니까 저거 그래서 이제 그럼 이제 왜 생기냐 이게 어떻게 생겼냐 하면 이게 혈관 조용수 해보면이 주머니 같이 생긴게 동맥류에 그러니까 지주막 출혈의 가장 큰 원인은 멀쩡한 혈관이 아니라 동맥류 동맥 과리 꼬리처럼 이렇게 변한 변 변한 혈관 변성이 원인입니다 아까는 아 이렇게 고혈압 당뇨 고지혈증 술담배를 하면 혈관 벽이 콜레스테롤 사인은 동맥경화가 생긴다고 했는데 이거는 멀쩡한 혈관에서 갑자기 풍선처럼 바깥으로 혈관이 부풀어 올라요 호이 생기는 거예요 생겨요 그 이게 기고 기고이 혈관벽이 약하다 보니까 살면서 수십년 동안 문제 없다가 어느 순간 빵 터질 수 있는데 이게 워낙 대혈관이다 보니까 아 맹렬한 압력으로 어마어마한 혈액이 뇌 바깥으로 쫙 오염을 시키면서 큰 압력과 화학적 손상을 주게 되는 거죠 세상에 그까 그럼 동맥류가 없으면 안 터지느냐 예 터지는 사람이 일부 있지만 워낙 가볍게 세는 문제라서 동맥류가 없는지 지주막과 추는 별로 걱정을 안 하셔도
(35:22) 되고요 예 동맥류에 의한 지주화 출혈만 걱정하셔 되는데 전체 지주 출혈에 한 60에서 한 80%이 원인이에요 가게 혹이 생기는 문제 심각한데 가장 흔해 아 혹이 왜 생길까요 저게까네 그래서 이게 왜 생기느냐에 대해서 이제 학술적으로 나온 얘긴데요 예 옛날에는 이제 선천성으로 생긴다 혈관벽이 그 위치가 선천적으로 좀 문제가 있다 그 우리가 사실은 혈관벽이 우리가 건강하게 태어났다고 믿지만 우리 모든 조직이 완결 무결 완전 무결하게 만들어진 건음 아닐 가능성이 높죠 누구나 별 병은 다 가지고 수 있는데 그래서 제가 책을 예 병을 무서워하지 말라는게 병이 없는 사람은 없다고 이렇게 설명을 하면서 그렇게 얘기를 했던 건데 자기는 생각는데 지장은 없었지만 태어날 때 혈관벽이 일부가 약해서 똑같은 압력을 받을 때 자꾸 뒤로 부풀어 나갈 수가 있어요 아 그럴 수 있겠네요 이게 부풀어 나간다 하더라도 혈액 자체 흐르는데 지장이 없으니까 살면서 전혀 모르는 거죠 선천성으로 동맥류가 생기시는 분들이 5에서 한 15% 됩니다 전체
(36:28) 지마가 출해 이게 되게 클 줄 알았는데 옛날에 그게 많다고 했는데 지금은 조사해 보니까 5에서 10% 5에서 15% 그럼 나머지는 후천성 없었는데 태어날 때 분명히 없었는데 살면서 생겨요네 어 그래서 살면서 이런 동맹 풍선처럼 혹이 생기더니 저 벽이 아무래도 약하다 보니까 나중에 어떻게 혈압이 크게 올라갈 상황에서 빵 터져 버릴 수가 있다는 거죠 그 원인이 뭐냐 선천적으로 혈관이 안 좋은 부분도 있고 혈관벽은 비교적 괜찮은데 예 물리적 손상을 주는 고혈압이나 화학적 손상을 주는 담배에 의해서 후천적으로 약간 약했던 부분이 점점 풍성 럼 커질 수가 있습니다음 그래 사실 후천적 요인의 큰 원인 중에 하나는 여기서도 또 고혈압과 담배가 나와요 아 그까 사실 고혈압과 담배가 그렇게 심하지 않았어도 선천적으로 약간 약한 혈관이 있었는데 태어날 때 동맥류는 없었지만 점차 그 부분이 잘하게 만들 수 있 요인이 될 수 있다는 거지 이걸 다 설명할 수 있는 건 아닌데 일반인들 강음 나 교적 목적으로는 선천 요인 외에 고혈압과 담배가 많다고 설명하는게
(37:33) 제가 조금 더 편리할 것 같아서 약간 단정적으로 이렇게 설명을 드리는 거고요 예 있다 하더라도 터지지만 않으면 문제가 안 되는데 그렇겠죠 터지면 죽는단 말이에요 절반이 죽어요 그러면은 왜 터지냐 여기서 또 똑같이 그 큰 혈관을 터트리게 만들 정도의 혈압 변동이음 근데 음주는 왜 터이냐 심한 과음을 하시게 되면은 술을 많이 마 때 이제 그 수분이 많이 들어와서 이제 혈압이 높아지고 또 이제 흥분하면서 여러 가지 재밌는 일이 있습니다 혈압 변동이 심할 수가 있는데 다음 밤에 주무시면서 이제 혈압이 크게 떨어질 수 있 탈수가 되거든요 혈이 떨어졌다가 다음 날 수치는 올라갔다 내려갔다 그러니까 사실 음주를 하는 것 때문에는 혈압 변동을 크게 해요 그날 아 그래서 이제 동맥류가 있는 분들은 그걸 파열 시킬 가능성이 있다는 거죠 음주는 동맥류를 만드는 요인이라 그보다음 동맥류를 터트리 요인 그래서 제가 지금 구별해서 얘기한게 선천적인 요인 과 고혈압과 담배가 동맥류를 만들거나 악화시키고 점점 크게 만들고 급격한 혈압 변동이 생길 만한 운동과 심리적인 충격
(38:38) 그다음에 음주 이게 이제 그거를 터치 유 그 저게 원래 상 저런 그 풍선 같은게 만들어진 사람이 어느 날 갑자기 과음을 했어요 그러면 그게 그날 밤에 술밤 수 있 다음날 뭐 이렇게 터질 수도 있고 이제 음주가 워낙 작다 그러면 그 기간 중에 사실은 우리가 스트레스를 받는다고 하면 심적인 스트레스가 하루 만에 끝나진 않잖아요 그 뭐 또 운동 괄호를 하는게 몸이 회복될 때까지 상당한 요양이 필요하잖아요 그래서 이제 어떤 과로나 충격을 받으면 그 기간 동안에 한두 달 내에 그런 사건이 생길 수 있는 경우들이 많죠 와 그럼 이제 대책이 없냐 이게 치료하는 방법이에요 그러니까 터졌어요 지금 동 매뉴가 있었는데 터졌다 근데 뭔가 사후 약방문 같은 느낌은 들지만 뇌 수술을 하러 들어가서 정말이 미세한 클립으로요 요거는 이제 일반인들 보기에 방향도 잡 힘든데 정말 미세한 클립으로 가가 살짝이 딱 잡아 버려요네 더 터지지 말라고 아요 방법이 옛날에 주된 치료 방법이었는데 지금은 이렇게 혈관 조형수 하면서 환자분을 혈관 조수를
(39:42) 하면서 그 혈관을 찾아 들어가서 여기다가 이제 금속 코일을 가득 채워 가지고 동맥류가 없는 것처럼 이렇게 막아 버리는 아 코일 색 전수를 하기도 해요 지금 코일 색 전술이 당장 해야 될 기본적인 치료 방법 그걸 못 할 경우에 수술을 이제 미 클립을 하기도 하고요 아 저 안으로 피가 들어가지 말아라 아예 예 혈액에 가지 마라 저 동맹 없는 골을 만드는 거죠 코일을 넣어서 근데 요게 현재 치료 방법이고 거의 유일한 근치적인 치료 방법인데 예 제가 모두에 설명드린 것처럼 뇌에 가장 큰 문제는 뇌는 우리 몸에서 가장 약한 장 장기고 재생이 거의 안 된다 예 그럼 이미 터져서 망가진 뇌는 되돌이킬 수가 없다는 것이고 그 두 번째 말씀드린게 혈액은 뇌의 입장에서 혈관 안에서 좋지만 혈관 밖에선 도극 물질이다음 도극 물질이 퍼졌는데 닦으면 안 된다 미치겠다 그니까 닦으면 안 돼요 닦을 수가 없다 음야 오염된 뇌를 그대로 둬야 돼요 그래서 사실은 어떤 치료든 극적인 치료를 하면 환자가 뇌경색 같은 경우는 혈관이 막혔다가
(40:45) 이걸 열어 버리거든요 환자가 확 주어져요음 치료하자 자 환자 갑자기 정상이 되기도 해요 그리고 성공률이 80% 뇌경색은 그 굉장한 치료 방법을 가지고 있는데 지주가 치료는 저렇게 순 상태로 왔을 때 저걸 치료를 했을 때 환자 상태 변화가 없어요 아 그대로 혼수 상태예요 흘러넘 더 문제가 생기는 걸 막은 치료지연이 생기지 말라고 막은 치료지연 대한 대책은 아니에요 그 혈액을 깔끔하게 걷어내야 되는데 걷어낼 방법이 없으니까이 환자가 그대로 혼수 상태일 거다라고 당연히 그렇게 생각하고이 환자 다 이제 중환자실로 들어가면 그다음에 사투를 버리게 되는 거죠 근데 그 사투를 버리다가이 혈액이 또 어떤 문제를 키냐 이게 물질이다 보니까 예 혈관이 혈액에 잠겨 있잖아요 바깥에 잠겨 있잖아요 예 그럼 혈관이이 독극 물질에 의해서 혈액이 독극 물질에 의서 안에 있으면 문제가 없는데 바깥에 있으면 흥분을 해요 예 자극을 받으니까 자극을 받으니까 막 흥분을 해 그러다가 정확한 맥박에서 뛰어야 되는데 흥분에서 바구 연축이 생겨 바 뛰어
(41:49) 연축이 생기면 혈액이 더 빨리 가는게 아니라 혈액이 멈춰요 예음 팔로 떨기만 하니까 그 자리에서 떨기만 하니까 그럼 뇌경색이 병발 돼요 아이구야 그러니까 이제 엎친데 덮친 일이 이제 지주 만카 출혈 환자는 출혈이 생겼는데 환자를 중간자 치료하다가 환자 또 갑자기 쾅하고 나빠지면 뇌경색이 또 생겼네 두 번째 뇌 뇌졸중을 또 맞아요 중환자실에서 그 지금 현재 치료 방법은 연축 줄이기 위한 약을 주긴 줘요 근데 완전하지 않고 혈액에 의한 치료를 혈액을 치우지 못하니까이 혈액이 독국 물질로서 염증을 일으키는 부분이 이제 굉장히 중요하게 문제가 된다 야 혈액이 우리 몸 안에 있는 건데 그렇게 도국 물질로 활 쓰 쓰니까 나머지는 작게 터지면 그냥 뻐근한 거죠 멍들어서 좀 아팠네 내가 언제 부딪혔는데 이게 아 아프네 혈액 때문에 좀 오염돼서 아프네이고 크게 터지면 뭐 가서 그냥 막아버리고 치워 버리면 되니까 씻어버리고 막 그러면 되는데 나머지는 다 씻을 수 있는 거고 실제 씻을 때는 솜 같은 걸로 닦아요 아니 아니 아니 볼관 같은
(42:53) 터지면 거의 뭐 이제 뭐 생리 식으면서 부어가지고 물 컬컬 부어가지고 씻어 되 손 씻고 뭐 세수하고 할 때 물듯이네데 뇌는 그게 안 되니까 뇌는 아예 여는 것조차 그리고 가장 염증이 약해서 그 지중 아가 출혈은 이제 이걸 미세 그 코일 색 전수를 못 했는데 이제 뇌를 열어야 된다 근데 만약에 수술장에 늦게 들어갔다 여러 사유로네 뇌를 이렇게 열면 뇌가 너무 염증이 쉬면서이 확 어져 나와요 예 아이고 팍 뿜어져 나오게도 돼요 뇌 자체가 그냥 액체 액체라고 보면 생 염증은 부을 하는 거기 때문에 엄청나게 커져서이 옛날 브레 지금도 앵리 브레인이라고 부르거든요 화난 브레인이다 그래서 뇌를 열었는데 못 덮어요 못 덮어요 압력 때문 근데 못 덮을 거라고 생각하고 열기도 해요 일단요 압력을 바깥으로 해야 된다 그래가지고 사실은 이제 뇌와 관련된 출혈 문제는 생사가 걸린 문제죠 아까 뇌실질 출혈은 치료 방법을 얘기 안 한 이유가 대부분 내과적인 치료예요
(43:57) 그니까 그가 혈압을 낮춰 주면 뿜어져 나온 압력을 줄이니까 더 출혈을 줄일 수 있고음 정말 심각한 경우에 그 혈액을 혈종을 이제 혈액을 뽑아내기도 하는데 예 뽑아낸게 문제가 되기도 해요 왜냐면 음압이 걸리면서 혈액을 출혈을 더 조장하기도 하거든요 아 그래서 이제 환자가 크게 심각하지 않으면은 뇌실질 출혈은 수수를 권장하지 않는데음 지주막과 출혈은 현재로선 수술이나 시술 밖에 없어요 어떻게든 물리적인 치료를 해야 돼 근데 그 물리적인 치료의 단점은 더 출혈이 생기는 걸 막는 건데 근데이 문제는 이미 터진 혈액은 씻을 수가 없고이 그리고이 문제는 젊은 사람한테 많이 생기고 30대에서 60대 세 호발하고 막 열심히 일하다가 하루 아침에 이제 그 가정에 뭐 아버님을 는다든지 엄마가 없어진다든지 뭐 이런 상황이 생길 수가 있다는 거죠 이런 뇌출혈 치료의 숙제는 요런 부분이라고 생각을 해요 그러니까 이제 요게 방금 얘기한 것처럼 터졌을 때 물리적인 손상은 우리가 치료할 방법이
(45:00) 있어요 혈액을 뽑아내거나 뭐 아니면 얘기한 것처럼 더 출혈이 생기는 걸 맞거나음 그런데 이런 화학적인 손상은 무방비한 말이에요 근데 화학적인 손상이 생겼을 때 우리 모든 우리 몸의 모든 세포에서 벌어지는 과정을 보면 만약에 굉장히 심한 손상이 생긴 세포 군들을 보면 예 요거를 이제 굉장히 심한 손상을 받은 세포들이 처음에 막 죽어 나가요 바로 옆에 세포 막 죽어요네 근데 멀쩡한 세포들이 있죠 멀쩡한 세포들이 있는데 어차피 이렇게 초반에 마구 죽어 나가는 세포는 의사 입장에서는 치료 대상이 아니에요 그건 포기해야 돼 포기하고네 멀쩡한 세포를 잘 살려서이 환자를 살려야 돼요네음 근데 멀쩡한 세포들이 2차 웨이브로 죽어 나가기 시작해요음 왜 혈액에 의해서 오염이 돼서 염증이 생기는데음이 염증이라고 온 상황이 불이 났는데 어떤 건물에 불이 났는데 소방차가 와서 물을 뿌릴 때 주변에 결계를 열심히 친 다음에 물을 이제 불
(46:05) 난다면 예쁘게 끊나요 막 막 부리죠 마구잡이로 해야 되죠 이제 지금은 이제 뭐 차 가리고 있으면 이제 치워버리고 버려버리고 뭐 멀쩡한 차를 뭐 박사를 내고 들어가잖아요 그러니까 주변 건물로 어마어마한 물이 튀는 건 어쩔 수가 없어요음 그게 염증이 그러니까 이제 우리 몸에서는 어떤 큰 독성 손상이나 어떤 문제가 있으면 우리 몸에서는 이만큼 결계를 쳐버리고 음 이만큼 다 물 뿌려 버릴게 하는 거예요 그게 염증 그게 염증이란 우리 모 굉장한 보호 반응이에요 나쁜게 아니고 그 우리 몸 장기를 살 살리기 위한 대의를 위해서 소위를 져 버리는 거지 그런데 문제는이 염증이라고 아 뇌가 다 죽을지도 모르겠네 적당히 죽여라음 그런게 없어요 오염된데 다 죽여라 해요음 그래서 오염된 영역이 넓으면 어떻해요 그럼 다 죽여 다 죽여요 그 뇌가 다 죽어요 어 그래서 환자가 처음에 들아와서 살았는데 어이 혈액을 오염된 부분만 깔끔하게 어떻게 했으면 좋겠는데 못 치운 건 아니까 그 오염된 걸 몸에서 면역 반응이 생기면서 오염됐다 그럼 오염된 부분을 다 걷어내야 되겠네 정상
(47:08) 세포들 다 죽이자 어 오염된 세포들은 그게 세컨더리 웨이브로 아이 염증이란 반응에 의해서 두 번째로 세포들이 죽어 나가기 시작을 합니다 그 주변 부위가 바고 죽어 나가는 거죠 근데 이게 명백하게 과잉 반응이에요 염증이란 거는 사실은 우리 몸에 어떤 균이 들어올 때 거기에 대해서이 균을 죽이고 예어 염된 주조은 좀 가다 살이 도게 하자 하 일차적으로 하는 반응인데 혈액 자기 몸에 있는 혈액에 의해서 오염됐습니다 사실 균에 의해서 손상되는 것보다 훨씬 덜한 건데도 불구 불구하고 구별한 능력이 좀 약간 떨어져 있거나 아직은 뭐 뭐 이게 종교적인 문제를 이을 수 있지만 진화적으로 아직 진화가 덜돼서 조금 더 염증이 좀 더 섬세하게 벌어져야 되는 상황이거나 아직까지 우리 몸은 그러다 보니 잘 구별 를 못하고 뇌 전체를 죽여버리는 사건이 벌어지는 거죠 허 그이 염증을 줄이느냐 어떻게 줄이느냐 이게 지금 현대 뇌출혈뿐 아니라 급성 염증을 줄인 치료 방법이 굉장히 좀 이렇게 빈곤하다 그래서
(48:11) 제가 지금 뭐 연구를 하는 영역도요 부분에 굉장히 집중돼 있고 제 저 염증을 어 아 혹은 피를 어떻게 치울 것이냐 치우지는 불가능하죠 예 뭐 그걸 이제 무슨 미세 로봇이 가서 어떻게든 혈액만 구별 가지 열심히 치우겠습니다 터 같은 혈액이 있는 건 어쩔 수 없다 그때 전제 조건을 놓고이 혈액에 의한 과잉 반응을 몸에 의한 과잉반응 우리 몸이 자기를 죽이는 거니까이 몸에 의한 과잉반응이 면역 세포들을이 대식 세포와 중성구 이런 세포들을 어떻게 하면 정신 차려라 너 네가 지금 뇌를 죽이고 있다라는 시그널을 줘서 적당한 수준에서 머무르게 하느냐 염증이 과도하게 안생기도록네 그래서 사실 그쪽 영역으로 이제 그 기본적인 약들도 많이 개발 됐었지만 굉장히 많은 실패를 했거든요 저도 이제 이쪽에 많이 연구를 하고 심지 제가 이제 회사도 세우고 뭐 신약도 만들고 하는 영역이 이제 이쪽 영이 되겠습니다 굉장한 숙제요 그러니까 교수님 그 말씀하셨던 그 과이 결국 그게
(49:13) 문제잖아요네 그거를 그거는 뭐 시티나 뭘 찍으면 다 나옵니까이 보시면 이제 자 보십니다면 다른 다음에 설명이 있나 보네네 이제 그래서 이제 뭐 발생했을 때 의 상황이 이제 얼마나 이제 의사들이 악전 고투를 하고 환자들 보호자들이 얼마나이 심각한 문제를 느끼느냐 예를 설명을 드렸지만 처음에도 말씀드린 것처럼 안 생기는게 무조건 좋아요 무조건 좋습니다 지주막 가출로 정말 안 생기는게 무조건 좋은데 환자는 줄지 않았어요음 제가 오늘 캠페인으로 이제 급격하게 환자가 줄었으면 좋겠는데 옛날에는 알 방법이 없었어요 근데 1990년대에 이제 MRI 혈관을 찍는 MRI 발전되면서 지금은 굉장히 정교하게 MRI 혈관을 찍기 시작했고 뒷 따라서 이제 시티가 굉장히 투박한 영상을 보여줬지만 조형재 시티가 이제 혈관을 굉장히 잘 보여주는 영상을 찍으면서음 시티와 MRI 다 동맥류가 파열되기 전 상태를 진단할 수 있습니다음음 터지기 전 상태 환자가
(50:19) 멀쩡한 상태로 이제 이분이 건강 검진을 했어요 했더니 어 여기 이렇게 부풀어 오는 부분이 발견되는 거죠음 풍선처럼 예 근데 저 풍선처럼 부풀어오는 부분을 보면 이게 만약에 너무 작다음 너무 초기 상태이거나 이건 더 발전되지 않을 것 같다라고 생각이 되면 안 건드리는게 낫죠음 근데 터지기 전 상태라면 터졌는데도 이제 가서 코일로 맞고 막 클립 하는 거니까 터지기 전이라면 클립으로 맞거나 코일을 넣어 버리면 되죠 그럼 그럼이 동맥류가 없는 것과 똑같이 만들 수 있으니까 근데 그게 너무 작은데 무리하게 시술을 하게 되면 이제 시술 관련된 합병증이 또 생길 수 있거든요 그래서 요거를 우리가 정교하게 정교하게 어떤 사람들은 터질지도 모른다라고 생각을 하고 그 사람을 이제 모니터링 해 나가거나 아니 어느 선을 넘었다고 하면 이제 저희들이 이제 시술이나 수술을 권유하게 됩니다음 사이즈가 크거나 굉장히 못생겨서 터질 것 같다 이렇게 생각되는 경우에 아 그러니까 요거는 만약에 본인이 30대 이후 30대 권장하는 수준은 아니지만 뭐
(51:24) 이게 복원 측면에서 권장하지 않는지 개인적으로 mrl 찍을 만 여력이 된다 그러면 30 넘어서 찍는 것도 좋다고 생각하고요음 저는 이제 50 넘어서 처음 찍어 봤는데 저는 동맥류가 없이 깨끗했고 예 뭐 주변 의료인들도 찍어봤는데 동맥류가 나온다는 분들이 있어요 근데 그러면 아 나는 큰일 났 내가 아니고 되게 운이 좋은 거죠음 미리 발견했으니 예 그걸 이제 우리는 없애 버릴 수 있는 의학 의학적인 기술을 가지고 있거든요 코일 넣으면 되니까 코일 넣어버리면 되니까 그 시술은 간단해요 이렇게 아니 쉽지 않은데 굉장히 숙련된 기술이 필요하고 그리고 잘해야 되고 근데 그런 전문가들 우리나라에 굉장히 많다고 생각하시면 됩니다 그리고 이건 미리 발견이 되면 시간이 많죠 지금 터져서 여섯 시간 안에 치료해야 되는 그런 급성 상황이 아니잖아요 천천히 잘하면 안 안 보다도 천천히 하면 되는 거지 그러니까 지금 아 내가 문제가 생겼는데 이걸 시술할 수 있는 병원 찾아가서 시술해 주세요 그럼 정 정규 시술 일정 잡아가지고 시술해 버립니다 응급이 아니고 어디로 들어가요 그 코일 같은
(52:22) 거 하면 뇌로 혈관이 들어가려면 그니까 저 기술이 가가지고 커 란 코일을 큰 덩어리를 넣으니까 이제 엄청나게 큰 혈관을 손상시키면서 들어가겠다고 생각하실 텐데네 아주 미세한 카세트를 대게는 대게는 대퇴동맥 여기서 대퇴동맥 크니까 이제 들어가서 들어가서 여기 쫙 펴지면서 이제 막 마구 넣 수가 있어요 어 굉장히 가는 미세 카세트로음이 대동을 통해서 여기서 이제 찾아 올라가는 거죠 뇌를 향해서 마취하고 해요 아니요 전신 마치를 하기도 하고 그냥 하기도 하고 세상에 요즘은 좀 이제 환자분이 워낙 기술이 발전되고 잘 막을 만한 자신이 있으니까 마취를 해서 많이 합니다 예 그냥 주무시고 계셔 야 본인이 굉장히 막 예민해질 거 아니에요 어 나 머리를 지금 뭘 하고 있는데 그까 그냥 잠 재우는게 편 서로 편하죠네 그래서 요즘 많이 재웁니다 아니 저게 그니까 어디 출혈이 있을 때 이렇게 넣어서 거기서 이렇게 탁 막더라 그요 정말 예 그러니까 요새 그런 기술은 굉장히 발달한 거 같데 예 폐출혈 폐도 이제 출혈이 생기면 이제 객혈이 많이
(53:26) 생기고 [음악] 예 들어가서 여기를 응급으로 색전 막아 버리죠 어 근데 이제 막는 방법은 여러 가지가 있는데 뇌는 이제 막는 방법이 금속 코일을 얻는다고 생각하시면 되겠어요 막아야 될게 사실은 이제 터진 상황이건 아니건 동맥류는 큰 공간에 뭘 넣어야 되다 보니까음 그렇습니다 그래서이 동맥류는 뇌에만 생기느냐 그건 아니에요 심지어이 대동맥에 생겨요 대동맥이 이렇게 커지기도 하고 그래서 대동맥이 이렇게 커졌다가 파열되면 급사 그래서 이제 그죠 어 키 큰 배구 선수들 같은 경우 대동맥이 동맥류가 생겨서 본인 몰랐다가 20대이 대동맥이 파열되면서 흉강 출혈로 사망하시는 경우들이 이제 왕왕 있죠 키가 큰 키가 큰 키가 큰 분 중에 이제 마르판 증후군이라고 있어서 대동맥이 약한 분들이 있습니다 그래서 키가 큰 분중에 예 키가 굉장히 큰 분들이 애초에 키가 큰 이유가 어 그 유전적으로 클게 아니었는데 말판 중이라는게 생기면서 이제 키도 크고 동맥도 약하고 그런 병원을 생기신 분들 그 우리나라
(54:29) 예전에 국가대표 그 배고 선수분도 유명하신 분이었는데 이제 그걸로 사망하신 분들이 꽤 있어요 아 그러면 교수님은 지금 찍어 보면 없지만 그럴 수도 있죠 뭐 오늘 생겼을 수도 있잖아요 그 후천적으로 생기는게 85% 가까이 되니까 예 제가 이제 아까 얘기한 것처럼 보이지 않지만 선천적으로 어딘가 좀 문제가 있는 부위가 있는데 고혈압과 담배 뭐 이런 걸 다시 뒤 늦은 나이에도 굳이 관리를 안 하면 음 늦나 생 수도 있는 거죠 그럼 교수님 지금 없 없으면 언 언제까지는 절대 안 생겨 하는게 있습니까 아 그런 건 아닌데 저 변화가 굉장히 느립니다 그러니까 느려 년 찍어보고 신경 써야 되 그런 건 아 그러니까 그러니까 이게 문젠데 멀쩡한 MRI 찍었는데 MRI 비용이 본인 경제 상태에선 뭐 자주 찍어도 괜찮겠단 말이에요 그래서 막 매년 찍겠다 이러신 분들이 있어요 근데 저 멀쩡한 혈관이 분들은 건강생활을 하라고 얘기를 드리 면서 뭐 제 개인적으로 5년 내지 한 10년 그때까지 굉장히 느려요 근데 이제
(55:33) 병변이 있다 그러면 이제 병 생긴 모양에 따라서 3년 뒤에 찍읍시다 내지는 내년에 찍읍시다 이렇게 이제 권유하는 상황이 생길 수 있죠 찍었을 때 까리가 나타나거나 아까 그 점점 점점이 나타나면 그게 미세 혈과 조금씩조금씩 파열 됐다가 무 상태라 할 수 있 아까 미세 출혈은 뇌로 올라가는 관통 동맥에서 슬쩍 생 거 작은 혈관네 동맥류는 큰 혈관에서 풍선이 부풀어 오른 것 그러니까 둘 다 무증상인 상태에서 Mr 찍었는데 미세 출혈이 나오면 아 난 정말 고혈압을 관리 안 하거나 담배 수를 많이 했던 사람이구나라고 반성하고 지금이라도 그걸 하면 그 미세 치료는 없어지지 않지만네 미세 출혈이 더 생기거나 큰 출혈이 생기는 걸 예방할 수 있고요 동맥류는 발견돼서 시수를 할 수 있다 하면 그분은 이제 인생일 대에 큰 행운이 생기신 거죠 그러면 안 생길 수 있다 그니까 지금 지주 아카 출혈은 만약에 국가가 너무너무 부강해진이 재벌이야 그럼 제 생각 나라에서 만에 다 찍어 이럴 거
(56:37) 같아요 어 급사를 막다 찍어서 굉장히 많은 인재들 아까 다 인재 들이잖아요 젊은 나이 때 30대부터 60대 갑자기 사망해서 국가적인 손상이 생기는 걸 예방할 수가 있다는 거죠 강수현 씨 같은 경우는 찍었으면 이미 과리 같은게 나타나 있었을 가능성이 높다는 거죠 그냥 멀쩡하게 세상에 배우 생활도 다 하고 그럴 수 있었겠죠 그럼 40살 이런 때 찍었어야 되네요 그때도 있었겠네요 그랬을 가능성이 높죠 그죠 그거 만들어지는데 10년은 걸린다고 하셨으니까 예 근데 이제 유 가족이 이제 사인을 밝히지 않으셨기 때문에 제 저희들 이제 갑자기 너무 일찍 사망하셔서 지마가 출혈이라고 예상을 하는 거고요 예 뇌 출혈이라고 만 알려져 있거든요 그래서 뇌실질 출혈일 수도 있는데 뇌실질 출혈은 그 3일 안에 거의 사망한 채로 병원에가 그러긴 쉽지 않아서 지주 만카 출혈 가능성이 높다고 생각하고 있죠 30대 되면은 직장 생활을 하면 한 번씩은 일단 한번 찍어 봐야 되겠네요 뭐 여유가 되시면 MRI 얼만데 자꾸 큰 여유를 자꾸 근데 이제 그 하고 찍을 수 있습니다 배로 찍으면 한 뭐
(57:40) 굉장히 저렴한 센터에서 30만 원 정도에서네 뭐 이제 그 종합병원 같은 경우는 이제 굉장히 비싸게 책정하기 때문에 이제 100만 원 훨씬 넘게 책정을 하고요 뭐 200만 원까지 뭐 여러 mrr 찍게든 그렇게 되기도 하니까 예 그러니까 이제 그 미세 출혈과 동맥류를 볼 수 있는 MRI 있지 확인하시고 근처에 영상 센터 가셔서 저렴한 거를 이제 알아보시고 찍으시면 업한 영상 의학과 같은 곳에 가도 그러면 영상의학과 아니면 건강 검진 영상 센터나 그런 데서 다 굉장히 중요한 수입원이기 때문에 연락하면 굉장히 좋아하실 거이야 큰병원에서 건강 검진할 때는 그 정도 받으면 큰병원에서 한 1 2 100만 원짜리 건강 검진 했으면 안 들어 있겠네요 거기는 다른 아 그러니까 이제 건강 검진 같은 거 할 때 굉장히 좋은 부유한 회사 같은 경우에 매번 하진 않지만 MRI 같은게 특약으로 포함된 건강 검진을 해 주기도 하죠 가끔음 그 보면 이제 사실 이게 그 아까 이종욱 박사님 같은 경우는
(58:46) who 사무총장이었던 그분이 갑자기 물러 나시면 벌어졌던 사건이 다른 who 사무총장이 잠깐 했는데 욕많이 먹고 물러나고 그다음 하신 분이 테놈 거불 어수스 현 사무총장이거든요 그분이 그 코로나 사건이 터졌을 때 얼마나 욕을 많이 먹었어요 판데믹 선언 안 하고 근데 만약에 이종욱 박사님이 만 여기는 이제 잘하면 계속 사총 하게 되니까 이종욱 박사님이 계셨으면 전 세계를 구하지 않았을까 세상에라는 생각을 하죠 그래서 제가 마지막 한 가지 요것만 말씀드리겠습니다 그래서 예 어 이거는 사실 정말 이게 미국 심장 학회 미국 심장 뇌졸중 학회에서 라이프스 이센셜 에라는 캠페인을 하고 있어요 참 미국 사람들이 참 그 의료 환경이 워낙 자본주의적이라 그렇게 좋은 건 아닌데도 불구하고 이런 캠페인 하는 거 보면은 정말 정말 표도 잘 만들고 예 잘한다고 생각하는데 그니까 딱 복잡하게 얘기하지 않고 인생의 핵심
(59:49) 여덟 개라고 표현을 하고 이걸 하면네 이것만 하면 돼 심장과 뇌로 문제가 생길 가능성이 엄청나게 줄어듭니다음 거의 건강이 살 수 있습니다 근데 이게 보면 뭐 뜬구름 잡는 얘기하네 싶을 수 있어요 잘 먹어라 빼로 살 빼라 으 많이 운동해라 담배 끊어라 잘 자라 혈압 조절해라 혈당 낮춰라 콜레스테롤 낮춰라 이게 제목만 보면 뭐 그거 누가 몰라 누가 몰라 이렇게 되는데 사실은 제가 지난번 얘기할 때 고혈압은 만약 고혈압이 있으면 130 80 이하로 낮추십시오 숫자를 얘기하는게 되게 중요하죠 그러니까 본인이 어떻게든 일상 생활을 잘 하든지 아니면 약을 먹어서음 그 숫자를 맞춰라 당뇨는 6.
(1:00:42) 0이 당화혈색소를 넘어가면 의심해라 예 만약 당뇨를 치료하게 되면 7.0은 넘지 마라 이게 구체적으로 알려주는게 중요하고음 고지질 혈증은 콜레스테롤은 병이 없다면 160 이하에선 크게 신경 쓰지 마라 그런데 만약 본인이 병이 있다면 70 이하로 낮춰라 이게 구체적인게 굉장히 중요하단 말이에요 그 여기도 보면 잘 먹어라 해 뭘 먹어라음 살을 빼라 해서도 BMI 그 체질량 지수를 18.5 25 사이로 맞춰라음 많이 운동해라 어떻게 하냐면 하루에 두시간 반을 운동해라 가벼운 정도에 걷기를 한다면 두시간 반 정도는 해라 두시간 반라 여기 우 좀 약간 과하긴 한데 어 사실 보통 한 한 시간을 꾸준히 거리면 한 7 8,000 버 정도 걷게 되거든요 만 빨리 걸는 분 만 보까지 걷고 만약에 두 시간을 걷는다 두 시간 반 거의 한 2만 보를 걷는 거죠 우리나라에서 말하기 편하게 하려면 뭐 운동량이 저 정도일 것 같지 않으니까 만 보 걸으세요음이 편하게 얘기하면 되고 콜레스테롤 아까 말씀드린 것처럼
(1:01:45) 160 70 담배는 그냥 끊어야 되고 잘 자라는 건 일고여덟 시간은 자라음 잠자는게 만약에 수면이 질이 안 좋다면 그 의사하고 상의하라음 혈압은 30 80을 기억해라 혈당은 당뇨는 7 걸렸다면 7.0 넘지 마라 건강이라면 6.0 넘지 마라 이렇게 구체적으로 딱 알려주면 그럼 이제 본인이이 여덟 가지를 집에 써 놓고서 1년에 한 번 체크할 때마다 아 내가 이걸 안 넘었으니까 난 이걸 지키고 냥 잘하네음음 그니까 사실 막연하게 얘기하면 아이 그냥 재밌게 살고 그냥 술 먹고 살린다 이럴 수가 있지만 저 목표가 대단치 않다는 거죠음 대단치 않 할수 있다 오히려 즐겁게 할 수 있고 그리고 아까 여기대 플러스원 우리나라에서 정말 정말 좋은 건 MRI 꽤 저렴한 나라다 전 세계적으로 드물게음 한번 찍어 봐라 하면 갑자기 사망할 수 있는 지주가 출혈을 아예 없는 것처럼 나는 없었던 사람인 것처럼 살 수 있다네이야 중요하네요 저런 걸
(1:02:50) 기억하고 숫자를 기억하고 만보 만보 만보를 걷고 야 거 아까 그 코일 집어넣는다고 하시는 술이요 술 그냥 직관적으로 보기에는 클 고안으로 못 들어가게 딱 그 클립 같은 걸로 딱 집어 놓으면 굳이 열국이 그 뭐 코일 런 근데 클립은은 잖 건 바깥에서 잡는 거고요 아 이거는 안에서는 클립을 잡을 방법이 없고 이제 채워넣는 것만 할 수 있는 거죠 아 그러니까 시술이 훨씬 간단해 시술이 가능하면 시술로 하는 거지 코일 아 그게 뭐 지방 같은 거 넣으면 다시 빠져나올 거고음음 들어갔다 안 나와야 되니까 어 코일 코일 같은 걸 금속 있데 괜찮겠냐 하겠지만 시간이 지나면 혈관 막이 만들어져 우리 몸은음 그래서 마치 없는 혈관인 거 깨끗한 혈관처럼 바꿔요 우리 몸이 야 너무 진짜 중요한 걸 배운 거 같은 느낌이네 그죠 예 그 고혈압이 진짜 관리해야 되는 거구나 엄청 무서운 거군요고 엄청
(1:03:53) 쉬운데 많이 좋아졌지만 그래 그래도 개인적으로 그러니까 보건적 측면에서 정말 많이 좋아졌는데 개별적으로는 조금만 더 하시면 정말 아 근데 교수님이 뇌치료 오늘 배운 거는 고등학교 때 좀 배워야 되는 거 아닙니까 좀 어느 정도 어떻게 이게 아무것도 모르는지 모르겠어요 문제는 의대생 때도 요걸 강의하는 시간이 한두 시간 정도밖에 안 되니까 예 예 우리 오늘 한두 시간 배웠는데요네 우리 의대생 그럼 오늘 의대생들이 배운 내용과 다예요 내 의대생 다 훨씬 자세히 가르쳤습니다 오늘요 어 그럼 그분들이 나와서 내출 보는 거예요 그거는 전공의로 하는 거겠지 왜 아 그 아니 그 바로 하진 않죠 그니까이 일반인들이 전문의 역할을 할 수 있는 건 아니고요 그러니까 졸업하고 그다음에 인턴과 이제 레지던트 과정에서 신경과 신경 외과를 겪으면서 아주 깊게 배 거 오늘 진짜 제대로 되 의대 나온 피복과 선생님한테 가서 내추럴 좀 아세요 그러면 오늘 저희보다 모르는군요 모습니다 아 그러니까 신경과 신경 외과가 아닌 선생님들은 제가 오늘 예 가르쳐드린 내용의 상당부분을
(1:04:57) 모르십니다 야 굉장히 전문화돼 있구나 그러니까 소화 안 돼 그러면 그냥 민 아저씨 수준이군요 그러니까 그니까 주시 수준은 아니겠지 그래도 의사들이 좀 병원에서 보이는 거 이제 겉으로 보면 이제 고쳐 주는 사람이고 하니까 이제 다른 종류의 사람으로 보일 가능성이 높은데요음 본인이 아프거나 가족이 아프면 똑같아요 굉장히 불쌍해지기 막 똑같습니다 습니다 야네 뇌출혈에 대해서 진짜 인생에 있어서 중요한 레슨 하나 또 배고네 이럴 때 배워 놔야지 언제다 시간내서 배우겠어이 못 배웁니다 오늘은 아니면 나앤 네버 어 그겁니다 뭐 선전하자 책에 굉장히 자세히 써 있 그래이 어 좀 사셔서 오늘 들었는데도 기억이 잘 안 난다 무 않습니다 좋 책은 좀 사시는게 좋을 것 같습니다 자기 목숨뿐만 아니라 가족들의 그 생명과도 관련 있는 거예요 저 안 사 그러니까요 인생에서 한한 명이 50만 원 투자하고 죽을 고비를
(1:06:01) 가능성을 넘길 수 있다는 거죠 아음 알겠습니다 이승 교수님 병을 무서워하지 않습니다네 서울대 이승훈 교수 님이었습니다 고맙습니다 잘 고갑니다 us