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통증자가조절기 사용 실태

Title
통증자가조절기 사용 실태
Other Titles
A Study on the Use of Patient Controlled Analgesia : Focused on patients who received laparoscopic hysterectomy
Authors
김혜영
Issue Date
2008
Department/Major
임상보건과학대학원 임상보건학과임상간호학전공
Publisher
이화여자대학교 임상보건과학대학원
Degree
Master
Abstract
본 연구는 복강경으로 자궁적출술을 한 대상자의 통증자가조절기를 통한 통증 조절 실태 및 관련 요인을 파악하기 위한 서술적 조사 연구이다. 본 연구는 경기도 B시 소재 S대학 부속 병원에서 2006년 11월부터 2007년 12월까지 복강경으로 자궁적출술을 한 후 통증자가조절기를 통한 진통제를 투여 받은 환자 138명 중 본 연구의 목적에 부합하는 65명을 대상으로 수술 후 통증, 통증자가조절기를 통한 진통제 투여량, 부작용, 추가 진통제 및 항구토제 투여를 조사하였다. 대상자의 수술 후 통증은 시각적 상사 척도(Visual analog scale, VAS)로, 부작용은 연구자가 작성한 설문지로 수술 24시간 후에 연구자와 연구보조자 5명이 대상자를 직접 방문하여 측정하였고, 통증자가조절기를 통한 진통제 투여량과 추가 진통제 및 항구토제 투여는 의무기록을 통해 수집하였다. 수집된 자료는 SPSS WIN 14.0 프로그램을 이용하여 분석하였다. 대상자의 일반적 특성, 수술 후 통증, 통증자가조절기를 통한 진통제 투여량, 부작용, 추가 진통제 및 항구토제 투여는 실수와 백분율, 평균과 표준편차로 분석하였고, 일반적 특성에 따른 수술 후 통증과 통증자가조절기를 통한 진통제 투여량과 추가 진통제 및 항구토제 투여 차이는 x2-test, t-test, ANOVA, Ducan으로, 부작용에 따른 수술 후 통증, 통증자가조절기를 통한 진통제 투여량은 t-test로, 수술 후 통증과 통증자가조절기를 통한 진통제 투여량과의 관계는 Pearson correlation coefficient로 분석하였다. 본 연구의 결과는 다음과 같다. 1. 대상자의 수술 후 통증은 평균 3.55(SD=2.11)이었고, 통증자가조절기 투여량은 평균 63.15ml(SD=9.98)이었으며, 부작용은 오심이 39명(60%)으로 가장 많았다. 수술 후 추가 진통제 투여는 Ketorolac을 1회(30mg) 추가 투여 받은 대상자가 수술 후 2일째 8명(12.3%)으로 가장 많았으며, 항 구토제 투여는 Metocolpramide를 1회(10mg) 투여 받은 대상자가 수술 직후 9명(13.8%)으로 가장 많았다. 2. 일반적 특성에 따른 수술 후 통증은 연령에 따라 유의한 차이가 있었으며(F=8.431, p=.001), 40세 미만인 대상자가 수술 후 통증이 높은 것으로 나타났다. 항구토제 투여는 마취방법에 따라 유의한 차이가 있었으며 (χ2=4.746, p=.029). 흡입마취를 시행한 경우 수술 직후 항구토제 투여가 증가하는 것으로 나타났다. 3. 부작용에 따른 통증자가조절기를 통한 진통제 투여량은 오심에 따라 유의한 차이가 있었으며(t=2.138, p=.018), 오심 발생 시 통증자가조절기를 통한 진통제 투여량이 감소하는 것으로 나타났다. 본 연구를 통해, 복강경으로 자궁적출술을 한 후 통증자가조절기를 투여 받는 대상자는 연령에 따라 수술 후 통증 차이가 있었고, 흡입마취 후 통증자가조절기를 투여했을 때 항구토제 투여가 증가하였으며, 오심 발생여부에 따라 통증자가조절기를 통한 진통제 투여량의 차이가 있음을 확인할 수 있었다. 따라서 복강경으로 자궁적출술을 한 후 통증자가조절기를 통한 통증관리 시 연령과 마취방법을 고려하고, 오심 예방을 통한 효과적인 통증간호중재 프로그램을 개발하여 간호 실무에서 활용 하는 것이 바람직 할 것이다.;Objective: The purpose of this study was descriptive research for investigate the status of pain control through patient controlled analgesia and associated factor in patients who received laparoscopic hysterectomy. Method: This study was conducted with 65 patients who met the purpose of this study, sampled from 138 patients administered with analgesic through patient controlled analgesia after they had received laparoscopic hysterectomy during the period from November 2006 to December 2007 at S University Hospital in B City, Gyeonggi‐do. We surveyed the postoperative pain, dosage of analgesic administered through patient controlled analgesia, side effects, and administration of additional analgesic and antiemetic. The postoperative pain was measured with a visual analog scale (VAS), and side effects were measured using a questionnaire prepared by the researcher as the researcher and 5 research assistants visited the patients 24 hours after the surgery. The dosage of analgesic administered through patient controlled analgesia and the administration of additional analgesic and antiemetic were collected from medical records. Collected data were analyzed using SPSS WIN 14.0. The general characteristics, postoperative pain, dosage of analgesic administered through patient controlled analgesia, side effects, and administration of additional analgesic and antiemetic were analyzed with real numbers, percentages, means and standard deviations, and differences in postoperative pain, the dosage of analgesic administered through patient controlled analgesia, and the administration of additional analgesic and antiemetic according to general characteristics were analyzed through x2‐test, t‐test, ANOVA and Duncan test. In addition, the correlations of side effects with postoperative pain and the dosage of analgesic administered through patient controlled analgesia were analyzed through t‐test, and the correlation between postoperative pain and the dosage of analgesic administered through patient controlled analgesia was analyzed through Pearson correlation coefficient. Results: 1. The subjects’ mean postoperative pain was 3.55(SD=2.11), the mean dosage of patient controlled analgesia was 63.15ml(SD=9.98), and the most common side effect was nausea (39 patients, 60%). As to the postoperative administration of additional analgesic, the number of patients administered with Ketorolac once (30mg) on Day 2 from the surgery was largest (8 patients, 12.3%), and as to the administration of antiemetic, the number of patients administered with Metocolpramide once (10mg) just after the surgery was largest (9 patients, 13.8%). 2. As to differences according to general characteristics, postoperative pain was significantly different according to age (F=8.431, p=0.001). That is, postoperative pain was higher in patients younger than 40. The administration of antiemetic was significantly different according anesthesia method (χ²=4.746, p=0.029). That is, the administration of antiemetic just after the surgery increased when inhalation anesthesia had been applied. 3. As to differences according to side effect, the dosage of analgesic administered through patient controlled analgesia was significantly different according to whether to have nausea (t=2.138, p=0.018). That is, when nausea occurred, the dosage of analgesic administered through patient controlled analgesia decreased. Conclusions: According to the results of this study, patients administered with patient controlled analgesia after laparoscopic hysterectomy showed different postoperative pain according to age. In addition, the administration of antiemetic increased when patient controlled analgesia was administered after inhalation anesthesia, and the dosage of analgesic administered through patient controlled analgesia was different according to whether to have nausea. Accordingly, we need to consider age and anesthesia method when controlling pains through patient controlled analgesia after laparoscopic hysterectomy, and to develop and apply effective pain nursing intervention programs through preventing nausea.
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