기관내흡인 전, 후 산소공급량과 두개강내압 변화와의 관계에 관한 임상적 연구

Abstract

본 연구는 신경외과 간호학 영역에서 두개강내압 상승에 가장 큰 영향을 미치는 간호활동의 하나인 기관내흡인을 색하여 이로 인한 두개강내압 상승을 최대한으로 줄일 수 있는 방법을 찾고자 시도되었으며, 기관내흡인 시행 전·후에 공급되는 산소량이 두개강내압의 변하에 미치는 영향을 밝혀 흡인을 위한 효율적인 간호수행방법을 제시하고자 시도하였다. 본 임상실험연구는 1985년 2월 1일부터 동년 9월 30일까지 Y대학 부속 S병원 신경외과 중환자실에 입원한 환자를 대상으로 무선구획설계방법에 의해 시행되었으며 최종 피험자 수는 9인이었고 실험관찰 건수는 90회이었다. 수집된 자료는 다음과 같이 분석하였다. 기관내흡인 시행 전·후의 산소공급량과 두개강내압의 상승폭 및 상승지속시간 간의 관계를 분석하기 위하여 t-test를 하였다. 추가분석으로 연구설계에 포함시킨 실험횟수가 두개강내압에 미치는 영향을 규명하기 위해 변량분석을 실시하였고 기관내흡인 시행 전·후의 산소공급량과 실험순서의 상호작용효과가 두개강내압에 미치는 영향을 평가하기 위하여 이원변량분석을 실시하였다. 또한 기관내흡인 전의 두개강내압과 흡인하는 동안 및 흡인 후의 두개강내압의 변화를 각각 paired t-test로 검정하였으며 활력증후와 두개강내압간의 관계를 Pearson 적율상관계수를 이용하여 분석하였다. 연구결과는 다음과 같다. A. 가설 검정 결과 기관내흡인 시행 전·후의 산소공급량이 두개강내압에 미치는 영향을 규명하기 위한 가설의 검정결과 제1가설 : “기관내흡인 시행 전·후 1분간 100% 산소를 공급받은 군이 40% 산소를 공급받은 군보다 흡인하는 동안 두개강내압 상승폭이 적을 것이다”는 두개강내압의 수축기 상승폭의 경우 t=-7.40, df=87.95, p<.001, 두개강내압의 이완기 상승폭의 경우 t=-2.01, df=48.61, p<.05로 지지되었다. 제2가설: “기관내흡인 시행 전·후 1분간 100% 산소를 공급받은 군이 40% 산소를 공급받은 군보다 흡인이 끝난 후의 두개강내압 상승지속시간이 짧을 것이다”는 t=-18.21, df=48.61, p<.001로 지지되었다. B. 추가분석 결과 1. 실험횟수와 두개강내압간의 관계 실험횟수에 따른 두개강내압의 수축기 상승폭, 이완기 상승폭, 상승지속시간은 통계적으로 유의한 차이가 없는 것으로 나타났다. 2. 기관내흡인 전·후 산소공급량과 실험순서에 따른 두개강내압의 변화 비교 기관내흡인 전·후 산소공급량은 두개강내압의 수축기 상승폭의 분산을 38%, 상승지속시간을 79% 설명할 수 있었으며 실험순서는 두개강내압의 수축기 상승폭의 분산을 14%, 상승지속시간을 1% 설명할 수 있는 것으로 나타났고 기관내흡인 전·후 산소공급량과 실험순서 간에는 상호작용이 없는 것으로 나타났다. 3. 기관내흡인 전·후 산소공급량에 따른 기관내흡인 전·중·후의 두개강내압의 변화 비교 두개강내 수축기압의 평균을 기관내흡인 전·후 100% 산소공급군과 40% 산소공급군에서 살펴볼 때 기관내흡인 전에는 각각 23.378nnHg, 25.933mmHg이었고, 흡인하는 동안에도 각각 51.489mmHg, 75.978mmHg로 나타났으며, 흡인 전의 두개강내 수축기압으로 회복되는 시간은 흡인 후 각각 2분과 11분이었다. 4. 활력증후와 두개강내압과의 관계 두개강내 수축기압은 활력증후중 맥박(r=.1872, p=.021)과만 통계적으로 유의한 관계가 있는 것으로 나타났으며 두개강내 이완기압은 수축기 혈압(r=-.2097, p=.011), 맥압(r=-.1856, p=.022), 맥박(r=.4119, p=.001)과 통계적으로 유의한 관계가 있는 것으로 나타났다. 이상의 결과를 요약하면 기관내흡인 시행 전·후100% 산소공급이 40% 산소공급보다 흡인하는 동안 두개강내압의 상승폭을 감소시키며 흡인 후 상승지속시간을 단축시킬 수 있는 효과적인 방법으로 지지될 수 있음을 제시해주고 있다. ; Early recognition and treatment of increased intractanial pressure is of upmost importance in managing the neurosurgical patient to minimize the deleterious effects that result in mortality. One important influencing factor in the increase of intracranial pressure in these patients is endotracheal suctioning. What is lacking is information about the effect of oxygen levels on intracranial pressure during endotracheal suctioning. This study examined the relationship between pre and post oxygenation amounts and changes in intracranial pressure when patients are receiving endotracheal suctioning. Two hypotheses were proposed. 1. That the magnitude of increase in intracranial pressure during suctioning of a group of patients receiving 100 percent oxygen pre and post endotracheal suctioning will be less than that of a group of patients receiving 40 percent oxygen. 2. That the sustaining time of increase in intracranial pressure after suctioning of the group of patients receiving 100 percents oxygen pre and post endotracheal suctioning will be shorter that that of the group of patients receiving 40 percents oxygen. 3. A randomized block design method was used for this clinical experimental study. The subjects were selected from the neurosurgical constant care unit in a large hospital in Seoul, Korea from Feb. 1, 1985 to Sept. 30, 1985. The number of patients included in this study was nine and the total number of experimental observational events was ninety. Data were analyzed as follows: The T-test was used to determine the relationship between pre and post oxygeneration amounts and changes in intracranial pressure in patients receiving endotracheal suctioning(Hypothese 1 and 2). Additional analysis were carried out. The one-way analysis of variance was used to identify the influence of the number of test trials on intracranial pressure. The two-way analysis of variance was used to determine the interaction effects between pre and post oxygenation amounts and experimental order on intracranial pressure. A paired t-test was used to determine the level of significance for changes in intracranial pressure and after endotracheal suctioning compared with before endotracheal suctioning. The Pearson correlation coefficient was used to identify the relationship between vital signs and intracranial pressure. The results of this study were as follows: Hypothesis 1 was supported: The intracranial pressure of a group of patients receiving 100 percent oxygen was less increased than did the intracranial pressure of those with 40 percents oxygen (the magnitude of increase in systolic I.C.P. was; t= -7.40, df=87.95, p<.001, the magnitude of increase in diastolic I.C.P. was; t=-2.01, df= 87.95, p<.05). Hypothesis 2 was also supported: The intracranial pressure of the patient group receiving 100 percent oxygen returned to pre endotracheal suctioning level significantly faster than did the intracranial pressure of those with 40 percent oxygen(t=-18.21, df= 48.61, p<.001). Relationship between number of test trials and intracranial pressure: There was no significat statistical difference between the magnitude of increase in systolic I. C. P., diastolic I. C. P., and sustaining time of increase in I. C. P. when the relationship between number of test trials and intracranial in I. C. P. when the relationship between number of test trials and intracranial pressure was examined. Comparison of intracranial variatioon depending in the experimental treatment order and amounts of oxygen supplied pre and post endotracheal suctioning accounted up to 38 percent for the distribution of the magnitude of increase in systolic I. C. P. and sustaining time of the increased pressure for up to 79 percent. The experimental treatment order accounted for up to 14 percent of the distribution of magnitude of increase in systolic I. C. P. and sustaining time of the increased pressure for up to 1 percent. However, no interaction was found to exist between the esperimental treatment order and amounts of oxygen supplied pre and post endotracheal suctioning. Comparison of intracranial pressure variation before, during and after endotracheal suctioning depending on the amounts of oxygen supplied pre and post endotracheal suctioning: The mean systolic intracranial pressure before endotracheal suctioning was 23.378 mmHg for the group receiving 100 percent oxygen supply and was 25.993mmHg for the group receiving 40 percent oxygen supply. During endotracheal suctioning the level were 51.489 mmHg, 75.978 mmHg, for the two groups respectively. The time required for intracranial pressure to return to pre endotracheal suctioning level was 2 minutes for the group receiving 40 percent oxygen supply. Relationship between vital signs and intracranial pressure: The intracranial systolic pressure was found to have a significant relationship only with the pulse(r=.1872, p=.021) and the intracranial diastolic pressure was found to have a significant statistical relationship with systolic blood pressure (r=-.2097, p=.011), pulse(r=-.1856, p=.022), and pilse (r=.4119, p=.001). In summary it was found that administration of 100 percent oxygen before and after endotracheal suctioning makes the magnitude of increase in I. C. P. during suctioning smaller than when 40 percent oxygen was administered. Another advantage found in providing 100 percent oxygen supply before and after endotracheal suctioning, was that it diminished the sustaining time of increase in I. C. P. after endotracheal suctioning.