수술후 환자의 진통제 투여방법이 동통과 생리적 반응에 미치는 영향에 관한 연구 : 상복부수술 환자를 중심으로

Abstract

[한글]

동통은 모든 인간이 경험하는 것이기 때문에 국제 간호사회에서는 동통경감을 간호목적의 하나로 설정하였으며 간호사들은 동통경감을 위한 간호중재에 대해서 많은 관심을 갖고 연구를 하고 있다.

수술은 조직의 손상을 일으키기 때문에 급성동통을 유발하며, 상복부 수술인 경우에는 환자의 70% 이상이 중등도 이상의 동통을 호소하며, 이러한 동통은 생리적 반응에 부정적 영향을 미친다고 한다.

그러므로 수술후 환자의 동통관리는 중요하며, 수술후 동통이 심한 기간에는 심리적 정서적 간호중재외에 진통제가 투여되므로 수술후에 진통제를 효율적으로 투여한다면, 환자의 동통을 감소시킬 뿐 아니라 생리적 반응을 향상시키게 되어 환자의 회복에 도움이 되리라고 생각한다.

이에 본 연구에서는 Roy의 적응체계 모형과 동통의 내인성 동통통제이론을 개념적 기틀로 하여 상복부수술 환자에게 경막외 투여방법, 규칙적 근육 투여방법, 전통적 근육 투여방법으로 진통제를 투여하고 각 투여방법에 따른 동통과 생리적 반응을 조사하기 위하여

대조군 사후실험설계를 사용하였다.

연구대상자는 1990년 6월 12일부터 8월 30일까지 Y대학 부속 S병원에 입원한 환자중 대상자 선정기준에 맞는 30명이며, 각군에 10명씩 성별을 구획으로 하여 무작위로 배정하였다.

연구도구로는 Endler의 신체위험 기질불안 측정도구, Eysenck의 성격 측정도구, Gracely 등의 동통 측정도구와 연구자가 작성한 생리적반응 조사표를 사용하였다.

자료분석은 SPSS PC와 SAS를 이용하였으며 분석에 사통한 통계방법은 x**2-test, 일원변량분석(ANOYA), Duncan 사후분석, 반복측정요인분석, Pearson correlation coefficient를 사용하였다.

연구결과의 요약은 다음과 같다.

1. 가설 ‘수술후 진통제의 경락외 투여군, 규칙적 근육 투여군과 전통적 근육 투여군간에는 동통정도에 차이가 있을 것이다.’는 통각에서만 유의한 차이를 보여(F=3.16, p＜.05) 부분적으로 지지되었다.

2. 가설 ‘수술후 진통제의 경막외 투여군, 규칙적 근육 투여군과 전통적 근육 투여군간에는 생리적 반응에 차이가 있을 것이다.’는 수면상태에서만 유의한 차이를 보여(F=5.55, p＜.01) 부분적으로 지지되었다.

3. 전통적 근육 투여군과 경막외투여군의 수술후 진통제 투여시간간격은 경막외투여군이 더 긴것으로 나타났다.

4. 수술후 36시간까지 동통은 보통이상이었으며, 변화양상은 규칙적으로 진통제를 제공하지 않은 전통적 근육 투여군과 경막외투여군이 통각변화에 주기를 나타내었다.

5. 성별, 연령, 성격, 신체위험 기질불안과 동통과는 유의한 상관관계가 없는 것으로 나타났다.

6. 수술후 경미한 합병증 발생의 빈도에서는 경막외투여군에서 배뇨곤란의 발생이 다른 두군보다 두배 이상 높은 것으로 나타났다.

이상의 연구결과에 의하면 경막외투여군이 동통감소에는 좋은 효과를 나타냈으나 배뇨곤란의 합병증 발생이 높았으며, 세 군간에 생리적 반응에서는 수면상태외에는 차이가 적게 나타났으므로 수술후환자의 진통제 투여방법의 선택은 환자의 동통수준과 생리적 반응을 기반으로 정해야 할 것이다.

그러나 진통제를 동통이 심해지기 전에 투여하는 것이 진통제 량을 감소시키면서 진통효과에 좋다는 보고들이 있으므로 일회 진통제 투여량과 진통제 투여시간을 달리하여 반복연구를 해볼 것을 제안한다.

The Effect of Three Analgesic Administration Methods on Postoperative Pain and

Recovery Rate after Gastrectomy

Hur, Hea Kung

Department of Nursing The Graduate School of Yonsei University

(Directed by Prof. Yoo, Ji Soo, RN, Ph.D.)

An acute pain is the common experience following surgery. After upper abdominal

surgery more than 70% of the patients complained of having moderate to marked pain.

The experience of postoperative pain negatively influences physiological well

being and delays recovery from the operation.

This study was designed to determine an effective method of analgesic

administration for postoperative pain relief in patients who had had upper

abdominial surgery.

An experimental design method of cost test only was used for this clinical study.

Thirty patients who had undergone major operations were randomly divided into

three equal groups to receive different regimens of analgesics over the first 24

hours postoperatively.

Patients in group A received 8.9mg of morphine by epidural infusion, those in

group B received 150mg of meperidine intramuscularly, every four hour for 24 hours,

and those in group C received 94mg of meperidine intramuscularly as needed.

The subjects in this study were patients from surgical wards in a large hospital

in Seoul, Korea. The data was collected was from June 12, 1990 to August 30, 1990.

The instruments used for this study were the physiological danger trait anxiety

scale developed by Endler et. al., the personality stale developed by Eysenck, the

pain scale developed by Gracely et. al. and the physiological responses list

developed by the researcher.

Data was analyzed using x**2- teat, t -test, ANOVA, Duncan muliple test, Repeated

measures ANOVA, Pearson correlation coefficient and Cronbach α

The results of this study were as follows;

1. Hypothesis 1 :‘The pain score will differ for patients receiving analgesic by

epidural infusion, regular four hourly intramucular injections and intramuscular

injections as needed’ was partly supported.

Among the three groups, patients receiving the epidural infusion of morphine

reported the lowest pain sensation score(F=3.16, p＜.05).

2. Hppothesis 2 : ‘The physiological response will differ for patients receiving

analgesic by epidural infusion, regular four hourly intramuscular injections and

intramuscular injections as needed’ was partly supported.

The physiological response in which there was a significant difference between

three groups was the ability to sleep at night(F=5.55, p＜.01 ). Among three

groups, patients receiving epidural infusion of morphine reported the best

condition, that is, no sleeping disturance due to pain.

3. Patients receiving an epidural infusion of morphine had a longer interval time

between analgesic injections than those receving intramuscular injections of

meperidine as needed.

4. All the patients in thin studs had a moderate pain score for the first 36

hours postoperatively. But the hourly pattern for postoperative pain showed that

the scores of patients in the epidural infusion group and those in the

intramuscular injections as needed group had a cyclic pattern for the pain

sensation score.

5. There was no statistically significant correlation among age, sex,

personality, physical danger trait anxiety and the pain score.

6. Patients receiving an epidural infusion of morphine had urinary retention

twice frequent than as compared to those in the other two groups.

In summary patients receiving an epidural infusion of morphine showed the lowest

pain sensation score, but the highest frequency of urinary retention. There was no

statistically significant difference in the physiological responses among the three

groups except for the ability to sleep at night.

Therefore it is difficult to choose one method of analgesic administration for

postoperative pain relief. It is important that the choice of analgesic

administration should be based on the nurses' pain assessment and patients'

physiological response.

[영문]

An acute pain is the common experience following surgery. After upper abdominal surgery more than 70% of the patients complained of having moderate to marked pain.

The experience of postoperative pain negatively influences physiological well being and delays recovery from the operation.

This study was designed to determine an effective method of analgesic administration for postoperative pain relief in patients who had had upper abdominial surgery.

An experimental design method of cost test only was used for this clinical study.

Thirty patients who had undergone major operations were randomly divided into three equal groups to receive different regimens of analgesics over the first 24 hours postoperatively.

Patients in group A received 8.9mg of morphine by epidural infusion, those in group B received 150mg of meperidine intramuscularly, every four hour for 24 hours, and those in group C received 94mg of meperidine intramuscularly as needed.

The subjects in this study were patients from surgical wards in a large hospital in Seoul, Korea. The data was collected was from June 12, 1990 to August 30, 1990.

The instruments used for this study were the physiological danger trait anxiety scale developed by Endler et. al., the personality stale developed by Eysenck, the pain scale developed by Gracely et. al. and the physiological responses list developed by the researcher.

Data was analyzed using x**2- teat, t -test, ANOVA, Duncan muliple test, Repeated measures ANOVA, Pearson correlation coefficient and Cronbach α

The results of this study were as follows;

1. Hypothesis 1 :‘The pain score will differ for patients receiving analgesic by epidural infusion, regular four hourly intramucular injections and intramuscular injections as needed’ was partly supported.

Among the three groups, patients receiving the epidural infusion of morphine reported the lowest pain sensation score(F=3.16, p＜.05).

2. Hppothesis 2 : ‘The physiological response will differ for patients receiving analgesic by epidural infusion, regular four hourly intramuscular injections and intramuscular injections as needed’ was partly supported.

The physiological response in which there was a significant difference between three groups was the ability to sleep at night(F=5.55, p＜.01 ). Among three groups, patients receiving epidural infusion of morphine reported the best condition, that is, no sleeping disturance due to pain.

3. Patients receiving an epidural infusion of morphine had a longer interval time between analgesic injections than those receving intramuscular injections of meperidine as needed.

4. All the patients in thin studs had a moderate pain score for the first 36 hours postoperatively. But the hourly pattern for postoperative pain showed that the scores of patients in the epidural infusion group and those in the intramuscular injections as needed group had a cyclic pattern for the pain sensation score.

5. There was no statistically significant correlation among age, sex, personality, physical danger trait anxiety and the pain score.

6. Patients receiving an epidural infusion of morphine had urinary retention twice frequent than as compared to those in the other two groups.

In summary patients receiving an epidural infusion of morphine showed the lowest pain sensation score, but the highest frequency of urinary retention. There was no statistically significant difference in the physiological responses among the three

groups except for the ability to sleep at night.

Therefore it is difficult to choose one method of analgesic administration for postoperative pain relief. It is important that the choice of analgesic administration should be based on the nurses' pain assessment and patients' physiological response.