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개심술후 섬망(Postcardiotomy Delirium)증후에 관한 탐색적 연구

Other Titles
 (An) exploratory study of postcardiotomy delirium syndrome 
Authors
 신영옥 
Issue Date
1986
Description
간호학교육 전공/석사
Abstract
[한글]

개심술후 섬망은 체외순환을 이용한 심장수술을 받은 환자가 수술후에 경험하는 지남력 장애, 지각상의 착오, 환각, 편집증적 사고로서, 이는 일시적으로 나타났다 사라지지만 그 빈도와 정도에 따라서 환자의 예후에 많은 영향을 미친다.

이에 본 연구는 개심술후 섬망의 발생빈도와 정도를 알아보고 이에 영향을 미치는 요인을 파악함으로서, 섬망에 대한 이해를 높이며 개심술을 받는 환자에게 효과적인 간호중재를 주기 위한 기초자료를 제공하고자 시도되었다.

연구대상은 1986년 3월 17일부터 5월 13일까지 58일동안 Y대학 부속병원에 입원하여 개심술을 시술받은 환자 30명이었다.

연구도구는 Pricilla Diane Sailer의 Delirum Assessment Checklist를 이용하였고, 연구방법은 면접법을 사용하였다. 수집된 자료는 전산으로 통계처리하여 섬망의 발생유무, 빈도, 정도를 백분율로, 섬망의 발생빈도와 정도에 대한 제 변수와의 관계를 Pearson Correlation, t-test, ANOVA로 분석하였고, 가설검정을 Pearson Correlation Coeffocoent로 분석하였으며, 섬망제 영향을 주는 요인을 Stepwise Multiple Regression으로 분석규명하였다.

연구의 결과는 다음과 같다.

(1) 개심술후 섬망의 발생율은 73.3%였다.

(2) 섬망의 발생빈도는 시간에 대한 지남력 장애가 56.7%, 장소에 대한 지남력 장애가 26.7%, 사람에 대한 지남력 장애가 3.3%, 지각상의 착오가 10.0%, 환각이 6.7%, 편집증적 사고가 3.3%로 나타났다.

(3) 섬망의 발생 빈도에 대한 관련요인은 연령, 중환자실, 입원기간, 수혈량, 수술명, 저체온 30℃이하 시간이었다.

(4) 섬망의 기간은 평균 2.4일 지속되었다.

(5) 섬망의 정도는 수술후 1일에 가장 높았고 점점 약화되었다가 수술후 5일에 다시 높아졌으며 수술후 7일에 매우 낮아졌다. 지남력 장애는 수술후 1일에 가장 높게 나타났고, 지각상의 착오는 수술후 5일에 가장 높게 나타났다.

(6) 섬망의 정도에 대한 관련요인은 중환자실 입원기간, 연령, 저체온 30℃이 하시간, 종교가 통계적으로 유의하였다.

(7) 가설의 검정결과는 다음과 같다.

제 1가설 : "환자의 연령이 높을수록 개심술후 섬망의 정도는 높을 것이다 "는 지지되었다 ( r = .2625, p < 0.1).

제 2가설 : "수술후 체외순환시간이 지연될수록 개심술후 섬망의 정도는 높을 것이 다"

는 기각되었다 ( r = .1313, p > 0.1).

제 3가설 : "체외순환시 최저평균동맥압이 낮을수록 개심술후 섬망의 정도는 높을 것이다"는 기각되었다( r = .0865,p > 0.1).

제4가설: "수술후 중환자실 입원기간이 길수록 개심술후 셤망의 정도는 높을 것이다"는 지지되었다 ( r = .3049, p < 0.1).

(8) 섬망의 발생빈도와 정도에 영향력 있는 설명변수는 수술명과 중환자실 입원기간이었다.

결론적으로 중환자실 입원기간은 섬망의 발생빈도와 정도에 가장 유의한 관련 요인 이며 영향력있는 설명변수임이 분석규명되었다.



[영문]

Postcardiotomy delirium refers to disorientation, perceptual illusion, hallucination, and paranoid ideation, and is experienced in varying frequency and degree among open heart surgery patients during their early recovery period.

The occurance of postcardiotomy delirium may complicate and prolong recovery from open heart surgery. The purpose of this study was to find out the frequency and degree of postcardiotomy delirium and to determine the relationship of other factors to the frequency and degree in patients who have undergone open heart surgery.

The subjects consisted of 30 patients who had undergone open heart surgery at Y University Hospital. The instrument used for this study was Delirium Assessment Checklist which was developed by Pricilla Diane Sadder.

Analysis of data was done using t-test 1 ANOVA, Pearson Correlation Coefficiency, and Stepwise Multiple Regression Analysis.

The results of study were as follows :

1. Postcadiotomy delirium was experienced in some manifestation by 73.3% of the sample.

2. There was a variation in the frequency of the postcardiotomy delirium.

Disorientation to tine was experienced by 56.7%, disorientation to place was experienced by 26.7% disorientation to identity was experienced by 3.3%, perceptual illusion was experienced by 10.0%, hallucination was experienced by 6.7%, and paranoid ideation was experienced by 3.3% of the sample.

3. The age of the patient, time in the I.C.U., total amount of blood transfusion, type of operation procedure , and time on hypothermia below 30℃ were related to frequency of postcardiotomy delirium.

4. Postcardiotomy delirium lasted 2.4 days.

5. There was a variation in the degree of the postcardiotomy delirium. The first postoperative day peaked in the degree of postcardiotomy delirium, second, third, and fourth postoperative days there was a progressive decrease, on the fifth postoperative day an increase, and by the seventh postoperative dart it had almostly disappeared.

6. The age of patient, tine in the I.C.U., time on hypothermia below 30℃, and religion were related to degree of portcardiotomy delirium.

7. Each of the four hypothesis was analyzed by computing the Pearson Correlation Coefficiency for degree of postcardiotomy delirium.

Hypothesis #1 : There was significant correlation between age of the patient and the degree of postcartiotomy delirium (r=.2625, p<0.1), therefore, the hypothesis was supported.

Hypothesis #2 : There was no significant correlation between a patient's total CP bypass time and the degree of postcardiotomy delirium in that patient (r=.1313, p>0.1), therefore, the hypothesis was not supported.

Hypothesis #3 : There was no significant correlation between a patient's lowest arterial mean pressure during CP bypass and the degree of postcardiotomy delirium in that patient (r= .0865,p>0.1), therefore, the hypothesis was not supported.

Hypothesis #4 : There was significant correlation between a patient's total time in the I.C.U. and the degree of postcardiotomy delirium in that patient (r=.3049, p<0.1), therefore, the hypothesis was supported.

8. The explained variance in the degree of postcardiotomy delirium was the type of operation procedure and time in the I.C.U.

The major filling of this study was that the time in the I.C.U. after surgery contributed the most to the explained variability in both the frequency and the degree of postcardiotomy delirium.
Full Text
https://ymlib.yonsei.ac.kr/catalog/search/book-detail/?cid=CAT000000004110
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Appears in Collections:
3. College of Nursing (간호대학) > Dept. of Nursing (간호학과) > 2. Thesis
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/138182
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