감각포화요법이 심장중환자실 영아의 처치 통증에 미치는 효과

Abstract

본 연구는 심장중환자실에 입원한 영아를 대상으로 경정맥 중심정맥관 제거 처치 시 관심전환요법 중 하나인 감각포화(Sensorial Saturation; SS)요법을 제공한 후 영아의 통증행동반응, 통증생리반응을 분석하여 감각포화요법이 처치 관련 통증 완화에 미치는 효과를 확인한 비동등성 대조군 전후 시차설계연구이다. 연구대상자는 서울 소재 S 병원 심장중환자실에 입원하여 2019년 4월부터 9월까지 선천성 심장질환으로 개흉술 수술을 받은 1세 미만의 영아로 경정맥 중심정맥관 제거 처치 시 일반적 간호중재를 제공한 대조군 38명, 감각포화요법을 제공한 실험군 40명으로 총 78명이었다. 실험군에는 Bellieni & Buonocore(2017)가 제공한 중재법을 따라 포도당 경구 투여(Taste), 가볍게 쓰다듬기(Touch), 낮은 목소리로 달래기(Talk)의 3가지 중재(3Ts)를 동시에 적용한 감각포화요법이 제공되었으며, 대조군에는 일반적 간호중재(감싸주기)가 제공되었다. 감각포화요법의 효과를 확인하기 위한 지표로 통증생리척도(심박동수, 산소포화도, 호흡수)와 통증행동척도(Modified Behavioral Pain Scale; MBPS)를 경정맥 중심정맥관 제거 직전, 제거 시작 3분 후, 제거종료 직후, 제거종료 1분 후에 측정하였다. 수집된 자료는 SPSS 25.0 프로그램을 이용하여 Independent t-test와 χ2 test, Repeated Measures ANOVA로 분석하였다. 연구의 주요 결과는 다음과 같다. 1) 감각포화요법을 적용한 실험군과 적용하지 않은 대조군 간 경정맥 중심정맥관 제거 시기별 통증생리반응은 다음과 같다. 심박동수는 그룹 간(F=6.46, p=.013), 시점(F=87.22, p<.001) 및 시점과 그룹의 교호작용(F=53.15, p<.001), 호흡수는 그룹 간(F=8.12, p<.001), 시점(F=26.20, p<.001) 및 시점과 그룹의 교호작용(F=15.19, p<.001)으로 유의한 차이를 보였다. 산소포화도는 그룹 간(F=.52, p=.47), 시점(F=13.53, p=.27)은 유의하지 않았으나, 그룹의 교호작용(F=4.46, p<.001)은 유의한 차이를 보였다. 2) 감각포화요법을 적용한 실험군과 적용하지 않은 대조군 간 경정맥 중심정맥관 제거 시기별 통증행동반응은 다음과 같다. 통증행동척도(MBPS) 그룹 간(F=92.06, p<.001), 시점(F=92.35, p<.001) 및 시점과 그룹의 교호작용(F=45.21, p<.001)은 유의한 차이를 보였다. 이상의 결과를 종합해보면, 감각포화요법을 적용한 실험군에서 통증생리반응은 시간이 지남에 따라 심박동수와 호흡수는 유의하게 감소하였으나 산소포화도는 유의한 차이를 보이지 않았다. 또한, 통증행동반응은 시간이 지남에 따라 유의하게 감소하여 감각포화요법이 통증을 완화시키는 효과가 있는 것으로 나타났다. 따라서 감각포화요법은 경정맥 중심정맥관 제거 처치와 같은 통증을 완화하는 독자적 간호중재로 활용될 수 있을 것이다.

The purpose of this study is to investigate the effect of sensorial saturation therapy, which is one of the distraction techniques of infants in the cardiac intensive care unit. It was performed a nonequivalent control group nonsynchronized design study, using the physiological pain scales and Modified Behavioral Pain Scale to assess pain during the procedure of internal jugular central venous catheter removal. The subjects were infants under one year of age who had been admitted to S hospital in Seoul and had undergone thoracotomy for congenital heart disease from April to September 2019. When jugular vein removal was performed, 38 patients received the general nursing intervention, 40 patients received sensory saturation, and 78 patients were enrolled. The experimental group was provided with sensory saturation therapy using three interventions(3Ts) simultaneously, oral sugar(Taste), massage(Touch), and speaking to the baby to obtain distraction(Talk), following the intervention provided by Bellieni & Buonocore(2017). The control group was given general nursing intervention(swaddle an infant with a rectangular blanket). The physiological pain scales(heart rate, oxygen saturation, respiratory rate) and the Modified Behavioral Pain Scale(MBPS) were measured immediately before the removal of the internal jugular central venous catheter, 3 minutes after the start of removal, immediately after the end of removal, and 1 minute after the end of removal. Collected data were analyzed using a descriptive statistic, independent t-test, χ2 test, and Repeated Measures ANOVA using SPSS 25.0 Windows program. The main results of the study are as follows. 1) The physiological pain responses by the time of the procedure of internal jugular central venous catheter removal between the experimental group receiving sensory saturation therapy and the control group providing general nursing intervention were as follows. Heart rate and respiratory rate were significantly different. Heart rate was measured between groups (F = 6.46, p = .013), time (F =87.22, p <.001) and interaction between time and group (F = 53.15, p <.001), and respiration rate was measured between groups (F = 8.12, p <.001), time (F = 26.20, p <.001) and interaction between time and group (F = 15.19, p <.001). Oxygen saturation was not significant between groups (F = .52, p = .47) and time (F = 13.53, p = .27), but the interactions between time and group (F = 4.46, p <.001) was significantly different. 2) The behavioral pain responses by the time of the procedure of internal jugular central venous catheter removal between the experimental group receiving sensory saturation therapy and the control group providing general nursing intervention were as follows. Modified Behavior Pain Scale(MBPS) was significantly different. It measured between groups (F = 92.06, p <.001), time (F = 92.35, p <.001) and the interaction between time and group (F = 45.21, p <.001). In conclusion, in the experimental group receiving sensory saturation therapy, the physiological pain response significantly decreased with time, but the oxygen saturation was not significantly different. Also, the behavioral pain response was significantly decreased over time, suggesting that sensory saturation was effective in relieving pain. Therefore, sensory saturation therapy can be used as an independent nursing intervention to relieve pain, such as internal jugular central venous catheter removal.