DOI QR코드

DOI QR Code

The Effects of Semi-Fowler's position on Post-Operative Recovery and Pain for Patients with Laparoscopic Abdominal Surgery

복강경 수술 후 반좌위가 수술회복성과 통증에 미치는 영향

  • Choi, Un Jong (Department of Surgery, School of Medicine, Wonkwang University) ;
  • Ha, Tae Uk (Department of Emergency Medicine, School of Medicine, Wonkwang University) ;
  • Kang, Ji Sook (Department of Nursing, School of Medicine, Wonkwang University)
  • 최운정 (원광대학교의과대학 외과학교실) ;
  • 하태욱 (원광대학교의과대학 응급의학교실) ;
  • 강지숙 (원광대학교의과대학 간호학과)
  • Received : 2017.04.12
  • Accepted : 2017.05.12
  • Published : 2017.05.31

Abstract

Purpose:This study was conducted to identify the effects of theSemi-Fowler's position on post-operative recovery and pain for patients with laparoscopic abdominal surgery Methods: This study utilized a non-equivalent control group non-synchronized design to validate the effects of theSemi-Fowler's position. After IRB approval, 56 patients took part in this study, 29 in the experimental group and 27 in the control group. Consent was obtained from the participants. The Semi-Folwer's position was applied to experimental group and the supine position was applied to the control group for 24 hours after surgery. All data were reviewed retrospectively from April to June 2016. Collected data, frequency, percentage, average, standard deviation, chi-squared test, independent t-test and repeated measures ANOVA were conducted using SPSS 20.0. Results: There was no significant difference between the experimental and control group with regard to recovery outcomes; however, there was a significance differencebetween groups and among check times with regard to post operational pain. Conclusion:The results of this study provide information that will be usefulto the development of strategies for improving recovery outcomes and pain for laparoscopic operation patients.

본 연구는 본 연구는 전신마취 하에 복강경 수술을 받은 환자를 대상으로 수술 후 반좌위가 수술 회복성과 통증에 미치는 영향을 규명하고 향후 복강경 수술환자 간호에 대한 근거기반 간호중재의 기초자료로 사용되도록 시도되었다. 본 연구는 전신마취하에 복강경 수술을 받은 비뇨기과 혹은 산부인과 환자를 대상 사전동의 후 진행되었으며, 실험처치로 실험군에게는 반좌위룰 대조군에게는 기존 앙와위를 수술직후부터 24시간까지 취하게 하였다. 수술후 회복성을 확인하기 위해 회복실저류시간, 장운동 회복기간, 자가배뇨 회복기간, 수술후 병동 체류기간을 측정하였고, 통증에 대한 영향을 확인하기 위해 수술일부터 수술 2일째 까지 VAS로 통증강도를 측정하였다. 수집된 자료는 SPSS Win 20.0을 이용하여 실수, 백분율, 평균, 표준편차, Chi-square test, Independent t-test 반복측정 분산분석(Repeated Measures ANOVA)로 분석하였으며 그 결과는 다음과 같다. 첫째, 대상자의 수술회복성은 수술 후 회복실 체류시간(t=-0.284, p=.506), 수술 후 최초 가스배출시간(t=-0.837, p=.407), 수술 후 최초 대변배출시간(t=0.665, p=.509), 유치도뇨관 삽입시간(t=1.635, p=.109), 유치도뇨관 제거 후 자가배뇨시간(t=1.427, p=.165), 수술 후 병동체류시간(t=0.290, p=.773)으로 실험군과 대조군의 유의한 차이가 없었다. 둘째, 대상자의 통증은 주효과인 통증에서 실험군과 대조군간의 유의한 차이를 보였으며(F=4.851, p=.032), 세 시점간의 통증의 변화도 유의한 차이를 나타내었다(F=24.200, p=<.001). 이상과 같이 본 연구에서 복강경 수술 후 반좌위는 수술회복성에 영향을 미치지 않지만 통증에는 효과가 있었다. 따라서 복강경 수술환자에게 반좌위는 통증을 완화시키고 안위를 개선하는데 유용한 간호중재임이 확인되었다.

Keywords

References

  1. M. S. Lee, S. Y. Ryu, S. H. Han, H. J. Kim, Y. D. Kim, H. Y. Kim, "Analysis of the hemodynomic and ventilatory effects of laparoscopic cholecystectomy" Korean Journal of Anesthesiology, 17(4), pp. 483-487, 1996.
  2. Kelman, G. R., Swapp, G. H., Smith, I., Benzie, R. J., Gordon, N. L. "Cardiac output and arterial blood gas tension during laparoscopy". British. Journal of. Anaesthesia, 44, pp. 1155-62, 1972. DOI: https://doi.org/10.1093/bja/44.11.1155
  3. MacMahon., A. J., Baxter, I. N., Kenny. G., O'dwyre, P. J. "Ventilatory and blood gas changes during laparoscopic and open cholesystectomy", British Journal of Surgery, 80, pp. 1252-1254, 1993. DOI: https://doi.org/10.1002/bjs.1800801010
  4. Paul, G. B., Bruce, F. C. Robert, K. S.. Clinical Anesthesia, 2nd ed. Philadelphia: JB Lippincott company, pp. 715-734. 1992.
  5. K. A. Kim, Y. K. Kim, "The effect of semi-fowler's position on post-operative recovery in recovery room for patients with laparoscopic abdominal surgery", Korean Journal of Adult Nursing, 16(4), pp. 566-574, 2004.
  6. D. S. Kim, Analysis of pulmonary function test. Practice of Respiratory Manage. SEOUL : Haemin Medical Company, 97-118, 1990.
  7. Townsend, W. C. "Spirometric forced expiratory volumes measured in sitting posture" American Review Respiration Distress, 130, p. 123, 1994.
  8. The Korean Society of Anesthesiologists . Patient's Manage of Recovery Period. Anesthesiology(3rd ed.). pp. 417-27, Seoul: Yeo Moon Gak Publishing Co., 1994.
  9. H. Y .Lee, J. H. Lee, C. J. Park, C. J. Choi, O. J. Park, Adult nursing. SEOUL: Soomoonsa. 2014.
  10. H. E. Kim, "Pattern, Management and Related Factors of Postoperative Pain: through EMR Analysis", Unpublished master's thesis, Gyemyung University of Korea, 2012
  11. Law, W. L., Lee, Y. M., Choi, H. K., Seto, C. L.,Ho, J. W.. Impact of laparoscopic resection for colorectal cancer on operative outcomes and survival. Annals of surgery, 245(1), p. 1-7, 2007. DOI: https://doi.org/10.1097/01.sla.0000218170.41992.23
  12. S. J. Woo, E. S. Lee, H. R. Kim, "Recovery outcomes following laparoscopic surgery in overweight rectal cancer patients" Journal of Korean Clinical Nursing Research 15(3), pp. 17-26. 2009.
  13. Y. H. Park, S. H. Kim, G. W. Lee, K. S. Seo. Laparoscopic Cholecystectomy, Hepato-Billiary-Pancreac Surgery. Seoul: Eui-hak Publishing & Printing Co, pp. 558-566, 2000.
  14. Melzack R. "Gate control theory: On the evolution of pain concepts", Pain Forum. 6, pp. 128-138, 1996. DOI: https://doi.org/10.1016/s1082-3174(96)80050-x
  15. Wewers, M. E., Lowe, N. K. "A critical review of visual analogue scales in the measurement of clinical phenomena", Research in Nursing and Health, 13, 227-236, 1990. DOI: https://doi.org/10.1002/nur.4770130405
  16. J. E. Kim, Y. T. Nam, Y. H. Chae, "The Effect of the body position and CO2 gas insufflation on airway pressure and compliance in normal subjects during laparoscopy or pelviscopy" Korean Jpurnal of anesthesiology, 36(5), pp. 802-807. 1999. https://doi.org/10.4097/kjae.1999.36.5.802
  17. D. I. Lee, "Alpha-2 Adrenergic Agonists for the Management of Surgical Pain Patient" The Korean Journal of Pain, 14(2), pp. 129-135. 2001.
  18. Y. H. Shin, "A Survey of Hospitalized Post-op Patients' pain Experience in Kyungbook Province Area", Gyemyung nursing science, 4(1), pp. 93-102. 1999.
  19. N. J. Kim, "A study on patients' and nurses' knowledge about and attitudes towards management of pain after surgery", Unpublished master's thesis, Hanyang University of Korea, 2003.
  20. H. S. Moon, H. Y. Lee, J. A. Lee, "The Effects of Relaxation Therapy on Pain and Anxiety in Spinal Anesthesia Surgery Patients", The Journal of East-West Nursing Research, 15(1), 54-62. 2009.