폐 절제술 후 걷기 운동을 경험한 폐암 환자의 수술 후 회복 관련 요인
Factors Associated with Postoperative Recovery among Lung Cancer Patients with Walking Exercise after Lung Resection
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
연구배경: 발생률과 사망률이 높은 폐암을 치료하기 위해폐 절제술을 실시하지만, 수술 후 폐 합병증의 위험이 높다. 조기 걷기 운동은 합병증을 예방하고, 일상생활 복귀를 위해 필수적인 수술 후 회복을 향상시키기 위해 중요한 요소이다. 본 연구는 중환자실 내 걷기 운동을 실시한 폐 절제술환자가 퇴원 전 인식하는 수술 후 회복에 영향을 미치는 요인에 대해 살펴보고자 한다. 방법: 본 연구는 조사 연구로, 서울의 일 상급종합병원에서 폐 절제술을 시행하고 중환자실 내 걷기 운동을 실시한후 퇴원을 앞둔 폐암 환자 90명을 대상으로 2019년 4월부터6월까지 자료를 수집하였다. 일반적 특성, 임상적 특성, 중환자실 내 걷기 운동 특성 및 수술 후 회복(역문항)을 조사하였다. 결과: 환자가 인식하는 수술 후 회복의 평균 점수는 3점 만점 중 0.70±0.41점이었고, 심리적 영역이 회복 정도가 가장높았으며 신체적 증상이 가장 낮았다. 또한 통증, 식욕의 변화, 소화기계 장애 순으로 회복이 부족하다고 나타났다. 수술후 회복은 직업이 없는 환자인 경우(β=4.353, P=0.005), 걷기운동 중 오심 및 구토 증상이 심할수록(β=0.596, P=0.043), 주관적 운동자각도가 심각할수록(β=1.105, P=0.007) 수술 후회복 정도가 낮은 것으로 나타났다. 결론: 폐 절제술 환자의 수술 후 회복을 향상시키기 위해신체적 증상을 조절하고 직장 복귀를 촉진시킬 수 있는 다학제적, 환자 맞춤형 중재 개발 및 적용이 필요하다. 또한이들의 수술 후 회복을 위해 적절한 강도로 운동을 실시하는 것이 동반될 필요가 있다.
Abstract
Background: Treatment for lung cancer, which has high incidence and mortality rates, involves lung resection; however, the risk of postoperative pulmonary complications is high. Early walking exercise is a core strategy for preventing complications and promoting postoperative recovery, which is essential for returning to everyday life. This study aims to identify the factors associated with the postoperative recovery of patients who performed walking exercises in an intensive care unit after having a lung resection. Methods: This cross-sectional study collected data from 90 patients on the day before discharge at a tertiary hospital in Seoul between April and June 2019. Patients’ postoperative recovery was measured using the Postoperative Recovery Profile. Results: The mean score for postoperative recovery was 0.70±0.41 out of 3, 0 being none of the problems. Among the five subcategories, the psychological dimension had the highest recovery level at 0.57±0.58, while physical symptoms were rated lowest at 0.89±0.50. As a result of regression analysis, employment status (β=4.353, P=0.005), symptoms of nausea and vomiting during walking (β=0.596, P=0.043), and perceived exertion during walking (β=1.105, P=0.007) were associated with postoperative recovery. Conclusions: The study indicated unemployed patients, those with more nausea and vomiting, and those who perceived severe exertion during walking showed lower perceived postoperative recovery levels. Not only multidisciplinary, patient-tailored interventions to facilitate return to work after surgery but also interventions to control physical symptoms actively should be developed and implemented to achieve higher postoperative recovery levels. Patients also need to exercise at an appropriate subjective level of perceived exertion.
참고문헌 (30)
- "The number of cancer occurrence and cancer incidence by type of cancer, gender, and age in Korea" (2019)[URL]
- "The number of deaths and mortality rate by cause of death, gender, and age in Korea" (2019)[URL]
- Bédat B, "Comparison of postoperative compli-cations between segmentectomy and lobectomy by video-as-sisted thoracic surgery : a multicenter study", J Cardiothorac Surg, 14(1), pp.189~ (2019)
- 최용수, "폐암수술에 있어서 최소 침습 수술", Hanyang Medical Reviews, 34(1), pp.26~30 (2014), 한양대학교 의과대학[DOI]
- Rupp M, "Incentive spirometry in postoperative abdominal", thoracic surgery patients, 2013, pp.24(3), 255~263
- Fernandez-Bustamante A, "Postoperative pulmo-nary complications, early mortality, and hospital stay following noncardiothoracic surgery : a multicenter study by the Perioperative Research Network Investigators", JAMA Surg, 152(2), pp.157~166 (2017)
- Allvin R, "Postoperative recovery : a concept analysis", J Adv Nurs, 57(5), pp.552~558 (2007)
- Allvin R, "Experiences of the postoperative recovery process : an interview study", Open Nurs J, 2, pp.1~7 (2008)
- Ljungqvist O, "Enhanced recovery after surgery : a review", JAMA Surg, 152(3), pp.292~298 (2017)
- Lau CS, "Enhanced recovery after surgery pro-grams improve patient outcomes and recovery : a meta-analysis", World J Surg, 41(4), pp.899~913 (2017)
- Batchelor TJP, "Guidelines for enhanced re-covery after lung surgery : recommendations of the Enhanced Recovery After Surgery(ERAS®)Society and the European Society of Thoracic Surgeons(ESTS)", Eur J Cardiothorac Surg, 55(1), pp.91~115 (2019)
- Moradian ST, "Early mo-bilization reduces the atelectasis and pleural effusion in patients undergoing coronary artery bypass graft surgery : a randomized clinical trial", J Vasc Nurs, 35(3), pp.141~145 (2017)
- Sosnowski K, "Early rehabilitation in the intensive care unit : an integrative literature review", Aust Crit Care, 28(4), pp.216~225 (2015)
- DePew ZS, "Correlations between gait speed, 6-minute walk distance, physical activity, and self-efficacy in patients with severe chronic lung disease", Respir Care, 58(12), pp.2113~2119 (2013)
- Bandura A, "Self-efficacy: the exercise of control" (1997), W. H. Freeman and Co
- Lin YY, "Effects of walking on qual-ity of life among lung cancer patients : a longitudinal study", Cancer Nurs, 38(4), pp.253~259 (2015)
- 김광회, "점증부하운동 중 주관적 운동강도척도로써 RPE와 CR10 비교", 한국체육학회지, 45(3), pp.513~524 (2006), 한국체육학회
- 이윤경, "호흡곤란 환자에 대한 Modified Borg Scale의 유용성", 임상간호연구, 10(2), pp.173~185 (2005), 병원간호사회
- Allvin R, "Development of a questionnaire to measure patient-reported postoperative recovery : content validity and intra-patient reliability", J Eval Clin Pract, 15(3), pp.411~419 (2009)
- 김영만, "위장관암 환자의 극복력과 사회적 지지가 수술 후 회복에 미치는 영향", 성인간호학회지, 29(4), pp.432~440 (2017), 한국성인간호학회[DOI]
- Schwarzer R, "Measures in health psychology: a user’s portfolio. Causal and control beliefs", pp.35~37 (1995), NFER-NELSON
- Schwarzer R, "The assessment of optimistic self-beliefs : comparison of the Chinese, Indonesian, Japanese, and Korean versions of the general self-efficacy scale", Psychologia, 40(1), pp.1~13 (1997)
- Jeon BH, "Relationships between gas-trointestinal symptoms, uncertainty, and perceived recovery in patients with gastric cancer after gastrectomy", Nurs Health Sci, 18(1), pp.23~29 (2016)
- 김수연, "심장수술 환자의 회복의 질 영향 요인", 재활간호학회지, 17(2), pp.64~71 (2014), 한국재활간호학회
- Slim K, "The benefits of enhanced recovery after surgery", J Visc Surg, 153(6), pp.S41~4 (2016)
- Bendixen M, "Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thor-acotomy for early stage lung cancer : a randomised controlled trial", Lancet Oncol, 17(6), pp.836~844 (2016)
- van Egmond MP, "Barriers and facilitators for return to work in cancer survivors with job loss experience : a focus group study", Eur J Cancer Care(Engl), 26(5), pp.e12420~ (2017)
- Ito H, "Employment status among non-retired cancer survivors in Japan", Eur J Cancer Care(Engl), 24(5), pp.718~723 (2015)
- Zaman AGNM, "Development of a tail-ored work-related support intervention for gastrointestinal can-cer patients", Eur J Cancer Care(Engl), 27(2), pp.e12782~ (2018)
- Leensen MCJ, "Feasibility of a multidisciplinary in-tervention to help cancer patients return to work", Eur J Cancer Care(Engl), 27(2), pp.e12690~ (2018)