외과계 병동 노인 수술 환자의 섬망 발생률과 위험요인
The Incidence and risk factors of delirium in elderly surgical patients
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목적: 본 연구는 노인 수술 환자의 섬망 발생률과 섬망 발생 관련 요인을 파악하기 위해 시행된 후향적 서술적 조사연구이다. 방법: 연구 대상자는 수술을 받은 만 65세 이상의 환자 394명이었다. 수술 후 섬망 진단은 간호사가 수술 당일부터 수술 후 4일까지 도구로 측정한 점수를 간호일지를 통하여 조사하였고, 수집된 자료는 Binary logistic regression으로 분석하였다. 결과: 연구 대상자의 섬망 발생률은 4.3%이었고, 섬망 발생시기는 수술 1일째에 가장 많이 발생해 평균 2.16일간 지속된 것으로 나타났다. 섬망 발생군 총 17명 중 76.5%가 위장관계 수술 환자였고, 섬망 양상은 지남력 저하가 100.0%로 가장 많았다. 대상자의 특성에 따른 섬망 발생은 나이(χ²=10.79, p=.005), 계통적 질환명(χ²=9.63, p=.047), 수술 전 섬망 유발 약물(벤조다이아제핀) 사용 여부(χ²=15.90, p<.001), 수술 전 활동상태(χ²=7.65, p=.006), 이전 섬망 경험(χ²=35.92, p<.001)과 응급수술 유무(χ²=16.40, p<.001)에 따라 통계적으로 유의한 차이를 보였다. 섬망 발생여부에 미치는 위험요인은 위장관계 수술인 경우 다른 수술에 비해 섬망 발생 위험이 12.57배(95% CI= 2.45∼64.46, p=.002), 수술 전 벤조다이아제핀 등 섬망 유발 약물을 복용했던 환자의 경우 10.07배(95% CI= 2.21∼45.87, p=.003) 증가하는 것으로 나타났다. 결론: 간호사는 노인 수술 환자의 섬망을 조기발견 및 예방하기 위해 선별 도구를 사용해서 적극적으로 섬망을 사정할 필요가 있다.
Abstract
Purpose: This retrospective chart review study was conducted to examine the frequency of delirium and to identify the risk factors of delirium in elderly surgical patients. Methods: The subjects of this study were 394 patients aged 65 years or older who underwent surgery. The diagnosis of delirium was based on the nursing assessment records with scores from the day of surgery to the 4th day after surgery. The collected data were analyzed by binary logistic regression analysis. Results: The incidence of delirium was 4.3%, and delirium occurred most frequently on the first day of surgery and lasted for 2.16 days on average. Of delirium patients, 76.5% underwent gastrointestinal surgery, and the most common delirium pattern was disorientation. In terms of the characteristics of the subjects, the occurrence of delirium was statistically different by age (x2=10.79, p=.005), systemic-specific disease (x2=9.63, p=.047), use of delirium-inducing drug(benzodiazepine) before surgery (x2=15.90, p<.001), walking ability before surgery (x2=7.65, p=.006), history of delirium (x2=35.92, p<.001), and emergency surgery (x2=16.40, p<.001). As risk factors of delirium, gastrointestinal surgery was found to increase the risk of delirium by 12.57 times (95% CI=2.45~64.46, p=.002), and the use of benzodiazepines before surgery was shown to increase delirium by 10.07 times (95% CI=2.21~45.87, p=.003). Conclusion: It is necessary for nurses to actively evaluate delirium using screening tools for early detection and prevention of delirium in elderly surgical patients with delirium risk factors.
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