급성통증관리 간호사 주도의 수술 후 통증관리 현황
Postoperative Pain Management Status led by an Advanced Practice Nurse of Acute Pain Service
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초록
목적: 본 연구는 nurse-based, anesthesiologist-supervised Acute Pain Service (APS)에 의해 관리된 수술 후 통증관리 현황의 객관적인 안정성을 입증하기 위해 수행되었다. 방법: 2017년 1월부터 12월까지 정맥 자가통증조절기(PCA)를 사용한 환자 5,748명을 대상으로 후향적 서술적 조사연구를 실시했다. 데이터는 기술통계, 빈도분석, ANOVA, 교차분석과 x^2 test, 상관분석을 사용하여 분석하였다. 결과: APS 간호사의 교육일수가 길어질수록 PCA 사용기간은 통계적으로 유의하게 길어졌고, PCA를 사용하는 도중에 중단하는 기간은 유의하게 짧아졌다(p<.001). 통계적으로 유의하게 가장 통증이 심했던 수술은 사지, 척추, 상복부, 흉곽 수술이었고, 반면에 가장 통증이 적은 수술은 하복부 수술이었다(p<.001). 하복부 수술이 PCA 사용량이 가장 많았고(p<.001), 사지와 척추 수술은 PCA를 가장 적게 사용하였으며 PCA 사용을 자주 중단하였다(p<.001). 가장 흔한 부작용은 수술 후 오심과 구토였으며 발생률은 24시간 이내 16.0%, 48시간 이내 9.8%로 나타났다. PCA로 인해 발생된 전체 오류는 1.5%였으며, 이 중 84.3%는 인적 오류였다. 결론: APS 간호사의 통증관리 효과로 환자들이 PCA를 더욱 효과적으로 사용하였으며, 선행 연구들에 비해 부작용도 적었고 오류 발생률도 적었다. 따라서 이 시스템이 안전하고 통증 관리에 효과적이라고 제안할 수 있겠다.
Abstract
Purpose: This study was conducted to demonstrate objective stability of postoperative pain management status managed by nurse-based, anesthesiologist-supervised Acute Pain Service (APS). Methods: A retrospective descriptive review was conducted with 5,748 patients who had used intravenous Patient Controlled Analgesia (PCA) from January to December 2017. Data were analyzed using descriptive statics, Frequency analysis, ANOVA, Cross tabulation with x2test, and Correlation coefficient. Results: As the APS nurse's education date increased, the period of using PCA was statistically significantly longer, and the period of stopping PCA while using it became shorter (p<.001). Statistically significant, the most painful operations were extremities, spine, upper abdomen, and thorax, while the least painful surgery was lower abdomen (p<.001). Lower abdominal surgery used the highest amount of PCA (p<.001), and extremities and spinal surgery, the lowest amount of PCA and frequently stop using it (p<.001). The most common side effects were nausea and vomiting after surgery, with an incidence of 16.0% within 24 hours and 9.8% within 48 hours. The overall error caused by PCA was 1.5%, with 84.3% being caused by human errors. Conclusion: With the pain management effect of APS nurses, patients used PCA more effectively. There were also fewer side effects and error rates compared to prior studies. Therefore, it is suggested that this system is safe and effective for pain management.
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