구조화된 냉요법이 발목 골절 수술환자의 부종, 염증 및 통증에 미치는 효과
The Effect of Structured Cryotherapy on Edema, Inflammation and Pain in Postoperative Patients with Ankle fractures
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본 연구는 구조화된 냉요법 적용이 발목 골절 수술 환자의 부종, 염증 및 통증에 미치는 효과를 확인하기 위한 비동등성 대조군 전후시차설계의 유사 실험연구이다. B광역시 정형외과전문 B병원에 입원하여 발목 골절 수술을 받은 환자 실험군 29명, 대조군 29명을 연구대상으로 하여 2016년 8월 19 일부터 2017년 3월 31일까지 자료수집을 하였다. 구조화된 냉요법은 발목에 최대한 밀착되도록 자체 제작한 방수포가 달린 주머니에 냉젤팩을 넣어 고정시키고 1시간 간격으로 20분간 적용 후, 40분의 회복기를 두고, 1일 10회 수술 후 1일부터 7일까지 적용하는 것을 의미한다. 자료분석은 SPSS Version 23.0을 이용하여 분석하였다. 실험군과 대조군의 가설검정은 발목둘레 변화, 염증수치의 차이및 객 관적 통증강도는 repeated measures ANOVA로 분석하였다. 주관적 통증강도의 변화는 정규성 가정을 만족하지 않고 동질성이 확인되지 않아 일반화추정 방정식 모형(Generalized Estimating Equation)으로 분석하였다. 실험군이 대조군보다 부종감소(F=36.02, p=.001), CRP수치 감소(F=3.64, p=.039), ESR수치 감소(F=4.51, p=.013) 및 주관적 통증강도(Wald χ2=13.995, p=.007)에는 효과가 있었 으나 진통제 사용횟수(F=2.83, p=.098)에는 차이가 없었다. 발목 골절 수술환자에게 적용한 구조화된 냉요법은 부종감소, 염증완화 및 통증완화에 효과가 있음을 확인하였고 구조화된 냉요법은 발목 골절 수술환자의 효과적인 간호중재로 활용될 수 있을 것이며, 근거기반 간호 실무에 기여할 수 있을 것이 다. 구조화된 냉요법의 정확한 효과 검증을 위해 추후 발목 골절 수술환자를 대상으로 한 반복 연구를 제언한다.
Abstract
This study is a quasi experimental study of the design of non - equality control postpartum time lag to confirm the effect of structured cold therapy on edema, inflammation and pain in patients with ankle fracture surgery. Study was conducted from August 19, 2016 to March 31, 2017. The research subjects were divided into experimental group (n=29) and control group (n=29). The structured cryotherapy using a cold gel pack in a plastic bag with a specially designed tarpaulin which can be molded around the ankle was applied. This intervention was performed 20 minutes followed by 40 minutes rest and repeated 10 times per day for 7 days after surgery. Statistical analysis was performed using the IBM SPSS Statistics 23.0 program. Hypothesis testing of the experimental group and the control group was based on repeated measures ANOVA. The change in subjective pain intensity did not satisfy the assumption of normality, and homogeneity was not confirmed, so it was analyzed by Generalized Estimating Equation. The results of this study showed that the application of structured cryotherapy to the ankle fractured patients after surgery was effective in reducing edema(F=36.02, p=.001) and decreasing the level of CRP(F=3.64, p=.039) and ESR(F=4.51, p=.013). While this intervention showed an effectiveness in relieving pain(Wald χ2=13.995, p=.007), there was no statistical difference found from the frequency of taking pain killers(F=2.83, p=.098) in both experiment and control groups. This study contributes an evidence based practice of using structured cryotherapy as an effective postoperative nursing intervention in ankle fracture patients. To validate the effect of structured cold therapy, we propose an iterative study on patients who have had an ankle fracture surgery in the future.
참고문헌 (31)
- "Foot ankle" (2017)[URL]
- "Ankle Fracture statistics" (2016)[URL]
- H. S. Kang, "Musculoskeletal radiology" (2013), Bummun education
- The Korean Orthopaedic Association, "Orthopaedics" (2006), Choisin
- Beaty, J. H., "Rockwood and Wilkins’ fracture in children" (2009), Lippincott, Williams, Wilkins
- 현윤석, "족부 및 족관절 손상 후 심한 부종에 대한 그물망 절개술: 술기 보고", 대한족부족관절학회지, 19(1), pp.39~41 (2015), 대한족부족관절학회
- U. C. Lee, "Foot and ankle" (2012), Kyohaksa
- H. S. Lee, "The effect of emotional state and social support of preoperative patients on postoperative pain", master, pp.2001
- Pasero, C., "Orthopedic postoperative pain management", Journal of PeriAnesthesia Nursing, 22(3), pp.160~174 (2007)
- Y. J. Noh, "Orthopedic nursing" (1991), Soomoonsa
- Y. M. Jung, "The effects of cold therapy on pain in patients with chest tube insertion", master, pp.2004
- 신용순, "전국 의료기관의 냉 요법 실무지침 및 임상간호사의냉 요법 실무 현황", 임상간호연구, 21(3), pp.355~365 (2015), 병원간호사회
- Y. S. Shin, "The effects of cryotherapy on postoperative pain, eyelid edema, and facial ecchymosis after craniotomy", doctor, pp.2007
- E. O. Shim, "A study on the effects of structured cryotherapy on pain, inflammation, range of motion and edema in patients with total knee arthroplasty", master, pp.2014
- M. Y. Jang, "The effects of cryotherapy on deviated nasal septum surgery patients’pain and discomfort", master, pp.2014
- Leegwater, N. C., "Cryocompression therapy after elective arthroplasty of the hip", The Joural of Clinical and Experimental Research on Hip Pathology and Therapy, 22(5), pp.527~533 (2012)
- Modabber, A., "Three-dimensional evaluation of postoperative swelling in treatment of zygomatic bone fractures using two different cooling therapy methods: a randomized, observer-blind, prospective study", Trials, 14, pp.238~247 (2013)
- National Health Insurance Service, "Standard operating procedures of comprehensive nursing care service", ~ (2016)
- Cohen, J, "Statistical power analysis for the behavioral sciences" (1988), Erlbaum
- Kenan Akgun, "Temperature Changes in Superficial and Deep Tissue Layers with Respect to Time of Cold Gel Pack Appliaction in Dogs", Yonsei Medical Journal, 45(4), pp.711~718 (2004), 연세대학교의과대학
- Bleakley, C., "The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials", Am J Sports Med, 32(1), pp.251~261 (2004)
- Kol, E., "Evaluation of the outcomes of ice application for the control of pain associated with chest tube irritation", Pain Management Nursing, 14(1), pp.29~35 (2013)
- Mora, S., "The role of pulsatile cold compression in edema resolution following ankle fractures: a randomized clinical trial", Foot Ankle International, 23(11), pp.999~1002 (2002)
- A. J. Yoon, "Effect of cryotherapy after one-side TKR on ESR, CRP, pain and swelling over time", master, pp.2014
- S. D. Kim., "Changes of KSR and CRP after total knee and hip arthroplasty", Knee Surgery and Related Research, 13(1), pp.23~29 (2001)
- D. H. Kim, "The effect of cryotherapy on release of inflammation in patient with acute rheumatoid arthritis", master, pp.2000
- Bleakley, C. M., "Cryotherapy for acute ankle sprains: a randomised controlled study of two different icing protocols", Br J Sports Med, 40(8), pp.700~705 (2006)
- D. H. Koh, "The effect of a proprioceptive exercise program for pain range of motion proprioception stability of subacute ankle sprain", master, pp.2008
- S. Y. Park, "The effect of adjuvant cold therapy before continuous passive motion on pain management in elderly total knee replacement patients", master, pp.2011
- Morsi, E, "Continuous-flow cold therapy arthroplasty", Journal of Arthroplasty, 17(6), pp.718~722 (2002)
- H. E. Kim, "Pattern, Management and related factors of postoperative pain: through EMR analysis", master, pp.2012