본 연구는 서울시 소재의 K 대학병원에서 담석증을 진단받은 입원환자 161명을 대상으로 담석증 환자가 빈번히 경험하는 통증정도를 파악하고 통증과 관련이 있는 인구사회학적, 임상적, 사회심리적 요인을 확인하기 위해 시행된 서술적 조사연구이다. 연구도구는 식욕, 우울, 사회적지지 측정도구를 이용하였으며, 일반적 특성, 통증, 오심과 구토정도를 함께 조사하였다. 수집된 자료는 SPSS 26.0을 이용하여 분석하였으며, 대상자의 인구사회학적, 임상적, 사회심리적 특성에 따른 통증의 차이는 t-test와 ANOVA를 시행하였고, 정규성 검정은 Shapiro-Wilk로 하였으며, 사후검정은 Scheffe’검정으로 하였다. 또한 대상자의 인구사회학적, 임상적, 사회심리적 특성에 따른 통증의 상관관계는 Pearson’s correlation coefficients로 산출하였다. 마지막으로 대상자의 인구사회학적, 임상적, 사회심리적 특성이 통증에 영향을 미치는지 파악하기 위해 다중회귀분석을 이용하여 분석하였다.
본 연구의 연구결과는 다음과 같다.
1) 입원한 담석증 환자의 평균연령은 58.0±16.3세로, 70대 이상이 42명(26.1%)으로 가장 많았으며, 60대 41명(25.5%), 50대 27명(16.8%) 순으로 나타났다. 성별은 남성이 91명(56.5%), 교육정도는 학력은 고졸이 58명(36.0%)로 가장 많았으며, 배우자가 있는 군이 123명(76.4%), 담석증 가족력은 51명(31.7%)이 있는 것으로 나타났다.
2) 담석의 위치는 담낭이 95명(59%)로 가장 많았다. 치료방법에서는 수술을 시행 받은 대상자가 108명(67.1%)으로 가장 많았고, 내시경적역행담췌관조영술(ERCP)은 64명(39.8%)으로 나타났다. 담석증의 동반질환은 담낭염이 64명(39.8%)로 가장 많은 것으로 확인되었다. 만성질환이 있는 군은 102명(63.4%), 흡연군은 70명(43.5%), 음주군은 99명(61.5%), 체질량지수는 비만군이 73명(45.3%)로 가장 많았고 과체중군이 37명(23%)로 가장 적게 나타났다. 투여된 진통제는 자가조절 진통제가 105명(65.2%)로 가장 많았고, 모르핀은 41명(25.5%), 페치딘은 31명(19.3%), 비스테로이드성 소염진통제가 102명(63.4%)으로 나타났다. 응급실을 경유하여 입원한군은 66명(41%)로 확인되었다.
3) 담석증 관련 소화기증상에서 오심은 2.42±3.11점, 구토는 1.99±3.33점으로 나타났고, 식욕은 12.53±3.14점으로 측정되었다. 우울은 9.81±8.37점, 사회적지지는 46.77±10.52점으로 나타났다.
4) 대상자의 통증은 10점 만점으로 입원 시 통증은 4.40±3.77, 평균 통증은 4.22±2.79로 나타났다.
5) 대상자의 인구사회적 특성에 따른 통증정도는 입원시 통증의 교육정도(F=4.55, p=.012)에서 유의미한 차이가 나타났으며 중졸이하(5.78±3.84)집단이 고졸(3.96±3.68), 대졸이상(3.74±3.57)군 보다 높은 것으로 나타났다.
6) 입원한 담석증 환자의 임상적 특성에 따른 통증정도에서 임상적 특성과 입원시 통증정도의 차이는 치료방법에서 내시경적역행담췌관조영술을 받은 환자(t=3.03, p=0.003)가 시행 받지 않은 환자보다 더 많은 통증을 경험 하였고, 수술을 받은 환자(t=-2.61, p=0.010)는 그렇지 않은 환자보다 적은 통증을 경험하였다. 담석으로 인한 동반질환이 있는 환자(F=2.69, p=0.016)는 그렇지 않은 환자보다 많은 통증을 경험하였다. 담석으로 인한 동반질환이 두 가지 이상으로 혼합되어 있는 집단(7.67±3.50)이 담석으로 인한 동반질환이 한가지만 있는 경우인 담낭염(3.92±3.64), 담관염(3.59±3.69), 췌장염(5.67±3.71), 동반질환이 없는 군(3.56±3.70)보다 더 많은 통증을 경험하였다. 응급실을 경유하여 입원한 대상자(t=8.28, p<.001)는 그렇지 않은 대상자보다 더 많은 통증을 경험하였고, 총빌리루빈 (t=-3.37, p<.001), 직접빌리루빈(t=-4.38, p<.001), 아밀라아제(t=-2.21, p=.028)의 수치가 정상범위에서 벗어난 대상자는 그렇지 않은 대상자보다 더 많은 통증을 경험하였다. 임상적 특성과 평균통증은 진통제 중 모르핀(t=3.82, p<.001)을 사용한 대상자가 그렇지 않은 대상자보다 더 많은 통증을 경험하였고, 응급실 경유(t=2.55, p=.012)하여 입원한 대상자가 그렇지 않은 환자보다 더 많은 통증을 경험하였다.
7) 담석증 환자의 제 특성과 통증과의 상관관계에서 입원시 통증은 연령(r=0.19, p=.018)이 높을수록 더 많은 통증을 경험하는 것으로 나타났고, 식욕(r=-0.30, p<.001)이 높을수록 통증의 경험은 낮아지는 것으로 나타났다. 평균통증은 식욕(r=-0.21, p=.007)이 낮을수록 더 많은 통증을 경험하는 것으로 나타났고, 우울(r=0.16, p=.041)이 높을수록 더 많은 통증을 경험하는 것으로 나타났다.
8) 입원한 담석증 환자의 통증에 영향을 미치는 요인으로는 입원시 통증에서 응급실 경유 입원(β=3.881, t=7.62, p=.000), 식욕(β=-.221, t=-2.76, p=.006)에 대해 통계적으로 유의하였으며 설명력은 32.5%로 나타났다.
본 연구 결과 입원한 담석증 환자의 통증은 인구사회적, 임상적, 사회심리적인 요인과 관련 있는 것으로 나타났다. 본 연구결과를 기반으로 의료진들은 입원한 담석증 환자의 통증의 정도와 관련된 요인을 확인하고, 통증을 효과적으로 관리하기 위한 중재 프로그램을 개발하여야 할 것이다.
Abstract
Pain-related Factors in Hospitalized Cholelithiasis Patients
Bo Mi Kim
Nursing Education, Korea University Graduate School of Education
Advisor: Sung Reul Kim
This study aimed to determine the level of pain frequently experienced by inpatients with cholelithiasis and to identify demographic, clinical, and psychosocial factors related to pain. This descriptive survey study was conducted on 161 inpatients who were diagnosed with cholelithiasis at K University Hospital in Seoul.
The collected data were analyzed using SPSS version 26.0 Regarding the differences in pain according to inpatients’ demographic, clinical, and psychosocial characteristics, t-test and analysis of variance were performed, and post-hoc analysis was performed using Scheffe's test. Additionally, the correlation of pain according to the patients’ demographic, clinical, and psychosocial characteristics were calculated using Pearson's correlation coefficients. Multiple regression analysis was used to determine whether the inpatients’ demographic, clinical, and psychosocial characteristics affected pain.
The results of this study were as follows:
1) The mean age of inpatients with cholelithiasis was 58.0±16.3 years, with 42 (26.1%) inpatients in their 70s or older, followed by 41 in their 60s (25.5%) and 27 in their 50s (16.8%). Ninety-one inpatients were male (56.5%) individuals and 70 were female (43.5%) individuals. The high school level of education was the most prevalent with 58 (36.0%) graduates, 123 (76.4%) inpatients had spouses, and 51 (31.7%) had a family history of cholelithiasis.
2) Regarding the location of gallstones, the gallbladder was the most common site, with 95 (59%) inpatients. Regarding treatment methods, the number of participants who underwent surgery was the highest at 108 (67.1%), and endoscopic retrograde cholangiopancreatography (ERCP) was performed in 64 (39.8%) inpatients. In inpatients with cholelithiasis, cholecystitis was the most frequent comorbidity and was observed in 64 (39.8%) inpatients. The group with chronic diseases had 102 (63.4%) inpatients, the smoking group had 70 (43.5%), and the drinking group had 99 (61.5%); the body mass index was the highest in the obese group, which had 73 (45.3%) inpatients, while the overweight group had 37 (23%). Regarding the analgesics administered, inpatients-controlled analgesics were the most common in 105 (65.2%) inpatients, followed by morphine in 41 (25.5%), pethidine in 31 (19.3%), and non-steroidal anti-inflammatory drugs in 102 (63.4%). Furthermore, 66 (41%) were hospitalized via the emergency room.
3) Among digestive symptoms related to cholelithiasis, nausea was scored 2.42±3.11 points, vomiting 1.99±3.33 points, and appetite 12.53±3.14 points. Depression was scored 9.81±8.37 points and social support 46.77±10.52 points.
4) In inpatients with cholelithiasis, pain at admission was scored 4.40±3.77 points on a 10-point scale, and the average pain score was 4.22±2.79.
5) Regarding the level of pain according to demographic characteristics of inpatients with cholelithiasis, there was a significant difference in the pain score on admission according to the inpatients’s educational level (F=4.55, p=.012), with the middle school graduate or lower (5.78±3.84) group having a higher level of pain than the high school (3.96±3.68) and university graduate or higher (3.74±3.57) groups.
6) Exploring the association between the clinical characteristics of inpatients with cholelithiasis and the level of pain at admission revealed that inpatients who underwent ERCP (t=3.03, p=.003) as a treatment method experienced more pain than those who did not, and inpatients who underwent surgery (t=-2.61, p=.010) experienced less pain than those who did not. Inpatients with comorbidities due to gallstones (F=2.69, p=.016) experienced more pain than those without gallstones. The group with two or more comorbidities due to gallstones (7.67±3.50) experienced more pain than the groups with cholecystitis (3.92±3.64), cholangitis (3.59±3.69), and pancreatitis (5.67±3.71) and the group without comorbidities (3.56±3.70). Inpatients via the emergency room (t=8.28, p<.001) experienced more pain than those who were not. In addition, inpatients whose total bilirubin (t=-3.37, p<.001), direct bilirubin (t=-4.38, p<.001), and amylase (t=-2.21, p=.028) levels were out of the normal range experienced more pain than those whose levels were not. Regarding clinical characteristics and the average pain score, inpatients who were administered morphine as an analgesic (t=3.82, p<.001) experienced more pain than those who were not, and inpatients who were hospitalized via the emergency room (t=2.55, p=.012) experienced more pain than those who were not.
7) In the correlation between the characteristics of inpatients with cholelithiasis and pain, it was found that the older the age (r=0.19, p=.018), the more the pain experienced at admission, and the higher the appetite (r=-0.30, p<.001), the lower the pain experienced. Regarding the average pain, the lower the appetite (r=-0.21, p=.007) the more the pain experienced, while the higher the depression (r=0.16, p=.041), the more the pain experienced.
8) Among factors that affect pain in inpatients with cholelithiasis, the factors that affected pain at admission were significantly ssociated with hospitalization via the emergency room (β=3.881, t=7.62, p=.000) and appetite (β=-.221, t=-2.76, p=.006), with an explanatory power of 32.5%.
As a result of this study, it was confirmed that the pain of cholelithiasis inpatients was related to demographic, clinical, and social psychological factors. Based on this, it is hoped that it will help to have an overall understanding and interest in the pain of cholelithiasis inpatients, and it is expected to be used as basic data for the development of educational programs for diseases and the function of the nursing process in clinical trials.
