수술 전 가온과 수술 중 가온이 수술환자의 체온과 전율에 미치는 영향 = (The) Effect of Surgical Patients' Body Temperature and Shivering by Warming Patients Before or During the surgical operations

국문 초록 (Abstract)

국문초록(이지연-간호행정)


수술환자의 체온변화는 마취와 여러가지 환경적인 요인으로 발생되며 수술동안 지속된 심부체온의 저하는 여러가지 합병증을 초래한다. 이에 본 연구는 수술과 마취로 인한 저체온을 예방하고 온도 불편감을 완화시키기 위한 효과적인 간호중재로서 가온적용시기에 따른 수술환자의 체온변화를 확인 하고자 시도되었다.
연구대상자는 일 대학병원에서 전신마취하에 수술받는 성인환자 중 근치자궁적출술(Total abdominal hysterectomy) 또는 자궁근종절제술(Myomectomy) 환자로서 실험 I군 20명, 실험 II군 20명, 대조군 20명등 총 60명이었으며 2001년 9월 1일부터 10월 20일 까지 자료를 수집하였다. 연구의 설계는 비동등성 대조군 전후설계를 이용한 유사실험연구이다. 실험 I군의 수술 전 가온은 대기장소에서 평균 38.5분 동안 40℃로 설정된 전기순환물담요를 사용하였으며 실험 II군의 수술 중 가온은 수술실 도착시부터 수술종료시까지 40℃로 설정된 전기순환물담요를 사용하였다. 체온은 대기장소 도착시 제 1회 측정 하였으며 수술중에는 10회 측정하였다. 수술후에는 회복실에서 15분 간격으로 전율을 5회 측정하였다. 이상의 실험처치에 따른 자료분석은 SPSS program를 이용하였으며 F-검증, 반복측정분산분석(Repeated measures of ANOVA)으로 분석하 였다. 그리고 p<.05수준에서 유의한 차이가 있는 부분은 DUNCAN의 다중비교방법을 이용하여 사후검증을 하였다.
본 연구의 결과는 다음과 같다.

제 1 가설 : “수술 전 가온한 실험 I군과 수술 중 가온한 실험 II군 그리고 가온하지 않은 대조군은 수술종료시 체온에 차이가 있을 것이다.”는 지지되었다(F=12.609, p=.000).
실험 I군의 수술 전 가온으로 수술실 도착시 체온은 세 군간 유의한 차이가 있었으나 마취유도 15분에 유의한 차이가 없어졌으며 마취유도 60분후 부터 세 군 간의 유의한 차이가 나타나기 시작했다. 수술종료시 체온이 실험 I군, 실험 II군 그리고 대조군 각각 35.96℃, 36.65℃, 35.59℃로 실험 II군의 체온 하강이 가장 적었다.

제 2 가설 : “수술 전 가온한 실험 I군과 수술 중 가온한 실험 II군 그리고 가온하지 않은 대조군은 수술 후 회복실에서 전율정도에 차이가 있을 것이다.”는 지지되었다(F=6.626, p=.000). 실험 II군은 전율이 전혀 없었으며, 실험 II군과 대조군간에 유의한 차이가 있었다(F=11.553, p=.002) 시간 경과에 따른 비교 결과 실험 I군과 대조군 모두 회복실 입실 후 15분에 전율이 높았다.

이상의 연구결과를 볼 때 수술 중 가온이 수술 전 가온보다 수술환자의 저체온 예방을 위한 효과적인 간호중재임을 알 수 있다.

다국어 초록 (Multilingual Abstract)

The changes to body temperatures of surgical patients occurred by anesthesia and various environmental factors. The gradual decrease in the core temperatures of the patients during the operation bring about various complication.
Therefore, this study's purpose is to examine the changes of surgical patient's body temperature by the time to apply warming patients.
The above examination is a kind of nursing mediation activity, of which aims are to prevent hypothermia by surgical operations or anesthesia, and to remove the dermal discomforts.
The study subjects were the adult patients who would take surgical operation under the general anesthesia in Il University Hospital; the surgical operations were Total abdominal hysterectomy or Myomectomy; 20 patients were included in the experimental group I, 20 patients were included in the experimental group II, and 20 patients were under the comparative group. The total number of study subjects was 60. The analysis data were collected from September the 1st, 2001 to October the 20th, 2001. The nonequivalent control group pre-test/post-test design was used for this quasi-experimental study. In examining the warming of the experimental group('I'group) patients before they take surgical operations, the researcher examined the warming at the waiting room for 38.5 minutes in average, and used an electrically circulating water-blanket setting on 40℃. In examining the warming of the experimental group('II' group) patients while they were taking surgical operations, the researcher examined the warming patients upon arrival at the operating room to the completion of surgical operations, and used an electrically circulating water-blanket setting on 40℃. Examining patients' body temperature, the researcher examined them one time when the patients arrived at the waiting room, and 10 times while they were taking operations. Examining patients' shivering, the researcher executed the examination at the convalescent ward, 5 times, every 15 minutes, after the operations ended. The data about the operations and their treatment were analyzed by SPSS program. F-test and Repeated measures of ANOVA were used. And DUNCAN's multi-comparison method was used for the sections that show the significance differences at the level of p<.05, which was an ex-post-facto examination.
The results of this study are as follows;
The first hypothesis, "The body temperatures of the three groups' patients will be respectively different when the operations end; the experimental group I who took the warming before operations were conducted, the experimental group II who took the warming while operations were being conducted, and the comparative group who didn't take any warming." was proved to be true.(F=12.609, p=.000)
With regard to the experimental group('I' group), warming before the operations, body temperatures of the three groups were significantly different when they arrived at the operating room. But after 15 minutes since the anesthesia was conducted, differences disappeared, and after 60 minutes since the anesthesia was conducted, significant differences began to be shown. When the operations ended, the average body temperatures of the experimental group I, the experimental group II, and the comparative group were respectively 35.96℃, 36.65℃, and 35.59℃, which tells that the temperature-drop rate was the smallest in the experimental group II.
The second hypothesis : "The shivering symptom and its degrees of the three groups' patients will be respectively different after the operations end, in the convalescent ward; the experimental group I who took the warming before operations were conducted, the experimental group II who took the warming＼while operations were being conducted, and the comparative group who didn't take any warming." was proved to be true.(F=6.626, p=.000) Actually, the patients of the experimental group II didn't have any shivering symptom at all, and significant difference in their degrees were found between the experimental group II and the comparative group.(F=11.553, p=.002) In addition, the comparative examination by the time around the operations proved that the patients of the experimental group I and the comparative group showed the highest shivering degree after 15 minutes since they entered the convalescent ward.
Summing up the above study, the assumed warming of during the operations was a more effective nursing-mediation way for preventing patients' hypothermia than the assumed warming of before the operations.