음악중재가 인공호흡기 유지 중환자의 통증에 미치는 효과

안미나; 안혜영

서지반출

국문초록

중환자실에 입원하는 환자의 3분의 1이상이 인공호흡기를 유지하여 치료를 받고 있고(Esterban et al., 2002), 국내의 한 연구에서도 중환자실 입원환자의 41%가 인공호흡기를 사용하고 있을 정도로(Hong, 2003) 인공호흡기를 이용한 치료는 중환자실에서 광범위하게 적용되고 있다. 중환자실에 입원하는 환자 중에서도 인공호흡기를 유지한 환자는 통증, 불안 및 수면 부족 등의 증상을 경험하게 되며(Tracy & Chlan, 2011), 인공호흡기 이탈(ventilator weaning)까지 외상이나, 침습적인 시술 또는 수술 등을 받게 되면서 통증을 경험하게 되고, 의료진에 의해 일상적으로 이루어지는 기관흡인과 같은 간호 처치에 의해서도 통증을 경험하게 된다(Brush & Kress, 2009). 통증은 카테콜아민 항진 효과를 나타내는데, 이는 수면부족, 불안, 섬망과 같은 부작용과 관련이 있다(Ebstein & Breslow, 1999). 통증은 환자에게 물어보았을 때 정확히 알 수 있지만(Stanik-Hutt, 2003), 인공호흡기를 유지한 중환자의 경우 통증이 있어도 자발적으로 통증에 대한 호소를 할 수 없는 경우가 많으며, 의료진의 지각에 의해서 통증이 인지되고 통증조절이 이루어지게 된다. 의료인들은 종종 통증의 정도를 과소평가하고, 그로 인해 통증조절이 충분히 이루어지지 않기도 한다. 이처럼 의료인이 환자의 고통을 알아채지 못하거나 통증이 해결되지 않음으로써 환자에게 해로운 생리적 효과를 가져 올 수도 있다(Stanik-Hutt, 2003). 중환자실 입원 환자의 50%에서 입원기간 동안 통증을 경험했다고 회상하며, 15%는 매우 중증도의 통증을 경험하였고, 이들 중 15%는 통증 조절이 만족스럽지 못하였다고 회상한다(Desbiens et al., 1996). 최근 중환자의 안정과 통증 조절이 중요해지면서 중환자실에서 환자의 진정 및 통증을 조절해주기 위해 많은 노력을 하고 있지만(Capuzzo et al., 2001) 중환자의 통증을 해결하기에는 충분하지 않은 실정이다.

영문초록

Purpose: This study aimed to determine the effects of listening to music on pain and vital signs of critically ill patients with ventilatory support in intensive care units during nursing treatment (changes of posture and tracheal suction). Methods: The experimental treatment was to use an mp3 player and a speaker to let them listen to classical music by Mozart during nursing treatment. To determine the effects of music intervention, pain (Critical-Care Pain Observation Tool-K) was used. The data analysis was carried out by using PASW Statistics 20.0. Results: Hypothesis “The scores for pain would differ between the experimental group provided with music intervention during nursing treatment, and the control group” was supported. Conclusion: Application of music intervention during nursing treatment for critically ill patients with ventilatory support in intensive care units was found to be effective in reducing pain. Therefore, music intervention during nursing treatment for critically ill patients with ventilatory support can be used as non-pharmaceutical nursing intervention to reduce pain for the patients.

키워드

Music Tracheal suction Ventilator Pain 통증 중환자 음악 인공호흡기 흡인

참고문헌 (31건)

American cancer society. (2008 November 1). Music therapy. Retrived August 11, 2012. from http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternative medicine/mindbodyandspirit/music-therapy
Arogon, D., Farris, C., & Byers, J. F. (2002). The effects of harp music in vascular and thoracic surgical patients. Alternative Therapies, 8(5), 52-60.
Arroyo-Novoa, C. M., Figueroa-Ramos, M. I., Puntillo, K. A., Stanik-Hutt, J., Thompson, C. W., & Wild, L. R. (2007). Pain related to tracheal suctioning in awake acutely and critically ill adults: A descriptive study. Journal of Intensive Critical Care Nur
Brush, D. R., & Kress, J. P. (2009). Sedation and analgesia for the mechanically ventilated patient. Clinics in Chest Medicine, 30, 131-141. http://dx.doi.org/10.1016/j.ccm.2008.09.001
Capuzzo, M., Pinamonti, A., Cingolani, E., Grassi, L., Bianconi, M., Contu, P., et al. (2001). Analgesia, sedation, and memory of intensive care. Journal of Critical Care, 16(3), 83-89.
Desbiens, N. A., Wu, A. W., Broste, S. K., Wenger, N. S., Connors, A. F., Lynn, J., et al. (1996). Pain and satisfaction with pain control in seriously ill hospitalized adults: Finding from the SUPPORT research investigations. Critical Care Medicine, 24(12
Epstein, J., & Breslow, M. J. (1999). The stress response of critical illness. Critical Care Clinics, 15(1), 17-33.
Engwall, M., & Duppils, G. S. (2009). Music as a nursing intervention for postoperative pain: A systematic review. Journal of Perianesthesia Nursing, 24(6), 370-383. http://dx.doi.org/10.1016/j.jopan.2009.10.013
Esteban, A., Anzueto, A., Frutos, F., Alia, I., Brochard, L., Stewart, T. E., et al. (2002). Characteristics and outcomes in adult patients receiving mechanical ventilation: A 28-day international study. The Journal of the American Medical Association, 287
Gélinas, C., Fillion, L., Puntillo, K. A., Viens, C., & Fortier, M. (2006). Validation of the Critical-Care Pain Observation Tool in adult patients. American Journal of Critical Care, 15(4), 420-427.
Good, M., & Ahn, S. (2008). Korean and American music reduces pain in Korean women after gynecologic surgery. Pain Management Nursing, 9(4), 96-103. http://dx.doi.org/10.1016/j.pmn.2008.02.002
Han, L., Li, J. P., Sit, J. W., Chung L., Jiao, Z. Y., & Ma, W. G. (2010). Effects of music intervention on physiological stress response and anxiety level of mechanically ventilated patients in China: a randomised controlled trial, Journal of Clinical Nur
Happ, M. B. (2001). Communicating with mechanically ventilated patients : state of the science. American Association of Critical-Care Nurses Issues, 12(2), 247-58.
Hong, S. B. (2003, November). A survey of mechanically ventilated patients in intensive care unit in Korea. Paper presented at the meeting of The Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea.
Hulley, S. B., Cummings, S. R. Browner, W. S., Grady, D. G., Newman, T. B. (2007). Designing clinical research(3rd ed.). Philadelphia, PA:Lippincott Williams & Wilkins.
International Association for the Study of Pain. (2012, May 22). IASP Taxonomy, Pain terms. Retrieved May 28, 2012, from http://www.iasp-pain.org/Content/NavigationMenu/GeneralResourceLinks/PainDefinitions/default.htm#Pain
Jaber, S., Bahloul, H., Guétin, S., Chanques, G., Sebbane, M., & Eledjam, J. J. (2007). Effects of music therapy in intensive care unit without sedation in weaning patients versus non-ventilated patients. Annales Francaises d’Anesthesie et de Reanimation,
Kwak, E., & Oh, H. (2012). Validation of a Korean translated version of the Critical Care Pain Observation Tool (CPOT) for ICU patients. Journal of Korean Academy of Nursing, 42(1), 76-84. http://dx.doi.org/10.4040/jkan.2012.42.1.76
Lee, J. M., & Hong, H. S. (2008). The effect of music therapy on anxiety and vital signs of spinal anesthesia operative patients. Journal of Korean Society of Biological Nursing Science 10(2), 113-120.
Nigel. (2012). So what is the mozart effect?. Retrieved November 30, 2012. from http://higher-music.com/so-what-is-the-mozart-effect/
Nilsson, U., Unosson, M., & Rawal, N. (2005). Stress reduction and analgesia in patients exposed to calming music postoperatively: a randomized controlled trial. European Journal of Anaesthesiology, 22(2), 96-102.
Nilsson, U. (2008). The anxiety and pain-reducing effects of music interventions: a systematic review. Journal of the Association of periOperative Registered Nurses, 87(4), 780-807.
Puntillo, K. A., Miaskowski, C., Kehrle, K., Stannard, D., Gleeson, S., & Nye, P. (1997). Relationship between behavioral and physiological indicators of pain, critical care patients’ self-reports of pain, and opioid administration. Critical Care Medicine,
Puntillo, K. A., White, C., Morris, A. B., Perdue, S. T., Stanik-Hutt, J.,Thompson, C. L., et al. (2001). Patients’ perceptions and responses to procedural pain: results from Thunder Project II. American Journal of Critical Care, 10(4), 238-251.
Rotondi, A. J., Chelluri, L. Sirio, C., Mendelsohn, A., Schulz, R., Belle, S., et al. (2002). Patient’s recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit. Critical Care Medicine, 30(4), 746-75
Stanik-Hutt, J. A., Soeken, K. L., Belcher, A. E., Fontaine, D. K., & Gift, A. G. (2001). Pain experience of traumatically injured patients in a critical setting. American Journal of Critical Care, 10(4), 252-259.
Stanik-Hutt, J. A. (2003). Pain management in the critically ill. Critical Care Nurse, 23(2), 99-103.
Sutoo, D., & Akiyama, K. (2004). Music improves dopaminergic neurotransmission: demonstration based on the effect of music on blood pressure regulation. Brain Research, 1016, 255-262. http://dx.doi.org/10.1016/j.brainres.2004.05.018
Tracy, M. F., & Chlan, L. (2011). Nonpharmacological interventions to manage common symptoms in patients receiving mechanical ventilation. American Association of Critical-Care Nurses, 31(3), 19-28. http://dx.doi.org/10.4037/ccn2011653
Vázquez, M., Pardavila, M. I., Lucia, M., Aguado, Y., Margall, M., & Asiain, M. C. (2011). Pain assessment in turning procedures for patients with invasive mechanical ventilation. Nursing in Critical Care, 16(4), 178-185. http://dx.doi.org/10.1111/j.1478-5
Wago, Haruhisa. (2005). Listening to Mozart’s illness cured; Mozart therapy (Song, S. Y. Trans.). Seoul, Korea: Nexus Books (Original work published 2004).

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참고문헌 (31건)