시간 경과에 따른 중환자실 환자의 욕창과 영양 상태

이하늬(Lee Ha Nee),박정숙(Park, Jeong Sook) 계명대학교 간호과학연구소 2016 계명간호과학 Vol.20 No.2

Purpose: This study was to identify the pressure ulcer and nutritional status of ICU patient according to time. Methods: Research subjects were 112 patients who were admitted to an ICU of a university hospital. Data were collected on questionnaires including general characteristics, diet-related characteristics, nutritional status, and pressure ulcer status. Results: Pressure ulcer prevalence of ICU patient was 58.9% and pressure ulcer prevalence was increased as time passed in ICU. There were no pressure ulcer group 41.2%, healing pressure ulcer group 7.1%, newly developed pressure ulcer group 12.4%, and continuous pressure ulcer group 30.3%, and nutritional status of newly developed and continuous pressure ulcer group were poorer than no pressure ulcer group. The caloric intake, calrolric supply status, glucose of ICU patients were increased over time, but BMR, Triceps skinfold thickness, hemoglobin, hematocrit, albumin were decreased over time. Comparing nutritional status as time passed in ICU by group of pressure ulcer status, hemoglobin and hematocrit of newly developed pressure ulcer group were lower than no pressure ulcer, healing pressure ulcer, and continuous pressure ulcer group. Total protein of no pressure ulcer, newly developed pressure ulcer and continuous pressure ulcer group were decreased as time passed in ICU, but total protein and albumin of healing pressure ulcer group were increased significantly. The MNA-SF score of no pressure ulcer group was high in normal nutrition, newly developed pressure ulcer group was high in normal nutritional risk, and continuous pressure ulcer group was high in malnutrition. Conclusion: It is important to assess nutritional status of patients including MNA-SF in ICU admission as risk factor of pressure ulcer. And appropriate prevention and management of pressure ulcer including nutritional approach for ICU patients is needed.

중환자실 환자의 욕창을 예측하는 영양 관련 요인

이하늬(Lee, Ha Nee),박정숙(Park, Jeong Sook) 기본간호학회 2014 기본간호학회지 Vol.21 No.4

Purpose: Purpose: The purpose of this study was to identify the nutrition-related factors influencing the prevalence of pressure ulcers among patients admitted to an intensive care unit. Methods: Research participants were 112 patients who were admitted to the ICU of a university hospital. Data were collected through questionnaires which included general characteristics, diet-related characteristics, nutritional status, and pressure ulcer status. Multivariate logistic regression was used to identify independent factors association with prevalence of pressure ulcer Results: The prevalence of pressure ulcers was 58 patients (51.8%) at 10th day after ICU admission. In multivariate analysis, prevalence of pressure ulcers at 10th day in ICU was significantly higher in the nutritional risk group (OR=6.43), malnutrition group (OR=88.02), and deceased serum albumin group (OR=28.83). Conclusion: The results of this research indicate that scores on MNA (Mini Nutritional Assessment) and serum albumin were significant predictors of pressure ulcer prevalence in ICU patients. Therefore, regular MNA-SF and albumin checkups are needed to identify risk for pressure ulcer for ICU patients. In the case of decreased MNA-SF scores and serum albumin levels, more intensive pressure ulcer care is needed for ICU patients.

중환자의 인공호흡기 관련 폐렴 예방을 위한 클로르헥시딘의 효과

이하늬(Ha-Nee Lee),박정숙(Jeong Sook Park) 한국콘텐츠학회 2017 한국콘텐츠학회논문지 Vol.17 No.8

본 연구는 인공호흡기 적용 환자들의 구강간호에 있어 클로르헥시딘의 적용에 대한 효과성을 분석하고, 이를 토대로 임상에서 실질적으로 구강간호 시행에 있어 명확한 근거를 제시 하고자 시도 되었다. 주요 검색어는 Ventilator associated pneumonia AND (Oral care OR Dental care OR Chlorhexidine*)으로 검색원으로는 국내 RISS, Koreamed, KISS와 국외 MEDLINE, Cochrane Central, CINAHL, Pub Med를 활용하여 2017년 5월까지의 문헌을 대상으로 검색하였다. 총 19편의 연구가 최종 선정되었고, Revman 5.3 프로그램으로 분석 하였으며, RoB (The Cochranes Risk of Bias)도구를 이용해 문헌의 질을 평가하였다. 연구결과 중환자의 인공호흡기 관련 폐렴 예방에 있어 클로르헥시딘의 적용은 통계적으로 유의한 효과가 있었음이 나타났다. This study was to determine the effectiveness of oral decontamination with chlorhexidine for prevention of ventilator associated pneumonia(VAP) using meta-analysis. MEDLINE, Pubmed, Cochrane library CINAHL and RISS, Koreamed, KISS databases were searched. key words used Ventilator-associated pneumonia, oral care, chlorhexidine Ninety studies met the inclusion criteria for the meta-analysis. data were analyzed by the Revman 5.3 program of cochrane library and assessed for methodological quality using RoB (The Cochranes Risk of Bias). The main findings of the current study suggest that chlorhexidine oral care have a positive impact on Ventilator associated pneumonia.

요도 카테터 삽입술에서 리도카인 윤활제의 통증 감소 효과

홍현정(Hyun-Jung Hong),김가은(Ga-Eun Kim),이하늬(Ha-Nee Lee),이아름(A-Reum Lee) 한국산학기술학회 2017 한국산학기술학회논문지 Vol.18 No.6

본 연구는 요도 카테터 삽입술에서의 리도카인 윤활제의 통증 감소 효과를 검증하기 위해 수행된 체계적 문헌고찰 및 메타분석연구이다. 문헌검색은 PRISMA 가이드라인에 의거하여 데이터베이스 7개(MEDLINE, Cochrane Central, CINAHL, RISS, Koreamed, KISS, NDSL)와 회색문헌을 통해 수행되었다. 비뚤림 위험은 Risk of Bias(RoB) 도구를 통해 평가되었으며 자료의 분석은 RevMan 5.3 프로그램을 이용하였다. 문헌의 선택배제기준에 따라 합계 성인 대상자 1904명이 포함된 16편의 문헌이 최종 선정되었으며 funnel plot에서 비뚤림 위험이 관찰되지 않았다. 리도카인 윤활제의 통증 점수는 대조군과 비교할 때 표준화된 평균차이가 SMD -0.96(95% CI: -1.43, -0.49)로, 전반적으로 유의한 통증 감소효과를 보였다(p<.001). 이질성((I2=95%, p<.001)의 원인을 탐색하기 위해 카테터 종류(도뇨카테터, 경성 및 연성방광경 카테터)에 따라 하위집단 분석을 실시하였으며 표준화된 평균차이가 각각 SMD -0.88(95% CI:-1.51, -0.26), -0.31(95% CI:-0.63, 0.01), -1.93(95% CI:-2.88, -0.97)이었다. 도뇨카테터 삽입에서는 성별에 관계없이 통증 감소 효과가 있었으나 경성방광경 카테터에서는 남성에서만 유의한 통증 감소 효과가 있었다. 용량에 있어 경성 방광경 카테터에서는 리도카인 윤활제를 10-11ml 이상을 사용한 경우 통증 감소 효과가 관찰되었다. 도뇨카테터에서는 리도카인 윤활제를 도포하는 방법만으로도 시간에 관계없이 유의한 통증 감소 효과가 있었다. 본 연구 결과 리도카인 젤은 남성의 요도 내로 경성방광경 카테터를 삽입하는 경우, 남녀 모두에게 도뇨카테터 삽입을 하는 경우에 유용한 통증 감소용 윤활제로 확인되었다. This study was a systematic review and meta-analysis that evaluated the results of research on the pain reduction effects of lidocaine gel for urethral catheterization in adults. A literature search was conducted using seven electronic databases, gray literature and other resources based on the guidelines of Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA). A Risk of Bias (RoB) tool was applied to assess the quality of selected studies. Data were analyzed using the RevMan 5.3.-program. Sixteen randomized controlled trials involving 1904 adults were included. RoB was not observed in the funnel plot. Overall, lidocaine gel was effective for pain reduction during urethral catheterization (Standard Mean Difference[SMD] -0.96;95% CI: -1.43, -0.49). To explore the cause of heterogeneity (I2=95%, p<.001), subgroup analysis was conducted according to three catheter types (urinary catheter, flexible cystoscopy, and rigid cystoscopy) and the SMDs were -0.88 (95% CI:-1.51, -0.26), -0.31 (95% CI:-0.63, 0.01), and -1.93 (95% CI:-2.88, -0.97), respectively. A significant pain reduction effect was observed regardless of gender in urinary catheterization. However, in rigid cystoscopy, a significant pain reduction effect was observed only in male subjects. Pain reduction effects were observed when 10∼11ml lidocaine gel was used during rigid cystoscopy and when lubrication was used during urinary catheterization, irrespective of application time. These findings suggest that lidocaine gel is a useful anesthetic lubricant for urinary catheterization and rigid cystoscopy in male adults.