성인과 노인에서 급성 외상성 경막하 혈종의 예후 비교: 후향적 조사연구 = Comparison of prognosis between Adult and Elderly Patients with Traumatic Acute Subdural Hematoma: Retrospective survey research

다국어 초록 (Multilingual Abstract)

This research was implemented to provide foundation information of nursing care provision to the proper age group by searching for the difference between general characteristics of Traumatic Acute Subdural Hematoma and disease-related characteristics, and comparing prognosis within two groups; adult group and elderly group based on 65-year-old subjects.

In this study, the test subjects were 239 patients(adult 104, the elder 135) diagnosed with traumatic subdural hematoma and treated at C University Hospital in Gwang-ju between January 2017 and March 2019. A retrospective medical survey study was conducted to investigate the general and disease-related characteristics of the subjects, GCS and GOS scores at discharge, and pre-hospital and post-hospital status. The data is collected by Win SPSS 25.0 and analyzed using test, t-test, and ANOVA.

The results of this study are as follows.

The general characteristics of the people surveyed were 50.90±11.86 years of age in the adult group and 75.04±6.1 years in the elderly group. There was a significant difference in gender(=20.776, p=.041) between the adult and the elderly, and there was a statistically significant difference in the presence or absence of comorbidities.(=20.776, p<.001). There was also a significant difference in the history of drinking(=20.117, p<.001) and of smoking(=22.485, p<.001) between the two groups. There was a statistically significant difference in job status between the two groups(=20.850, p<.001). The two groups showed statistically significant differences in traumatic occurrence(=20.029, p=.003); adults came in orders of 34.6% of falling down and 25.0% of slipping, and 39.3% of slipping and 17.8% of falling down in the elderly group.
The disease-related characteristics of the people surveyed were statistically significant at GCS of 10.24±4.449 in the adult group and 11.44±3.674 in the elderly group(=-2.221, p=.028). There was a significant difference in pupil reflection at admission(=8.037, p=.005), but there was no significant difference in pupil reflection during admission(=0.544, p=.461). There were significant differences in pH(=-3.299, p=.001) and Serum blood glucose(=-0.849, p=.040) between the two groups at admission. There were significant differences in systolic blood pressure(=-3.097, p=.002) between adult and elderly groups. There was also a statistically significant difference between the two groups in terms of history of surgery(=10.159, p=.001) and complications(=6.450, p=.011).
There was no statistically significant difference between the GCS at discharge(t=-0.027, p=.978) and the GOS at discharge(t=0.173, p=.863) after comparing the clinical results of the people surveyed. However, when examined in detail there were significant differences in GCS, pupil reflection at admission, pupil reflection during admission, hematoma type, INR, hyperglycemia, blood pressure, and history of surgery.
Through out the result of this study proved both adult and elderly group with traumatic acute subdural hematoma after admission resulted in better prognosis after admission with higher GCS at admission. With the cases of existence of pupil reflection at admission, or without any change during admission, small size hematoma, low INR, normal range in blood sugar, maintaining high blood pressure, and patients without surgery showed good prognosis after admission in two groups: adult and elderly. Therefore, nurses need to provide care service to the subject group with traumatic acute subdural hematoma at the site of clinic in consideration of the study mentioned above.

국문 초록 (Abstract)

본 연구는 만 65세를 기준으로 성인군과 노인군으로 나누어 외상성 급성 경막하 혈종의 일반적인 특성과 질병관련 특성의 차이를 알아보고 예후를 비교하여 연령대에 맞는 간호서비스제공의 기초 자료를 제공하고자 이 연구를 시행하였다.
연구대상은 G광역시에 소재하는 C대학병원에 외상성 급성 경막하 혈종(Traumatic acute subdural hematoma)으로 진단 후 치료받은 239명(성인군: 104명, 노인군: 135명)이었고, 자료 수집은 2017년 1월부터 2019년 3월까지 실시하였다. 본 연구는 후향적 의무기록조사 연구로 대상자의 일반적 특성과 질병적 특성에 따른 퇴원 시 GCS, GOS를 조사하였다. 수집된 자료는 Win SPSS 25.0을 이용 하였으며 test, t-test, ANOVA를 통해 분석하였다.


본 연구의 결과는 다음과 같다.

대상자의 일반적 특성은 성인군의 평균 연령 50.90±11.86세였고, 노인군의 평균 연령은 75.04±6.1세였다. 성인군과 노인군의 성별(=-4.186, p=.041)유의한 차이가 있었고, 동반질환 유무도 통계적으로 차이가 있었다(=20.776, p<.001). 두 군 간의 음주력(=20.117, p<.001)과 흡연력(=22.485, p<.001)또한 유의한 차이가 있었다. 두 군 간의 직업의 유무는 통계적으로 유의한 차이가 있었다(=20.850, p<.001). 두 군은 외상기전별로도 통계적으로 유의한 차이를 보였는데(=20.029, p=.003), 성인군은 떨어짐 34.6%이 가장 많았고, 노인군은 넘어짐 39.3%이 가장 많았다.
대상자의 질병 관련 특성은 입원 시 GCS는 성인군은 10.24±4.449점, 노인군은 11.44±3.674점으로 통계적으로 유의한 차이가 있었다(=-2.221, p=.028). 입원 시 동공반사 유무는 유의한 차이가 있었으나(=8.037, p=.005), 입원 중 동공반사의 변화는 유의한 차이가 없었다(=0.544, p=.461). 입원 시 동맥혈검사에서는 두 군 간에 pH(=-3.299, p=.001)와 Serum blood glucose(=-0.849, p=.040)가 유의한 차이가 있었다. 성인군과 노인군의 수축기 혈압(=-3.097, p=.002)은 유의한 차이가 있었다. 두 군 간의 수술력(=10.159, p=.001)과 합병증의 유무(=6.450, p=.011)도 통계적 으로 유의한 차이가 있었다.
대상자의 임상 결과를 비교한 결과 성인군과 노인군의 퇴원 시 GCS(t=-0.027, p=.978), 퇴원 시 GOS(t=0.173, p=.863)는 통계적으로 유의한 차이가 없었다. 그러나 세부적으로 살펴본 결과, 성인군과 노인군에서 입원 시 GCS, 입원 시 동공반사의 유무, 입원 중 동공반사의 변화, 혈종의 형태, INR, 고혈당, 혈압, 수술력에서 유의한 차이가 있었다.

이상의 연구결과를 통해 성인군과 노인군의 외상성 급성 경막하 혈종의 퇴원 시 예후는 두 군 모두 입원 시 GCS가 높을수록 퇴원 시 예후가 좋았다. 입원 시 동공반사가 있는 경우와 입원 중 동공반사의 변화가 없는 경우, 혈종의 크기가 크지 않는 경우, INR은 낮은 경우, 혈당은 정상범위인 경우, 혈압은 높게 유지되는 경우, 수술은 하지 않는 경우에서 두 군 모두 퇴원 시 예후가 좋은 것으로 나타났다. 따라서 임상현장에서 외상성 급성 경막하 혈종 대상자를 간호할 때 본 연구결과를 고려하여 간호를 제공하는 것이 필요하다고 생각한다.

목차 (Table of Contents)

• (국문초록) ········································································ ⅲ
• Ⅰ. 서 론 ··········································································· 1
• 1. 연구의 필요성 ······························································· 1
• 2. 연구 목적 ···································································· 2
• 3. 용어정의 ······································································ 3
• Ⅱ. 문헌 고찰 ······································································ 5
• 1. 외상성 경막하 혈종 ························································· 5
• 2. 외상성 급성 경막하 혈종 예후와 관련된 특성 ·························· 8
• Ⅲ. 연구 방법 ····································································· 11
• 1. 연구설계 ····································································· 11
• 2. 연구대상 ····································································· 11
• 3. 연구도구 ····································································· 12
• 4. 자료수집기간 및 수집방법 ················································ 13
• 5. 자료분석방법 ······························································· 14
• Ⅳ. 연구 결과 ···································································· 15
• 1. 대상자의 일반적 특성 ····················································· 15
• 2. 대상자의 질병 관련 특성 ················································· 18
• 3. 성인군과 노인군의 임상 결과 비교 ····································· 20
• Ⅴ. 논 의 ·········································································· 33
• Ⅵ. 결론 및 제언 ································································· 40
• 1. 결론 ·········································································· 40
• 2. 제언 ·········································································· 41
• 참고 문헌 ········································································· 43
• Abstract ··········································································· 46
• 부 록 ·········································································· 49
• 부 록 1. 증례기록지 ··························································· 49
• 부 록 2. 생명연구윤리위원회 심의결과 통보서 ···························· 50