DOI QR코드

DOI QR Code

말기암환자의 섬망으로 인한 진정제 투약과 생존기간에 관한 후향적 코호트 연구

Retrospective Cohort Study on the Administration of Sedative for Delirium in Terminally Ill Cancer Patients and Survival Time

  • Park, Hyoung Sook (College of Nursing, Pusan National University) ;
  • Kim, Dae Sook (Department of Nursing, Pusan National University Hospital) ;
  • Bae, Eun Hee (Department of Nursing, Pusan National University Hospital) ;
  • Kim, Jung Rim (Department of Nursing, Pusan National University Hospital) ;
  • Seo, Jung Hwa (Department of Nursing, Pusan National University Hospital) ;
  • Yun, Jung Mi (Department of Nursing, Pusan National University Hospital)
  • 투고 : 2015.10.27
  • 심사 : 2016.05.30
  • 발행 : 2016.06.01

초록

목적: 본 연구의 목적은 섬망이 있는 말기암환자에 있어 진정제의 투약 투약 관련 특성을 파악하고, 진정제 투약군과 비투약군 간의 생존기간의 차이를 확인하기 위함이다. 방법: 본 연구는 2012년 1월부터 2013년 12월까지 B 광역시 소재 P대학교병원에서 응급실과 수술실, 중환자실을 제외한 병동에서 임종한 암환자 900명 중 경과기록지, 간호기록지를 통해 섬망선별 도구인 Nu-DESC를 이용하여 섬망이 있었던 말기암환자 240명을 대상자로 선정하였다. 투약기록지를 통해 진정제인 haloperidol, diazepam, lorazepam을 정맥 또는 근육주사로 규칙적이거나 필요 시 투여한 횟수를 조사하였다. 결과: 연구 대상자의 섬망기간은 최소 1일에서 최대 61일까지 나타났고, 중앙값은 5일이었다. 연구 대상자에게서 나타난 섬망 특성은 부적절한 행동이 35.0%로 가장 많았다. 연구 대상자의 연령(F=3.96, P=0.021), 원발암의 종류(F=3.31, P=0.010), 항암치료 여부(t=-3.44, P=0.001)에 따른 섬망기간이 유의한 차이가 있었다. 연구 대상자가 진정제를 복용한 경우는 72.1%이었고, 투약된 진정제의 종류는 haloperidol이 59.6%로 가장 많았다. 진정제 투약군의 생존기간은 평균 16.85일, 비투약군은 9.37일로 나타났으나 이는 통계적으로 유의하지는 않아(t=1.766, P=0.079) 진정제 투약이 생존기간에 영향을 미치지는 않았다. 결론: 말기암환자의 섬망 발생 시 진정제 투약이 생존기간에 미치지 않았다. 이러한 결과를 바탕으로 생명단축의 윤리적 문제로 인해 진정제 사용을 꺼려하기 보다는 증상완화를 위한 진정제 치료를 적극적으로 권유할 수 있다. 또한 섬망은 가족이나 의료진과의 의사소통 장애를 유발할 뿐 아니라 환자나 가족들에게 스트레스로 작용하며 돌봄에 대한 부담감을 가중시키므로, 적절한 진정제의 투여는 말기암환자와 가족의 안위를 위해 적극적으로 추천하는 바이다.

Purpose: This study analyzed the difference in survival time of patients with delirium according to sedative medication. Methods: From January 2012 through December 2013, a retrospective cohort study was performed using the electronic medical records (EMR) of Pusan National University Hospital. Among 900 patients who died from cancer, we selected 240 who suffered delirium based on the EMR. The Nu-DESC delirium screening test was used to diagnose delirium. Results: The median length of delirium period was five days. Delirium characteristics were dominated by inappropriate behaviors (35.0%). Sedatives were administered in 72.1% of the cases. The most frequently used sedative was haloperidol which was used in 59.6% of cases. The delirium period significantly differed by patients' age (F=3.96, P=0.021), cancer type (F=3.31, P=0.010), chemotherapy (t=-3.44 P=0.001). The average survival time was 16.85 days for the sedative medication group and 9.37 days for the non-medication group, which, however, was not significant (t=1.766, P=0.079). Conclusion: In this study, the use of sedatives did not affect patients' survival time. Thus, appropriate sedative medication can be positively recommended to comfort terminal cancer patients and their families.

키워드

참고문헌

  1. National Cancer Registration and Statistics [Internet]. Seoul: Ministry of Health and Welfare; 2012 [cited 2013 Jan 20]. Available from: https://ncrs.cancer.go.kr/index.do.
  2. Cancer control Act [Internet]. Seoul: Ministry of Health and Welfare; 2010 [cited 2012 Arp 10]. Available from: http://www.lawkorea.com.
  3. Lee HR. Management of non-pain symptoms in terminally ill cancer patients: based on National Comprehensive Cancer Network Guidelines. Korean J Hosp Palliat Care 2013;16:205-15. https://doi.org/10.14475/kjhpc.2013.16.4.205
  4. Chiu TY, Hu WY, Chen CY. Prevalence and severity of symptoms in terminal cancer patients: a study in Taiwan. Support Care Cancer 2000;8:311-3. https://doi.org/10.1007/s005209900112
  5. Kim MH. Main symptoms of cancer patients by stage in a general hospital [master's thesis]. Seoul: Hanyang Univ.; 2010. Korean.
  6. Cheon JS. Practical guide to terminal delirium. J Korean Soc Biol Ther Psychiatry 2010;16:93-101.
  7. Brown TM, Boyle MF. Delirium. BMJ 2002;325:644-7. https://doi.org/10.1136/bmj.325.7365.644
  8. Irwin SA, Rao S, Bower KA, Palica J, Rao SS, Maglione JE, et al. Psychiatric issues in palliative care: recognition of delirium in patients enrolled in hospice care. Palliat Support Care 2008;6: 159-64.
  9. Cho MA. The attitude of family members about sedative injection for relief to terminal cancer patients [master's thesis]. Daejeon: Chungnam National Univ.; 2012. Korean.
  10. Kwak KH, Do BS, Park SY, Lee SM. Risk factors for delirium in elderly patients visiting an emergency department. J Korean Soc Emerg Med 2011;22:489-93.
  11. Kim HY, Park MS, Lee HJ. The effects of delirium prevention education on hospitalized elders at high risk for delirium. J Korean Gerontol Nurs 2007;9:60-7.
  12. Yang YH. Prevalence and precipitating factors for delirium in elderly patients admitted to long-term care hospitals or to general hospital. J Korean Acad Fundam Nurs 2010;17:26-34.
  13. Im CS, Cha SM, Kim JH, Lee JM, Kim JL. Retrospective study on the development and outcome of delirium in elderly inpatient. J Korean Soc Biol Ther Psychiatry 2012;18:186-93.
  14. Han MI. Clinical approach to delirium in elderly patients. J Korean Geriatr Psychiatry 2004;8:96-101.
  15. Hwang SW, Kang SW, Kang YG, Choi SG, Lee J, Kim MJ, et al. Risk factors of delirium in elderly inpatients. J Korean Acad Fam Med 2002;23:112-21.
  16. Suh HJ, Yoo YS. Intensive care unit nurse's knowledge, nursing performance, and stress about delirium. J Korean Acad Adult Nurs 2007;19:55-65.
  17. Choi EJ, Lee HJ, Kim IA, Lim YJ, Lee MS, Kim MJ. Delirium assessment ability of clinical nurses. J Korean Gerontol Nurs 2011;13:233-41.
  18. Jang JE, Kim SW, Kim YH, Kim SY, Kim JM, Shin IS, et al. Relationship between severity of delirium and mortality in patients with cancer. J Korean Soc Biol Ther Psychiatry 2011;17:131-9.
  19. Ahn MH, Yeom CH, Lee HR. The factual survey of using sedative agents in terminal cancer patients. J Korean Acad Fam Med 2002;23:521-6.
  20. Cho HJ, Kim HK, Kim KK, Kim YI, Suh SY, Cho KH, et al. Delirium in the final weeks of terminally ill cancer patients. Korean J Fam Med 2009;30:285-91. https://doi.org/10.4082/kjfm.2009.30.4.285
  21. Morita T, Ikenaga M, Adachi I, Narabayashi I, Kizawa Y, Honke Y, et al. Family experience with palliative sedation therapy for terminally ill cancer patients. J Pain Symptom Manage 2004;28:557-65. https://doi.org/10.1016/j.jpainsymman.2004.03.004
  22. Song HN, Lee AN, Lee US, Go SI, Kang MH, Kim HG, et al. S-455 : Palliative sedation: experience in a tertiary center in Korea. Korean J Intern Med 2013;1:267.
  23. Lee KW, Lee JH, Choi YJ, Lee TK, Kim SS, Shin HJ, et al. Analysis of deaths of the patients with terminal cancer. Korean J Med 2003;65:66-70.
  24. Gaudreau JD, Gagnon P, Harel F, Tremblay A, Roy MA. Fast, systematic and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. J Pain Symptom Manage 2005;29:368-75. https://doi.org/10.1016/j.jpainsymman.2004.07.009
  25. Park YS. The development and effects of evidence-based nursing practice guideline for the nursing of delirium in cancer patients [dissertation]. Jinju: Gyeongsang National Univ.; 2011. Korean.
  26. Ko HJ, Youn CH, Chung SE, Kim AS, Kim HM. Risk factors related to development of delirium in hospice patients. Korean J Hosp Palliat Care 2014;17:170-8. https://doi.org/10.14475/kjhpc.2014.17.3.170
  27. Morgenthaler TI, Silber MH. Amnestic sleep-related eating disorder associated with zolpidem. Sleep Med 2002;3:323-7. https://doi.org/10.1016/S1389-9457(02)00007-2
  28. Park YH. Risk factors of delirium among the patients in the medical intensive care unit at a general hospital [master's thesis]. Ulsan: Ulsan Univ.; 2014. Korean.
  29. Yu JC. Delirium: concept, evaluation and treatment guidelines. J Korean Geriatr Psychiatry 2008;12:51-6.
  30. Caraceni A, Somonetti F. Palliating delirium in patients with cancer. Lancet Oncol 2009;10:164-72. https://doi.org/10.1016/S1470-2045(09)70018-X
  31. Bae JH, Kang WS, Paik JW, Kim JW. Changing trends in the occurrence and management of delirium for 5 years in a university hospital. Korean J Psychosomat Med 2012;20:112-9.
  32. Breitbart W, Strout D. Delirium in the terminally ill. Clin Geriatr Med 2000;16:357-72. https://doi.org/10.1016/S0749-0690(05)70061-6
  33. Sykes N, Thorns A. The use of opioids and sedatives at the end of life. Lancet Oncol 2003;4:312-8. https://doi.org/10.1016/S1470-2045(03)01079-9