• 분석과학
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• 제5권3호
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• pp.345-347
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• 1992

• Clinical and Experimental Pediatrics
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• 제52권10호
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• pp.1153-1160
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• 2009

목 적:최근 다양한 치료 방법의 발전과 지지요법의 발달로, 소아 종양/혈액 질환 환자의 생존율이 향상되었으나, 적극적이고 다양한 치료를 하게 되면서 이와 관련된 여러 합병증으로 소아 중환자실에 입실하는 경우 또한 많아졌다. 이에 본 연구에서는 소아 중환자실에 입실한 소아 종양/혈액 질환 환자의 임상양상과 사망률을 살펴보고, 소아 종양/혈액 질환 환자에게 적합한 중증도 측정 체계와 사망률에 영향을 미치는 위험 요인에 대해 알아보고자 했다. 방 법:2005년 9월부터 2008년 7월까지 서울아산병원 소아 중환자실에 입실한 소아 종양/혈액 질환 환자 중 3일 이상 재실한 환자를 대상으로 후향적으로 의무기록을 조사했다. 생존군과 비생존군으로 나누어 나이, 성별, 재실 일수에 대하여 조사했고, 기저 질환과 중환자실 입원 이유, 인공호흡기 적용 여부, 투석 및 승압제 투여 여부, CRP 및 ANC에 따른 사망률을 알아보았다. 또, 생존군과 비생존군의 OSF number, SOFA score, PRISM III score, O-PRISM score를 비교하고, 점수에 따른 사망률을 알아보았다. 결 과:총 88예 중 30예가 사망하여 사망률은 34.1%이었다. 남아가 49예, 여아가 39예이었고, 평균 나이는 $7.0{\pm}5.7$세, 평균 재원일수는 $18.1{\pm}22.2$일로 이었다. 기저 질환은 혈액 질환이 68예(77.3%)로 가장 많았으며, 중환자실 입실 이유는 호흡기능 부전이 35예(39.8%)로 가장 많았고, 패혈쇼크가 19예(21.6%)이었다. CRP는 생존군에서 $9.1{\pm}9.0$, 비생존군에서 $16.4{\pm}11.2$로, 비생존군에서 유의하게 높았고(P<0.01), 비생존군에서 인공호흡기 치료나 투석이 필요했던 경우가 많았으며(P<0.01), 조혈모세포 이식을 받은 군의 사망률이 유의하게 높았다(P<0.05). 중증도 측정 체계 중에서는 initial OSF number, highest OSF number, SOFA score, PRISM III score가 비생존군에서 의미있는 증가를 보였고(P<0.01), 이들을 수용자 작업특성곡선을 사용하여 비교하였을 때, highest OSF number가 곡선하면적 0.845로 가장 높았고, 중환자실 입실 24시간 이내에 측정한 PRSIM III score와 SOFA score의 곡선하면적이 각각 0.723, 0.751로 유의한 결과를 보였다. 총 21예에서 조혈모세포 이식을 받았으며 이들의 O-PRISM score는 비생존군에서 높은 경향을 보였으나, 통계적으로 유의하지는 않았다. 결 론: 본 연구에서 소아 중환자실 입실한 소아 종양/혈액 질환 환자 사망의 위험인자로는 CRP, 인공호흡기 치료, 투석, 조혈모세포 이식이 있었으며, 예후 예측지표로는 highest OSF number, PRISIM III score, SOFA score가 의미 있는 것으로 분석되었다.

• Childhood Kidney Diseases
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• 제13권2호
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• pp.189-196
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• 2009

목적 : 신증후군에서 사구체 단백 투과성이 증가하는 것은 전신적인 순환 인자와 관련되어 있는 것으로 여겨진다. 전신적인 순환 인자의 사구체 외 기관에서의 영향과 관련하여, 본 연구에서는 복막 투석 중인 steroid resistant nephrotic syndrome (SRNS) 환자에서의 복막투석을 통한 단백 소실 정도를 파악하고자 하였다. 방법 : 2001년부터 2009년까지 복막 투석 중인 신증후군 환자 12명(SRNS)과 대조군 14명을 대상으로 후향적 환자-대조군 연구를 시행하였다. 성별, 투석 시작 시 연령, 체중, 신장, 투석 방법, 투석양, 투석 시작 시 검사 소견(혈액 요소 질소, 혈청 크레아티닌, 혈청 단백, 혈청 알부민, 24시간 투석액 부피, 24시간 투석액 단백, Kt/V)과 1년 뒤 투석 시 검사 소견(24시간 투석액 단백)을 조사하였다. 단백질 섭취 정도를 평가하기 위해 nPNA (normalized protein equvalent of total nitrogen appearance)를 측정하였다. 결과 : SRNS군과 대조군은 nPNA를 비롯한 다른 지표에 의미 있는 차이를 보이지 않았으나, SRNS군에서 혈청 알부민이 $3.7{\pm}0.3$ g/dL로 대조군($4.0{\pm}0.4$ g/dL, P=0.021)보다 낮았다. 복막액을 통한 단백 소실량은 SRNS군에서 대조군보다 통계학적으로 의미 있게 높았으며($3,044.4{\pm}837.6\;mg/m^2$/day vs. $1,791.6{\pm}1,244.0\;mg/m^2$/day, P=0.007), 혈장 단백에 대한 복막의 투과성은 SRNS군에서 대조군보다 2배 가량 높았다($1.06{\pm}0.46%$ vs. $0.58{\pm}0.43%$, P=0.010). SRNS군과 대조군 모두 초기와 1년 뒤 복막 단백 소실량이 증가하였으나 대조군에서 더 큰 차이를 보였으며 복막 단백 소실량의 시간 경과에 따른 변화는 두 군(SRNS군 vs. 대조군)간에 의미있게 차이가 있었다(P=0.023). 결론 : 신증후군을 앓고 있는 소아 환자에서 복막 투석을 시행할 때는 이들의 영양상태, 성장 및 발달에 평가가 보다 적극적으로 이루어져야 하고, 복막을 통한 단백 소실을 모니터링하여 이를 보충하려는 노력 또한 필요하리라 생각된다.

• 대한간호학회지
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• 제45권2호
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• pp.271-279
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• 2015

Purpose: This study was done to examine the relation of uncertainty, uncertainty appraisal, and self-management in patients undergoing hemodialysis, and to identify factors influencing self-management. Methods: A convenience sample of 92 patients receiving hemodialysis was selected. Data were collected using a structured questionnaire and medical records. The collected data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlations and multiple regression analysis with the SPSS/WIN 20.0 program. Results: The participants showed a moderate level of uncertainty with the highest score being for ambiguity among the four uncertainty subdomains. Scores for uncertainty danger or opportunity appraisals were under the mid points. The participants were found to perform a high level of self-management such as diet control, management of arteriovenous fistula, exercise, medication, physical management, measurements of body weight and blood pressure, and social activity. The self-management of participants undergoing hemodialysis showed a significant relationship with uncertainty and uncertainty appraisal. The significant factors influencing self-management were uncertainty, uncertainty opportunity appraisal, hemodialysis duration, and having a spouse. These variables explained 32.8% of the variance in self-management. Conclusion: The results suggest that intervention programs to reduce the level of uncertainty and to increase the level of uncertainty opportunity appraisal among patients would improve the self-management of hemodialysis patients.

• 간호행정학회지
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• 제11권1호
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• pp.33-44
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• 2005

Purpose: This study was aimed to estimate nursing cost for hemodialysis of tertiary hospitals using Resource Based Relative Value Scale(RVRBS). Method: First, we calculated nursing workload of the each hemodialysis-nursing behaviors compared with basic nursing behavior(check vital sign) for the most severe hemodialysis patients in general hospitals. Second, we measured each spent time according to each nursing behaviors. Third, we computed Resource Based Relative Value(RBRV) scores and nursing expenses of each 14 nursing behavior for hemodialysis. Finally, we estimated nursing cost of each hemodialysis-behavior for the most severe hemodialysis-patients in general hospitals. Result: The mean RBRV scores for each nursing behaviors were from 218.9 to 383.9 points. The highest RBRV socres were 383.9(Complication during hemodialysis). The Nursing behavior that spent the most time was "access the vascular( 31.7 minutes)". Nursing cost per hemodialysis for the patient with severe condition was estimated 63,455(won). Conclusion: Total average workload was 347.6 points and total spent time was 306.5 minutes for 14 hemodialysis nursing behaviors provided to severe patients. There were clear differences in nursing workload and cost according to patient's severity-mild, moderate and severe class.

• Journal of Korean Biological Nursing Science
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• 제15권1호
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• pp.15-23
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• 2013

Purpose: The purpose of this study was to identify the relationship among the attitudes on exercise, physical activity and quality of life (QOL) in hemodialysis patients. Methods: A total of 42 patients in a hemodialysis unit participated in this study. Physical activity level was measured directly by 6 minute walking test and grip strength test. Structured questionnaires were also used for measuring their attitudes on exercise, physical activity and QOL. Participants' medical records were reviewed for obtaining their biochemical and clinical information. Statistical analysis was performed using Pearson correlation, and multiple liner regression. Results: A significant positive correlation between participants' attitudes and physical activity level measured by International Physical Activity Questionnaire (IPAQ) was found. And the physical activity level measured by Korea Activity Scale/Index (KASI) was significantly related to QOL. Conclusion: This study shows that QOL of the hemodialysis patients was significantly associated with their physical activity level.

• 성인간호학회지
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• 제23권6호
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• pp.615-623
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• 2011

Purpose: The purpose of this study was to identify the effects of aromatherapy on sleep disorders, satisfaction of sleep and fatigue in hemodialysis patients. Methods: The study design was a quasi-experimental study with nonequivalent control group pretest-posttest design. The subjects were assigned an experimental group (N=17) and a control group (N=17). The experimental group had inhaled lavender and sweet orange for 2 minutes three times a day for 7 days. Sleep disorders were measured using Sleep Measuring Instrument and satisfaction of sleep was gauged using Visual Analogue Scale. Fatigue was checked using Fatigue Measuring instrument. Collected data were analyzed by ${\chi}^2$-test, t-test, Fisher's exact test, and paired t-test using SPSS/WIN 17.0 program. Results: There are significant differences in the sleep disorders, satisfactions of sleep and fatigue between experimental group and control group. Conclusion: Aromatherapy reduced the sleep disorders and the fatigue and increased satisfactions of sleep in hemodialysis patients. Based on the results of this study, aromatherapy can be used at the any setting as a safe and effective independent nursing intervention to sleep disorders and fatigue in hemodialysis patients.

• 임상간호연구
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• 제20권3호
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• pp.395-405
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• 2014

Purpose: This study was a descriptive correlation research designed to provide basic data on family nursing interventions by examining burden, social support and quality of life for family caregivers of patients on hemodialysis. Methods: Data were collected from 132 family caregivers of patients on hemodialysis and analyzed using frequency analysis, correlation analysis, independent samples t-test method, one-way ANOVA and post-hoc analysis of $Scheff{\grave{e}}$, and multiple regression analysis. Results: Burden for family caregivers of patients on hemodialysis was 3.03, social support, 4.77, and quality of life, 3.26. Burden showed a negative correlation with social support (r=-.34, p<.001), and with quality of life (r=-.54, p<.001). There was a positive correlation between social support and quality of life (r=.54, p<.001). Factors predicting quality of life for family caregivers, were a significant and positive effect from social support (t=5.72, p<.001) and a negative effect from family burden (t=-5.62, p<.001). Conclusion: Results of the study indicate that burden of these family caregivers can be reduced by social support which plays an important role in improving quality of life. A nursing intervention program which goes beyond simply caring for patients and includes assessment of family burden and support for overall family caretaking needs to be developed.

• 대한간호학회지
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• 제26권4호
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• pp.903-916
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• 1996

The purpose of this study was to discover practical health problems which hemodialysis clients experienced so as to present basic data for development of a health assessment tool. The research subjects were 70 clients receiving hemodialysis in Seoul and Inchon from Mar. 1996 to Sep. 1996. Data were collected by researcher's informal indepth interview and nurses' open ended question. Content analysis was applied to collect similar contents and common experiences in order to derivate concepts and categories for better understanding of hemodialysis clients' experiences. As a result, 9 categories derivated to identify the health problems of clients receiving hemodialysis were as follows : 1) They experienced 'the decreased digestive function' which contained the changed appetite, nausea, vomiting, constipation and diarrhea. 2) They experienced 'the decreased respiratory and circulatory function' which contained dyspnea, changed blood pressure, tingling sensation and the fear of aggrevated vascular condition. 3) They experienced 'the aggrevated oral condition' which contained dry mouth and destruction of teeth and their soft tissue. 4) They experienced 'the decreased sensory function' which contained visual disturbances, sensation difficulty, and hearing loss. 5) They experienced 'the aggrevated skin condition' which contained dark brown skin color, dry skin (and hyperpigmentatic freckle, seborrheric keratosis, scale), itching sense, and alopethia. 6) They experienced 'the decreased urinary reproductive function' which contained anuria or oliguria, dysmenorrhea, sterility and decreased libido. 7) They experienced 'the restricted activity' which contained decreased activity, muscle cramp and stiffness of joint. 8) They experienced 'the changed mental status' which contained memory disturbance, decreased cognition, disorientation, neurosis and psychosis. 9) They experienced 'the aggrevated general condition' which contained kyphosis, weight loss, fatigue, sleep disturbance, bleeding tendency, inflammation, generalized edema and foul oder of uremia.

• 한국보건간호학회지
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• 제15권2호
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• pp.314-323
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• 2001

The purpose of this study was to investigate the levels of hope and the influencing factors on the hope in the hemodialysis patients. The subjects of this study consisted 101 patients who had received hemodialysis In two hospitals affiliated with Catholic University from June to August, 2000. The instruments used for the study were the Hope scale by Miller(1998) and Quality of life scale, Self esteem scale and Social support scale. Cronbach's $\alpha$ of measurement tools used in the study were 0.93 for the hope, 0.96 for quality of life, 0.78 for self-esteem and 0.92 for the social support. The data were analyzed by mean, t-test, ANOVA. Scheffe test, Pearson correlation coefficients and Stepwise multiple regression using the SAS program. The results were as follows; 1. Out of a score of 164 the mean score of the hope was $107.3\pm16.7$. The mean quality of life score was 102.5 out of 160. The scores concerning social support turned out to have a mean of 67.8 out of 100. The levels concerning self-esteem and self respect had a mean of 25.1 out of 40. 2. There was a positive relation between the quality of life and social support. Furthermore, the hope level was proportional to factors such as quality of life and social support. 3. Social support accounted for $32\%$ of influential variable on the hope. If transportation way to the hospital and quality of life were added. the total predictors explained $45\%$. The results suggested that the hope levels of hemodialysis patients were influenced by their social support and quality of life. Therefore nurses are encouraged to elevate the levels of patients' hope by using the social support and quality of life in caring the patients receiving hemodyalysis.