정신신체의학 (Korean Journal of Psychosomatic Medicine)

한국정신신체의학회 (Korean Psychosomatic Society)
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내시경 점막하 박리법을 시술 받은 위종양 환자에서 심리적 요인이 시술 후 통증에 미치는 영향

The Effect of Psychological Factors on Postoperative Pain in Gastric Tumor Patients after Endoscopic Submucosal Dissection

  • 이준협 (국민건강보험 일산병원 정신건강의학과) ;
  • 전한호 (국민건강보험 일산병원 소화기내과) ;
  • 이산 (국민건강보험 일산병원 정신건강의학과) ;
  • 이혁 (국민건강보험 일산병원 정신건강의학과) ;
  • 오승택 (국민건강보험 일산병원 정신건강의학과) ;
  • 장진구 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소) ;
  • 임우영 (건양대학교병원 정신건강의학과) ;
  • 박재섭 (국민건강보험 일산병원 정신건강의학과) ;
  • 최원정 (연세하나 정신건강의학과 및 정신건강연구소)
  • Lee, Joon-Hyub (Department of Psychiatry, National Health Insurance Service Ilsan Hospital) ;
  • Jeon, Han Ho (Department of Internal Medicine, National Health Insurance Service Ilsan Hospital) ;
  • Lee, San (Department of Psychiatry, National Health Insurance Service Ilsan Hospital) ;
  • Lee, Hyeok (Department of Psychiatry, National Health Insurance Service Ilsan Hospital) ;
  • Oh, Seung-Taek (Department of Psychiatry, National Health Insurance Service Ilsan Hospital) ;
  • Chang, Jhin Goo (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine) ;
  • Im, Woo Young (Department of Psychiatry, Konyang University Hospital) ;
  • Park, Jaesub (Department of Psychiatry, National Health Insurance Service Ilsan Hospital) ;
  • Choi, Won-Jung (Yonsei Hana Psychiatry Clinic and Institute of Mental Health)
  • 투고 : 2018.04.28
  • 심사 : 2018.06.19
  • 발행 : 2018.06.30
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초록

연구목적 암 환자에게 있어 통증은 삶의 질과 예후에 큰 영향을 주는 중요한 요소로 통증을 줄이기 위한 시도가 활발히 이루어지고 있다. 이러한 관점에서 위종양 환자에게 많이 시행되는 내시경 점막하 박리법 후 통증을 줄이기 위한 노력이 계속되고 있는데, 시술 후 통증에 영향을 미치는 생물학적 요인이 많이 알려진 것에 비해 심리적 요인에 대해서는 연구가 거의 이루어지지 않았다. 본 연구의 목적은 내시경 점막하 박리법을 시술 받은 위종양 환자가 시술 후 겪는 통증에 영향을 미치는 심리적 요인을 알아보고자 하였다. 방 법 본 연구는 2015년 5월부터 2016년 6월까지 국민건강보험 일산병원에 내원하여 내시경 점막하 박리법을 시술 받은 91명의 위종양 환자를 대상으로 시행되었다. 내시경 점막하 박리법을 시술 받기 전에 사회인구학적 요인과, 불안, 우울, 회복탄력성을 평가하였다. 환자들이 호소하는 통증의 정도가 시각적 유추척도 3점 이상인 군(고통증군)과 3점 미만인 군(저통증군)으로 나누었고, 시술 후 통증에 영향을 주는 요인에 대해 독립표본 T검정 및 카이제곱 검정을 시행 후 유의한 차이를 보인 요인에 대해 로지스틱 회귀분석을 시행하였다. 결 과 고통증군이 저통증군에 비해 음주량이 낮았고 우울 점수가 높게 나타났다. 또한 고통증군이 저통증군에 비해 회복탄력성 점수가 낮았으며, 회복탄력성의 하위 항목 중 자기조절능력, 긍정성 항목에서 점수가 낮았다. 다변량 로지스틱 회귀분석 결과 회복탄력성 중 자기조절능력(OR, 0.911 ; 95% CI, 0.854-0.971, p=0.004)이 낮을수록 내시경 점막하 박리법 시술 후 겪는 통증이 큰 것으로 나타났다. 결 론 본 연구 결과 내시경 점막하 박리법을 시술 받는 환자의 회복탄력성 하위 항목인 자기조절능력이 낮을수록 시술 후 더 큰 통증을 호소하는 것을 확인하였다. 따라서 본 연구에서 대상으로 한 심리적 요인 중 개인의 회복 탄력성이 통증에 영향을 주는 것을 확인하였다.

Objectives : Since pain in cancer patients is an important factor that greatly affects the quality of life and prognosis, many attempts have been actively made to reduce the pain. Despite continuous effort on reducing pain after Endoscopic submucosal dissection (ESD), research has not been done on psychological factors as much as on biological factors affecting pain. The objective of this study is to investigate the psychological factors affecting postoperative pain in gastric tumor patients who underwent gastric ESD. Methods : 91 gastric tumor patients who visited National Health Service Ilsan Hospital in Korean between May 2015 and June 2016, and received ESD were evaluated. Baseline characteristics including sociodemographic factors, anxiety, depression, and resilience were evaluated before the procedure. Multivariate logistic regression was done to analyze factors affecting postoperative pain. Results : The group with high postoperative pain showed lower alcohol consumption and higher depressive symptom scores than the group with low postoperative pain. Also, the group with high postoperative pain showed lower total resilience score with lower subtotal scores in self-control and positive item. Multivariate logistic regression analysis of the postoperative pain showed that patients with lower score in self-control of resilience [odd ratio (OR), 0.911 ; 95% CI, 0.854-0.971, p=0.004) reported more pain after ESD. Conclusions : This study showed that patients with lower self-control ability of resilience felt more pain after ESD. Among the psychological factors evaluated in this study, resilience of an individual seems to have effect on pain.

키워드

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