기립저혈압 노인을 위한 자율신경균형기반 통합 프로그램 개발 및 효과

Other Titles
Effects of Mechanism-based Integrated Approach to Autonomic Dysfunction in the Elderly with Orthostatic Hypotension
Authors
한정화
Issue Date
2020-02
Abstract
The purpose of the study was to develop and examine the effects of the Mechanism-based Integrated Approach to Autonomic Dysfunction (MIAAD) in the elderly with orthostatic hypotension. A non-equivalent control group pre/post-test design was used. Data was collected between February 1 to July 24, 2019. The experimental group consisted of 26 subjects and 24 subjects in the control group who were elderly community-dweller living with orthostatic hypotension in D city. The experimental group participated in 12 sessions of the MIAAD program, and the control group received 30 minutes of education on the management and prevention of orthostatic hypotension along with the use of a workbook. SPSS Statistics 20.0 was used to analyze the data. The Chi-square test, Fisher's exact test, and Mann-Whitney U test were used to test homogeneity. Hypothesis test was performed using the Wilcoxon signed-rank test, Mann-Whitney U test, and ANCOVA. The results of the study: There were significant difference between the two groups' change in both systolic blood pressure (z=-2.80, p=.005) and diastolic blood pressure (z=-2.63, p=.009) when standing up, self-reported orthostatic symptoms (U=84.50, p=<.001), amounts of subjective physical activity (U=25.00, p=<.001), and light intensity of physical activity (F=6.61, p=.014), level of falls efficacy (U=77.50, p=<.001), level of depression (U=97.50, p=<.001), level of social isolation (U=57.00, p=<.001), and level of health-related quality of life (U=45.20, p=<.001). However, autonomic nervous system activity [standard deviation of n-n interval (U=292.00, p=.698), total power (U=275.00, p=.472), root mean square of successive n-n interval differences (U=282.00, p=.560), high frequency [HF] (U=285.00, p=.600)], low frequency [LF] (U=269.00, p=.404), LF/HF ratio (U=284.50, p=.593)], amounts of objective physical activity [total physical activity (F=0.13, p=.725), sedentary time (F=1.72, p=.197), moderate intensity of physical activity (F=0.05, p=.829), vigorous intensity of physical activity (F=3.75, p=.059), metabolic equivalent of task (F=1.27, p=.266)] showed no significant difference between the two groups. In conclusion, the MIAAD program had no significant effect on improving the function of the autonomic nervous system in the elderly with orthostatic hypotension. However, MIAAD program indirectly impacted the function of the autonomic nervous system in a positive effect. Therefore, by expanding and incorporating the MIAAD program to the community-dwelling elderly population whose quality of life reduced by orthostatic hypotension, the MIAAD program can improve health-related quality of life in affected the elderly with orthostatic hypotension.
본 연구는 기립저혈압 노인을 위한 자율신경균형기반 통합 프로그램을 개발하고 그 효과를 검증하기 위한 목적으로 실시되었다. 연구설계는 비동등성 대조군 전후 설계로 자료수집 기간은 2019년 2월 1일부터 7월 31일이었다. 연구대상은 D광역시에 거주하고 있고 기립저혈압이 있는 재가 노인으로 실험군 26명, 대조군 24명이었다. 본 연구에서 실험군에게는 자율신경균형기반 통합 프로그램을 총 12회로 제공하였고, 대조군에게는 30분간의 기립저혈압 예방 및 관리 교육과 워크북을 제공하였다. 자료분석은 SPSS Statistics 20.0을 이용하였으며, 동질성 검정은 Chi-square test, Fisher’s exact test 및 Mann-Whitney U test로, 가설검정은 Wilcoxon signed rank test와 Mann-Whitney U test, ANCOVA로 분석하였다. 연구결과는 다음과 같다. 자율신경균형기반 통합 프로그램 중재 전·후 기립 시 수축기 혈압(z=-2.80, p=.005), 이완기 혈압(z=-2.63, p=.009), 기립성 증상(U=84.50, p=<.001), 주관적 신체활동량(U=25.00, p=<.001), 객관적 저강도 신체활동량(F=6.61, p=.014), 낙상효능감(U=77.50, p=<.001), 우울(U=97.50, p=<.001), 사회적 고립감(U=57.00, p=<.001), 건강관련 삶의 질(U=45.20, p=<.001)은 그룹 간 유의한 차이가 있는 것으로 나타났다. 그러나 자율신경계 활성도[standard deviation of n-n interval (U=292.00, p=.698), total power (U=275.00, p=.472), root mean square of successive n-n interval differences (U=282.00, p=.560), high frequency (U=285.00, p=.600)], low frequency (U=269.00, p=.404), LF/HF ratio (U=284.50, p=.593)], 객관적 신체활동량[총 신체활동량(F=0.13, p=.725), 휴식시간(F=1.72, p=.197), 중강도 신체활동량(F=0.05, p=.829), 고강도 신체활동량(F=3.75, p=.059), 신체활동 에너지소비량(F=1.27, p=.266)]은 두 그룹 간 유의한 차이가 없는 것으로 나타났다. 결론적으로, 자율신경균형기반 통합 프로그램은 기립저혈압 노인의 자율신경기능 개선에는 직접적인 효과가 없었으나 간접적으로는 자율신경기능 개선에 긍정적인 영향을 미친 것으로 사료된다. 그 결과 자율신경기반 통합 프로그램이 기립저혈압 노인의 기립 시 저혈압을 완화시키는데 효과적인 것으로 확인되었다. 따라서 추후 MIAAD 프로그램을 확대·적용하여 기립저혈압으로 인해 삶의 질이 저하된 노인의 건강관련 삶의 질을 향상시키는데 도움을 줄 수 있으리라 생각된다.
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/42586
Appears in Collections:
3. Thesis (학위논문) > 2. College of Nursing (간호대학) > 박사
Full Text
http://dcollection.kmu.ac.kr/common/orgView/000000118543
File in this Item
 사서에게 요청하기
Export
RIS (EndNote)
XLS (Excel)
XML


qrcode

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

BROWSE