혈액투석 환자의 응급실 내원 예측요인

Abstract

The objective of this descriptive study was primarily to identify predictors associated with hemodialysis patients visiting the emergency room. To achieve this, emergent hemodialysis patients's predictors were specifically investigated and the result will provided a basic structural information which could possibly reduce the number of hemodialysis patients. Data of 195 hemodialysis patients were collected from August 11, 2014 to September 13, 2014, at the K university hospital located in Daegu. Measurement scales were designed in categories of social support, BDI(Beck Depression Inventory), knowledge about hemodialysis, self-efficacy, and self-management behavior. For both dialysis-related characteristics and the physiological index were reviewed by EMR (Electronic Medical Record) by using the structured paper. The analysis for this study was generated using SPSS version 18.0 to calculated to frequency, percentile, average, standard deviation, t-test, chi-square test, and logistic regression. The results are as follows: 1. Of these 195 hemodialysis patients who visited the emergency room results, 82 (42.1%) had visited the emergency room before 113 (57.9%) had no previous emergency room visits. 2. Initially univeariate analysis was conducted to identify candidate predictor variables that were whether diabetes (p = .002), hospitalization experience after hemodialysis started (p < .001), count of medication (p < .001), whether complications (p = .021), heart disease (p = .047), amount of erythropoietin stimulation agents (p = .006), systolic blood pressure (p = 015), hemoglobin (p = .005), WBC (p = .017), Glucose (p = .003), depression (p < .001). 3. There were five factors shown to be predictors with 75.4% prediction probability in the model. In the multivariate analysis, the number of hemodialysis patients who visited the emergency room was significantly increased with under common the following co-factors: depression (CI = 1.51-10.50, OR = 3.98), under serious depression (CI = 1.85-10.54, OR = 4.42), one to two hospitalization experiences after hemodialysis started (CI = 1.42-9.25, OR = 3.63), three times more of hospitalization experiences after hemodialysis started (CI = 1.55-10.37, OR = 4.01), whether diabetes (CI = 1.04-5.57, OR = 2.41), amount of erythropoietin stimulation agents (CI = 1.07-5.23, OR = 2.37), count of medication (CI = 1.11-5.75, OR = 2.53). Consequently, it is highly expected that hemodialysis patient visited emergency room: under common depression diagnosis, under serious depression diagnosis, with more hospitalization experience after hemodialysis started, diabetes diagnosis, with more amount of erythropoietin stimulation agents, with more count of medication. Therefore, it is important that hemodialysis patients and health care staff must be attentitive, according to the results of the study. it can be used to develop further nursing interventional strategies for hemodialysis patients visiting emergency rooms. Futhermore, it is necessary that nursing interventional strategies measures the effect.

본 연구는 혈액투석 환자들의 응급실 내원율과 응급실 내원 예측요인을 파악하는 서술적 조사연구이다. 이를 바탕으로 혈액투석 환자의 응급실 내원 예측요인을 조사하고, 혈액투석 환자의 응급실 내원을 줄이기 위한 간호중재 개발의 기초자료를 제공하기 위함이다. 연구대상자는 대구 소재 K대학병원에서 2014년 8월에 혈액투석을 받고 본 연구의 선정기준을 만족한 195명을 대상으로 하였다. 측정도구는 사회적지지, BDI (Beck Depression Inventory), 혈액투석 관련 지식, 자기효능감, 자가간호수행 도구를 사용하였고, 투석관련 특성과 생리적 지표는 구조화된 기록지로 전자의무기록을 조회하였다. 자료분석은 SPSS/WIN 18.0을 이용하여 빈도, 백분율, 표준편차, t-test, χ²-test, 로지스틱 회귀분석을 사용하였고, 본 연구의 연구결과를 요약하면 다음과 같다. 1. 혈액투석 환자 195명 중 응급실 내원군 42.1%(82명), 응급실 비내원군 57.9%(113명)으로 나타났다. 2. 응급실 내원군에서 통계적으로 유의하게 나타난 변수들은 당뇨(p=.002), 혈액투석 시작 후 입원경험(p<.001), 약복용수(p<.001), 합병증 유무 (p=.021), 심장질환(p=.047), 조혈제량(p=.006), 수축기 혈압(p=.015), Hemoglobin(p=.005), WBC(White Blood Cell)(p=.017), Glucose(정 량)(p=.003), 우울(p<.001)이었다. 3. 로지스틱 회귀분석 결과 삽입한 11개의 예측변수 중 중등우울(CI=1.51- 10.50, OR=3.98), 중증우울(CI=1.85-10.54, OR=4.42), 혈액투석 시작 후 입원경험 1-2회(CI=1.42-9.25, OR=3.63), 3회이상(CI=1.55-10.37, OR=4.0 1), 당뇨유무(CI=1.04-5.57, OR=2.41), 조혈제량(CI=1.07-5.23, OR=2.37), 약복용수(CI=1.11-5.75, OR=2.53)이 유의한 예측요인으로 확인되었으며, 모형의 예측확률은 75.4%이었다. 결론적으로 중등우울, 중증우울이 있을수록, 혈액투석 시작 후 입원경험이 있을수록, 당뇨가 있을수록, 조혈제량이 많을수록, 약복용수가 많을수록 혈액투석 환자의 응급실 내원 가능성이 높은 것으로 나타났다. 따라서 혈액투석 환자의 응급실 내원율을 낮추기 위해서는 혈액투석 환자의 응급실 내원 예측요인에 대한 환자와 의료인의 관심 및 관리가 중요하며, 예측요인을 포함한 응급실 내원에 대한 간호중재 개발과 그 효과 측정이 필요하다.