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박수정 ( Park Su-Jeong ) - 전남대학교 대학원 간호학과
이영숙 ( Lee Young-Sook ) - 전남대학교 의과대학 간호학과
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Abstract
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-서론-
1 . 연구의 필요성
척추마취를 위해 처음 시도된 요추천자는 거의 1세기 이전부터 임상에 널리 이용되어 왔
으며 그 중요한 합병증 중의 하나인 요추천자 후 두통은 1898년에 이미 Bier에 의해 처음
보고되었다(Ostheimer, 1979). 요추천자 후 두통의 발생률은 대개 약 30% 정도로 보고되고
있지만(Raskin, 1990), 천자를 시행하게 된 목적이나 보고자에 따라 10%에서 70%로 다양하
며(이광호, 1993: Gallagher, 1954: Kuntz et al., 1992; Vandam, 1956), 이 같은 발병률의 차
이는 요추천자 후 두통의 원인적 요인에 대한 연구를 부추기게 되었다. 이후, 그 원인적 요
인에 따른 발병률에 대한 많은 연구가 이루어졌으며, 그 중 천자에 이용된 바늘의 굵기
(Flaatten et al., 1989: Gourts et al., 1990: Kovanen, 1986; Rasmussen et al., 1989), 천자시
누출된 뇌척수액의 양(Carbaat 1981; Gilroy, 1975: Raskin, 1990), 천자 후 자세(Kuntz et al.
1992) 및 침상 안정 시간에 대한 연구(Cook et al. 1989 Dieterich 1985: Handler et al.
1982)가 가장 활발히 이루어졌다. 요추천자 후 두통의 원인은 수기 중에 바늘이 지주막에 손상을 입히고 이 손상 부위를 통해 뇌척수액이 소실되어 (김홍균, 1993, Gilroy & Stirlingmeyter, 1975, Hickey, 1986; Wyngaarden et al., 1995), 뇌의 지지적 쿠션이 감소하여 뇌의 고정구조인 통증 감작 경뇌막동이 확장되고 긴장되어 발생된다고 알려져 왔지만(Carbaat & Crevel, 1981, Raskin, 1990: Spielman, 1982: Sternbach, 1985), 그 정확한 기전은 아직 완전히 밝혀지지 않았다(Frenkelet al., 1992).
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The purpose of this study is to compare the effect of bed rest on the post lumbar
puncture headache in pediatric oncologic patients, to analyse the risk factors of post
lumbar puncture headache, and to speculate objective rationale for the management of
patient undergone lumbar puncture. In this prospective case-control study, for the 3 month period, from January 3, 1996 to March 30, 1996, the in-patients admitted to the S National University Hospital pediatric ward for chemotherapy were enrolled, and were randomly assigned to the groups, of 1hour or of 6 hours post lumbar puncture bed rest. One hundred and thirty two lumbar puncture was studied and 66 case assigned to 1 hour group, and 66 case to 6 hours group.
The response of the patient was assessed by McGrath’s Face Scale and Oucher Pain
Scale for patient less than 7 years of age, and by Verbal Rating Scale and Visual
Analog Scale for patient great equal than 7 years of age. The medical records were reviewed and two nurses, whose career is more than 3year in pediatric unit interviewed the patients or parents with formulated questionnare, and the collected data was analyzed by Chi-square test, Student t-test and Ridit analysis, using PC-SAS statistic package. In the study population, the mean age was 8.8 years and the male proportion is
slightly larger than female (67.4%). The most common diagnosis was acute lymphocytic
leukemia (62.1%), and malignant lymphoma, acute myelogenous leukemia, retinoblastoma,
rhabdo-myosarcoma, and neuroblastoma were involved, in such order. The incidence of
post lumbar puncture headache was 16.7%, and no significant difference in the incidence
according to age(t=0.248, p=0.804), or sex(x2=0.835, p=0.361).
The study was proved that the incidence of post lumbar puncture headache is not
influenced by WBC count, previous tapping, drained amount of cerebrospinal fluid,
previous headache, skill of the doctor, gauge of the needle, attempt to puncture, sedation,
and bone marrow examination. The incidence of post lumbar puncture headache in acute lymphocytic leukemia was 18.3%, and 22.2%, 0%, 11.1%, 14.3% and 50% in malignant lymphoma, acute myelogenous leukemia, retinoblastoma rhabdomyosarcoma and neuroblastoma, respectively. The severity of headache, and the incidence of nausea vomiting, and lumbago was not influences by the diagnosis.
The incidence of headache was not influenced by the duration of post lumbar puncture
bed rest and the incidence of headache was 10.6% and 22.7% in 1 hour group and 6
hour group, respectively. The severity of headache, nausea, vomiting, and lumbago was
not also differ in both group. With such results, at least, the suggestion that in pediatric patient, more than 6 hours post lumbar puncture bed rest is no more obligate management for prevention of headache, was speculated.
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KeyWords
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Lumbar puncture, headache, bed rest
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원문 및 링크아웃 정보
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등재저널 정보
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