유지혈액투석을 받는 신부전 환자의 정서적 변인과 치료순응도와의 관계

The Relationship between Therapeutic Compliance and Emotional Variables in the Patients on Maintenance Hemodialysis

목 적： 본 연구는 혈액투석을 받는 말기 신부전환자의 정서적 변인과 치료 순응도와의 관계를 알아보고 이들의 치료대책 수립에 도움이 되고자 수행되었다. 방 법： 12개월 이상 장기간 혈액투석 중인 43명의 말기 신부전 환자들을 대상으로 Cook-Medly 적개심척도, Beck 우울증척도, 자가 평가 불안척도로서 적개심, 우울 및 불안을 측정하였고, 식이요법, 투약, 염분섭취에 대한 순응도를 혈중칼륨, 인의 농도, 투석간 체중 증가량으로 측정하였다. 결 과： 1) 투석을 받고 있는 환자들은 정상인에 비해 우울의 정도가 심하였고 불안과 적개심의 정도는 비슷하였다. 2)정서상태와 투석 순응도와의 관계에 있어 불안과 우울점수가 높았을때 혈중칼륨에 의한 순응값은 의미 있게 저하되었으며 그 정도는 순응값＝4.656×(우울점수)＋2.592×(불안점수) -0.13×(우울점수)×(불안 점수) -9.742 식으로 표현할 수 있었다. 3) 1개월간 지지적 면담을 실시한 결과 불안과 우울의 척도가 감소되었으며 따라서 순응값이 상승했으나 연구 방법의 미숙으로 혈중칼륨의 감소는 확인할 수 없었다. 결 론： 치료순응도는 정서적 변인중 우울과 불안에 의존하고 치료순응도를 높이는 방법으로 지지적 면담이 유용 한 것으로 생각된다.

Objectives：The purposes of this study were to evaluate the relationship between therapeutic compliance and emotional variables in the patients on maintenance hemodialysis and to make a help in planning the treatment in order to promote the therapeutic outcomes. Methods：Subjects consisted of 43 end-stage renal disease patients who had been treated with hemodialysis for more than one year. Hostility was measured with Cook-Medly Hostility Scale and depressive symptom, with Beck Depression Inventory(BDI) and anxiety, with Self-rating Anxiety Scale of Zung(SAS). Serum potassium(K), and phosphorus(P) level, and interdialytic weight gain(IWG) were selected as compliance indices, for they were said to reflect the effect of diet, medication and salts restriction, respectively. Results： 1) While the patients on hemodialysis got the scores within the normal range in their anxiety and hostility scale, they showed higher score of BDI than normal person, which was statistically significant. 2) Considering the relationship between therapeutic compliance and emotional variables, diet compliance was significantly associated with the emotional variables such as depression and anxiety. The relationship would be drawn with the equation listed below： Compliance Value＝4.656×(Depression)＋2.592×(Anxiety) -0.13×(Depression)×(Anxiety) -9.742 3) When the patients were given a series of supportive psychotherapy for about 1 month, they showed the decrease in the scores of anxiety and depression scales, and the elevation in compliance value. However, there was no room for saying that the compliance ratio was improved, because of the limitation in the research methodology. Conclusion：Therapeutic compliance depended on between depression and anxiety among the emotional variables, the supportive psychotherapy was useful method to improved the therapeutic compliance.