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1 5) 대한한방부인과학회지 J Korean Obstet Gynecol. VOL.29 NO.1 : (2016) 중고등학교여학생의월경통한방치료효과및만족도분석 1 원광대학교한의과대학, 2 전라북도한의사회, 3 전북교육장학재단박수정 1, 주종천 1,2, 김정호 2, 김성배 2, 이상덕 3 ABSTRACT Effect and Satisfaction Measurement of Korean Medicine Treatment on Adolescent Dysmenorrhea Soo-Jung Park 1, Jong-Cheon Joo 1,2, Jeong-Ho Kim 2 Seong-Bae Kim 2, Sang-Duk Lee 3 1 College of Korean Medicine, Won-Kwang University 2 Jeonbuk Korean Medicine Association 3 Jeonbuk Association of Educational Scholarship Objectives: The aim of this study is to evaluate the effect and satisfaction measurement of the Korean medicine treatment on the adolescent dysmenorrhea. Methods: The subjects of this study were 24 volunteers, suffering from dysmenorrhea, who were middle and high school students in Jeonbuk province. They were treated by Korean medicine, those were acupuncture, cupping, moxibustion and herbal medicine, for two months from July to December The results were investigated by the visual analogue scale (VAS) of overall pain, most severe pain and amount of the analgesic taken for menstrual period. The effects of treatment were assessed three times, those were before treatment, after treatment for 1 month and after treatment for 2 months, for two months. Results: The VAS score on dysmenorrhea was decreased significantly. Also, the VAS score on the disturbance in school activity was decreased significantly. The amount of analgesic taken for menstrual period was decreased, but not significantly. Conclusions: This study suggests that the Korean medicine treatment on the adolescent dysmenorrhea is effective. Key Words: dysmenorrhea, menstrual pain, menstruation, adolescent, Korean medicine, visual analog scale Corresponding author(jong-cheon Joo) : Won-Kwang University Jeonju Korean Medicine Hospital, 99, Garyeonsan-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do, Korea Tel : Fax : jcjoo@wku.ac.kr 69

2 중고등학교여학생의월경통한방치료효과및만족도분석 Ⅰ. 서론 월경통은월경개시직전또는월경중에발생하는하복부통증으로 48~72 시간동안지속되며치골상부의경련과요추미골부위의통증을동반하는산통이다. 또한복부팽만감, 소화불량, 두통, 유방통이나타나기도하며우울이나정서적불안정, 신경과민과같은부정적정서변화가동반되기도한다 1,2). 월경통은여성의사춘기에나타나는가장흔한부인과질환으로 60~90% 의유병률을나타낸다. 일차성월경통은다른골반질환이없는상태에서발생하는월경중의통증을말하며이차성월경통은골반질환이있으면서월경통이발생하는것을말한다 3,4). 월경통은청소년의경우학교단기결석의주요원인이며, 월경통이있는청소년은학업성적, 교우관계, 체육활동에영향을받게되고활동제한을받게된다 5,6). 또한월경증상으로인하여월경에대한부정적인태도를가지게되어충동성과불안감이높아지고심리적안녕감이낮아지게된다. 따라서치료와교육을통하여월경에대한긍정적인인식을심어주는것이매우중요하다 7). 월경통이있는여학생은통증이심한경우증상을완화시키기위하여진통제를복용하는데우리나라의경우누구나쉽게구할수있어남용의우려가높으며, 과량복용이나장기복용할경우약물에의존하게되어신체적, 정신적문제점이나타날수있다 8). 특히월경통으로인한약물의투여를결정할경우에가족과친구에게서정보를얻고있으며 전문가에게의존하는비율은현저히낮았다 9). 따라서월경으로인해일상생활에지장을받는여학생에대해서는국가적, 사회적차원에서체계적인건강관리프로그램의개발과관리가필요하다고할수있다. 전라북도한의사회와전북교육장학재단에서는월경통을호소하는전라북도내중고등학교여학생을대상으로침, 부항, 뜸, 한약등의한방치료사업을실시하였으며, 월경통정도, 학교생활지장정도, 진통제복용량, 한방치료만족도등의변화를조사분석하여보고하게되었다. Ⅱ. 대상및방법 1. 대상자치료대상자는전라북도에거주하고특별한여성질환의과거력이없으며월경통을호소하는 24명의중고등학교여학생이었다. 월경통의한방치료및연구는전북내시군지역의 23곳의한의원에서치료및연구에대한동의서를받은후에시작하였다. 2. 치료방법 1) 치료기간 2015년 7월 1일부터 12월 31일까지의기간중 2개월간치료하였다. 2) 치료주기및내용침, 부항, 뜸처치를위해 2주일에 1회이상내원하도록권장하였다. 치료혈위및부위는천추, 기해, 관원, 자궁혈, 복부와요부의압통점을위주로시행하도록하였으며, 유침시간, 부항시술시간, 뜸시술시간, 기구의규격, 제조회사 70

3 J Korean Obstet Gynecol Vol.29 No.1 February 2016 등은제한하지않았다. 3) 한약처방처방의내용은학생의상태및변증에따라한의사가결정하였으며, 20첩을 30 봉지로추출하여월경전후에하루 2회씩복용하도록하였다. 3. 치료평가치료평가는치료시작전, 치료 1개월후, 치료 2개월후총 3회에걸쳐시행하였다. 평가항목과방법은월경기간중전반적월경통정도와가장심한월경통정도, 결석, 지각, 조퇴, 학업장애등의학교생활지장정도, 한방치료만족도를최소 0점에서최대 10점의시각적상사척도로표현하도록하였다 (Fig. 1). 월경통기간중진통제복용량은이전 1개월간복용한진통제개수를적도록하였다. Fig. 1. Visual analogue scale. 4. 통계분석모든값은빈도또는평균 ± 표준편차로표현하였다. 통계처리방법은치료전과치료 1개월후, 치료전과치료 2개월후를짝지어대응표본 t-검정을실시하였으며, 치료만족도는기술통계수치만을제시하였으며, 기간간의비교분석은시행하지않았다. 유의수준은 0.05로하였으며, 통계프로그램은 SPSS 20.0을이용하였다. Ⅲ. 결과 1. 일반적특성및월경력치료대상자 24명중중학생은 16명 (66.7%), 고등학생은 8명 (33.3%) 이었다. 나이는최저 14세에서최고 19세로평균 14.90±3.67세이었다. 초경나이는최저 11세에서최고 15세로평균 12.70±1.32세이었다. 월경주기는최단 15일에서최장 50일로평균 30.35±1.32 일이었다. 키는평균 ± 5.22 cm이었으며, 체중은평균 56.35±11.03 kg이었다. 월경통으로진통제를복용하는경우가 18명 (75%) 이었으며, 진통제를복용하지않는경우가 6명 (25%) 이었다. 월경통발생시기는초경후 2년이내가 15명 (62.5%), 2년이후가 6명 (25%), 모름이 3명 (12.5%) 이었다. 다중응답한월경통의주된증상은 22명 (91.7%) 이복통을, 18명 (75.0%) 이요통이라고하였으며, 이외에구토, 두통, 유방통, 전신통등을호소하였다. 한의원에서월경통치료를위해투여한처방은현부이경탕 ( 玄附理經湯 ) 3명 (12.5%), 조경탕 ( 調經湯 ) 3명 (12.5%), 태음인청심연자탕 ( 太陰人淸心蓮子湯 ) 2명 (8.3%), 귀비탕합소요산 ( 歸脾湯合逍遙散 ) 2명 (8.3%), 오적산 ( 五積散 ) 2명 (8.3%) 이었으며, 이외에청경사물탕 ( 淸經四物湯 ), 반하백출천마탕 ( 半夏白朮天麻湯 ), 옥녀전 ( 玉女煎 ), 온경탕 ( 溫經湯 ), 계지복령환 ( 桂枝茯苓丸 ) 및기타처방이사용되었다 (Table 1). 71

중고등학교여학생의월경통한방치료효과및만족도분석 Table 1. Characteristics of the Patients Suffering from Dysmenorrhea Variable Value* School High school 16 (66.7%) Middle school 8 (33.3%) Age (year) 14.90±3.

4 중고등학교여학생의월경통한방치료효과및만족도분석 Table 1. Characteristics of the Patients Suffering from Dysmenorrhea Variable Value* School High school 16 (66.7%) Middle school 8 (33.3%) Age (year) 14.90±3.67 Menstrual cycle (days) 30.35±1.32 Height (cm) ±5.22 Weight (kg) 56.35±11.03 Taking analgesic Yes 18 (75%) No 6 (25%) With two years after menarche 15 (62.5%) Beginning of menstrual pain Without two years after menarche 6 (25.0%) Not reported 3 (12.5%) Chief symptom of menstrual pain Abdominal pain 22 (91.7%) Low back pain 18 (75.0%) Hyeonbuikyeong-tang 3 (12.5%) Jokyeong-tang 3 (12.5%) Prescriptions Taeeumin Cheongsimyeonja-tang 2 (8.3%) Combination of Guibi-tang and Soyo-san 2 (8.3%) Ojeok-san 2 (8.3%) Others 12 (50.0%) * : The values were expressed by number or mean±standard deviation. : multiple response 2. 월경통정도의변화 월경기간중전반적월경통정도는치료전에는 6.69±1.62점이었으며, 치료 1개월후에는 5.94±1.91점 (p=0.042), 치료 2개월후에는 4.93±1.94점 (p=0.002) 으로유의하게감소하였다. 월경기간중가장심한월경통정도는치료전에는 7.94±1.23점이었으며, 치료 1개월후에는 6.81±1.80점 (p=0.011), 치료 2개월후에는 5.60±1.88 점 (p=0.001) 으로유의하게감소하였다 (Fig. 2). Fig. 2. Change of overall pain and most severe pain for menstrual period. 3. 학교생활지장정도의변화 학교생활지장정도는치료전에는 7.38±2.06점이었으며, 치료 1개월후에는 72

J Korean Obstet Gynecol Vol.29 No.1 February 2016 6.31±2.63점 (p=0.028), 2개월후에는 5.00 ±2.25점 (p<0.001) 으로유의하게감소하였다 (Fig. 3). 치료 1개월후에는 7.22±1.64점, 치료 2개월후에는 7.44±1.

Change of the disturbance in school activity for menstrual period. 4. 진통제복용량변화 진통제복용량은치료전에는 3.80±2.62 개이었으며, 치료 1개월후에는 2.58±2.94개 (p=0.869), 치료 2개월후에는 1.29±2.

고찰 이차성월경통은주로초경후 2년이후에나타나며자궁근종, 자궁내막증, 자궁의만성염증성질환등의기질적인병변에서기인하는경우가많으며 10,11), 일차성월경통은프로스타글란딘이과다하게분비되어평활근을과도하게수축시키고자궁근허혈을초래함으로써신경말단조직이자극을받아통증이유발되는것으로알려져있다.

5 J Korean Obstet Gynecol Vol.29 No.1 February ±2.63점 (p=0.028), 2개월후에는 5.00 ±2.25점 (p<0.001) 으로유의하게감소하였다 (Fig. 3). 치료 1개월후에는 7.22±1.64점, 치료 2개월후에는 7.44±1.67점이었다 (Fig. 5). Fig. 5. Satisfaction measurement of Korean medicine treatment on adolescent dysmenorrhea. Fig. 3. Change of the disturbance in school activity for menstrual period. 4. 진통제복용량변화 진통제복용량은치료전에는 3.80±2.62 개이었으며, 치료 1개월후에는 2.58±2.94개 (p=0.869), 치료 2개월후에는 1.29±2.28 개 (p=0.327) 로감소하였으나통계적유의성은없었다 (Fig. 4). Fig. 4. Change of amount of the analgesic taken for menstrual period. 5. 한방치료에대한만족도 월경통의한방치료에대한만족도는 Ⅳ. 고찰 이차성월경통은주로초경후 2년이후에나타나며자궁근종, 자궁내막증, 자궁의만성염증성질환등의기질적인병변에서기인하는경우가많으며 10,11), 일차성월경통은프로스타글란딘이과다하게분비되어평활근을과도하게수축시키고자궁근허혈을초래함으로써신경말단조직이자극을받아통증이유발되는것으로알려져있다. 일차성월경통은생리적원인만으로통증의발생기전을설명하기에는어려운점이있어프로게스테론과자궁근활성요인설, 내분비요인설, 해부학적요인설, 정신적요인설등이제시되고있으며, 빈혈, 당뇨병, 만성소모성질환, 과로등과도관련이있다고알려져있다. 월경통은초경후 2년이경과한군에서그렇지않은군에비해더빈번하게발생하며, 월경전증후군과도관련이있다고알려져있다 12,13). 본연구에서는초경후 2년이내에월경통이발생한비율이 62.5% 로 2년이후에발생한비율인 25% 에비해높게조사되었다. 73

6 중고등학교여학생의월경통한방치료효과및만족도분석 월경통평가는시각적상사척도 (visual analogue scale, VAS) 를기본으로하여 MVRS(multidimensional verbal rating scale), 일상생활의제한정도, 진통제복용량, 피임약복용여부등을이용하는경우가일반적이다. 월경통에대한한약의효과를평가할때에는월경 2주기이상을기록한다고보고된바있다 14). 본연구에서도월경 2주기를평가하여전반적통증과가장심한통증모두에서 2주기동안지속적인감소를보여한방치료가통증감소에유의한효과가있다는것을알수있었다. 청소년기는 2차성징이발현되기시작하여여러기관의성숙으로임신이가능하게되는변화의시기로월경장애가잘유발된다. 청소년기의월경장애는생식기관및비생식기관의이상을암시하는첫신호일수있으며, 성인이된후의생식생리에영향을미칠수있으며, 월경통이나월경시불편감의경험은월경을하는여성에대해부정적인태도를가질수있으며, 여성으로서의성역할인식에도부정적인영향을미칠수있다 15,16). 월경통정도와간이정신진단검사 (Symptom Checklist-90-Revised, SCL-90-R) 각항목의관련성을분석한연구에서 SCL-90-R의모든척도는월경통정도에따라유의한차이를보였으며, 특히신체화, 대인기피증, 우울, 적대감, 공포불안, 편집증척도에서높은유의성을나타내어월경통이심할수록심리적으로불안정한상태에놓일수있다고볼수있었다 17). 그러나일반적으로대부분의청소년들은월경통에대해특별한관리나치료없이지내거나단순한자가치료에의존하고있는실정이다. 월경통은개인뿐아니라가족, 학교, 사 회생활에영향을미치므로청소년기부터질병에대한정확한이해와치료방침의수립이중요하다고생각된다 18,19). 본연구의결과로볼때월경통의한방치료는월경통감소뿐만아니라학교생활지장정도의안정화에도기여하므로제도적인지원과체계적인프로그램의마련을검토할필요가있다고하겠다. 월경통의치료효과는 VAS, MVRS 외에진통제복용량의변화를통해서도평가할수있는데 20,21), 본연구에서월경 2주기간의진통제사용량을살펴본결과 2주기의평가기간동안감소하기는하였으나통계적유의성은없었다. 그러나향후본연구보다더많은환자나피험자를대상으로연구를진행한다면유의한결과를확인할수있을것으로생각된다. 일반적으로월경통완화를위해사용되는방법으로는프로스타글란딘합성억제제, 경구용피임약, 일반진통제등과신체적안정요법, 국소온열요법, 정신요법, 수술요법등이있다. 이러한치료법과비교할때월경통감소에효과적이며경제적이라고할수있는한방치료는환자의편견, 홍보부족, 정책적지원미비등으로인해저평가되어보편화되지못하고있으며, 여학생및대부분의여성들은손쉽게구할수있는진통제에의존해오고있는실정이다 22). 향후진통제사용량, 진통제의부작용, 월경통에대한한방치료의안전성과유효성을주제로대규모연구를진행함으로써경제적이며효과적인월경통한방치료의근거를확인하고정책적으로추진할필요가있다. 이전의월경통에대한한방치료의유효성관련연구는여러방면에서수행된 74

7 J Korean Obstet Gynecol Vol.29 No.1 February 2016 바있다. 안마, 지압, 기공, 단전호흡, 식이요법, 영양요법 23) 등의연구와체침 24), 전침 25), 이침 26), 약침 27) 등의침치료연구와계지복령환 28), 현부이경탕 29), 칠제향부환 30) 등의처방연구가있었다. 본연구에서는한의사의변증에따라투여된처방을조사한결과현부이경탕, 조경탕, 태음인청심연자탕, 귀비탕합소요산, 오적산등이월경통에활용되고있다는것을확인하였으나구체적인침, 부항, 뜸시술방법이나부위의유효성및특정처방의진통효과여부는확인하기어려웠다. 대만국가데이터베이스를활용한연구 31) 에서 13~25세여성원발성월경통환자 57,315명에게쓰인처방을조사한결과를보면연구대상의 27.2% 에서당귀작약산, 20.7% 에서가미소요산, 20.5% 에서온경탕처방이사용되었다고하였으며, 연구대상의 33.1% 에서현호색, 29.2% 에서향부자약재가사용되었다고보고한바있다. 우리나라에서도월경통에한약을사용할수있는사회적기반을마련하고대규모의통계연구가이루어진다면표준화된처방개발및치료시스템이마련될수있으리라생각한다. 본연구에서조사한한방치료의단순만족도는 1개월후와 2개월후가모두 70점대로비교적낮은편이었다. 이는학생이학업과치료를병행하기에는시간적인제약이많다는점, 한방치료인침, 뜸, 부항등에대한거부감이있을수있다는점, 한약을탕제형태로제공하여복용시불편감있을수있다는점등이추정되나정확한원인이나만족도증진을위한치료시스템개선방향은추가연구가필요할것으로생각된다. 본연구의한계는연구대상자선정이특정지역에제한되어본연구가중고등학교여학생의상황을정확하게대표하였다고보기어려운점과자발적인참여에의하여치료및연구가이루어져평가의편향이발생할수있다는점이라고하겠다. 향후표준화된프로그램개발과더불어적절한연구설계가이루어진다면더욱의미있는결과를얻을수있을것으로생각된다. Ⅴ. 결론 2015년 7월 1일부터 12월 31일까지전라북도내중고등학교여학생 24명을대상으로월경통에관한한방치료및분석을시행하여다음의결과를얻었다. 1. 전반적월경통정도와가장심한월경통정도는치료전에비해한방치료 1개월후와 2개월후모두에서유의하게감소하였다. 2. 학교생활지장정도는치료전에비해한방치료 1개월후와 2개월후모두에서유의하게감소하였다. 3. 진통제복용량은치료전에비해한방치료 1개월후와 2개월후모두에서유의한변화는없었다. 이상의결과를통하여한방치료는월경통에효과적인치료법이라는결론을얻었다. 향후정책적인지원과체계적인치료프로그램에의한대규모연구가필요하다고생각된다. Received : Jan 24,

8 중고등학교여학생의월경통한방치료효과및만족도분석 Revised : Jan 29, 2016 Accepted : Feb 06, 2016 Acknowledgement This paper was supported by Wonkwang university in 참고문헌 1. Kim MY, Jung MS, Chung KA. Degree of Dysmenorrhea and Self-management of Dysmenorrhea in the High-school Girl-student. Korean J Women Health Nurs. 2000;6(3): Jeong MK. Study on the Menstrual knowledge, attitudes, symptoms and coping of the high school girls. Ewha Womans University. Master s thesis Campbell MA, McGrath PJ. Use of medication by adolescents for the management of menstrual discomfort. Arch Pediatr Adolesc Med. 1997;151(9): Hillen TI, et al. Primary dysmenorrhea in young Western Australian women: prevalence, impact, and knowledge of treatment. J Adolesc Health. 1999; 25(1): Wilson CA, Keye WR. A survey of adolescent dysmenorrhea and premenstrual symptom frequency. A model program for prevention, detection, and treatment. J Adolesc Health Care. 1989;10(4): Alvin PE, Litt IF. Current status of the etiology and the management of dysmenorrhea in adolescence. Pediatrics. 1982;70(4): Jeong IS. A Study on the Relation between the Attitude and Psychological Dispositions about Menstruation of High School Girls. Graduate School of Education, Kyungnam University. Master s thesis Park YJ. A Study on Analgesic Use in Dysmenorrhea of Female High School Students. Korea University. Master s thesis Hong SS. Study on middle and high school girl students' menstruation characteristics and their menstruation dysmenorrhea. Graduate School of Education, Korea National University of Education. Master s thesis Jung MS. 1st rev. Women s Health Care. Seoul:Jeongdam Publisher Korean Society of Obstetrics and Gynecology. Gynecology. Seoul:Calvin Book Publisher. 1997:214-52, , Choi YD. Clinical Gynecology. 2nd rev. Seoul:Korea Medical Book Publisher. 2001: Kim HO, et al. Premenstrual syndrome and dysmenorrhea in Korean adolescent girls. Obstet Gynecol Sci. 2008;51(11): Park JS, et al. A Study for Suggestion of Quantitative Scale for Dysmenorrhea in Clinics. J Orient Gynecol. 2011; 24(1): Cho SH, et al. Adolescent menstrual 76

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Lumbar spine

Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical