Journal of Korean Medicine Rehabilitation Vol. 25 No. 3, July 2015 pissn 1229-1854 eissn 2288-4114 http://dx.doi.org/10.18325/jkmr.2015.25.3.81 Case Report 급성경 요추염좌로진단된교통사고환자에서歸脾湯과當歸鬚散의효과에대한임상연구 박정오 정훈 허동석 * 대전대학교한의과대학한방재활의학과교실, 누리제한의원 * Clinical Study of the Effects of Gwibi-tang and Danggwisusan on Traffic Accident Patients with Acute Cervicolumbar Disorder Jung-Oh Park, K.M.D., Hoon Jung, K.M.D., Dong-Seok Heo, Ph.D.* Department of Rehabilitation Medicine of Korean Medicine, College of Korean Medicine, Dae-Jeon University, Nurijae Korean Medicine Clinic* RECEIVED June 22, 2015 REVISED July 4, 2015 ACCEPTED July 7, 2015 CORRESPONDING TO Dong-Seok Heo, Nurijae Korean Medicine Clinic, 5591, Doan-daero, Yuseong-gu, Daejeon 305-301, Korea TEL (042) 482-1075 FAX (042) 482-1071 E-mail hurds@hanmail.net Copyright 2015 The Society of Korean Medicine Rehabilitation Objectives This study was designed to compare the effects Gwibi-tang herbal-medication with Danggwisusan herbal-medication for patients with acute cervical and lumbar sprains due to a traffic accident. Methods This study was carried out on 119 acute cervical & lumbar sprain patients by traffic accident. We divided these patients into 2 groups. Group A was treated with Gwibi-tang and Group B was treated with Danggwisusan three times a day for three days. Each patient was treated with acupuncture, physical therapy and two types of herbal-medication. We measured the numerical rating scale (NRS) at two time points : pre-treatment (Tx). and post-tx. Results 1. The NRS scores significantly decreased after treatment in all patients. 2. The changed NRS scores of nuchal pain showed a borderline significant difference between Group A and Group B (p=0.067). 3. In sub-group analysis, Gwibi-tang showed a greater effect on NRS scores of lumbago pain in female patients (p=0.068) and patients under 30s (p = 0.054) compared to Danggwisusan. Conclusions In this study, both types of herbal-medication; Gwibi-tang and Danggwisusan were highly effective on acute cervical and lumbar sprain patients. Especially Gwibi-tang (Group A) was more effective than Danggwisusan (Group B) in reducing the initial nuchal pain. Also Gwibi-tang was more effective for lumbago pain in female and patients under 30s. (J Korean Med Rehab 2015;25(3):81-90) Key words Gwibi-tang herbal-medication, Danggwisusan herbal-medication, Acute cervical & lumbal sprain, Traffic Accident 서론»»» 자동차사고는인적피해및사회경제적손실이크다 1). 교통사고에의한자동차보험의료비통계에서환자의 96.50% 가경상자로분류되고있으며 2), 경상자의특성상 응급처치나수술적처치가필요하지않은경우가많다. 이러한교통사고후경상자에게나타나는통증과후유증의치료는침, 한약, 추나등의한의학적처치에대한환자의호응도가높고 3), 해당환자군에대한한방의료의역할이지속적으로커지고있어 4) 한방병원에래원하는환 www.e-jkmr.org 81
박정오 정훈 허동석 자가꾸준히증가하고있는실정이다 5,6). 교통사고후한방병원을찾는환자들의증상으로는경항통, 견비통, 요통, 두통, 현훈등을주로호소하는데이는급작스런외부의충격으로인한氣滯로血行不調하게되어瘀血이발생하는것으로생각해왔으며 7), 김 8) 과김등 9) 의여러연구를통해한약처방치료의유효성이입증되었다. 그중當歸鬚散은明代에저술된李 10) 의醫學入門에처음수록되었으며打撲損傷, 氣滯凝結, 胸腹脇痛을치료한다고알려져있고, 이처방을구성하는약재들은각기破瘀血, 行血破瘀, 理氣, 淸熱凉血, 活血化瘀, 通血脈하는약효를가진약물들로조성되어있어 11,12) 氣滯瘀血辨證의대표적인처방으로사용되어왔다 13-15). 歸脾湯은嚴用和 16) 가처음創方하였고薜己 17) 가當歸와遠志를첨가하여완성한方으로, 思慮傷脾, 心脾兩虛하여일어나는健忘, 怔忡, 嗜臥, 小食, 盜汗, 肢體作痛, 不寐등에주로활용되고있다. 교통사고환자는기체어혈변증이외에도교통사고직후의스트레스가감정과신경내분비계뿐만아니라신경계및면역계에까지영향을미칠수있다는보고가있어 18,19), 치료에있어서도단순히근골격계통증의해소만이아니라, 그들의정신적인스트레스를고려하여심리적인방면으로접근이필요하다 20). 최근에는歸脾湯의실험적연구들을통하여항스트레스효과 21), 면역조절기능 22), 항피로효능 23), 위점막손상예방효과 24), 항산화효능및항우울효능이있음을입증되어 25) 제반심인성질환및스트레스성질환에널리활용되고있다 21). 본연구는교통사고로발생한외상성질환이라도치료적접근에서는불안, 공포등의심리적요인을먼저고려할것인지, 타박, 어혈등의신체적요인을우선고려할것인지에대하여확인하고자이미근골격계질환에치료효과가검증된當歸鬚散 11) 과스트레스성질환에치료효과가검증된歸脾湯 11) 을교통사고로발생한급성경추및요추부염좌환자에게나누어통증및치료경과에미치는임상효과를비교하고자시행하였다. 이에저자는교통사고로인해발생한급성경ㆍ요추염좌로진단된입원환자를대상으로歸脾湯을처방한 45 명과當歸鬚散을처방한 74명의환자두그룹에대하여 Numeric Rating Scale (NRS), 입원기간및외래진료횟수등을평가한결과약간의지견을얻었기에보고하는바이다. 대상및방법»»» 1. 연구대상 1) 선정기준본임상연구는대전대학교부속대전한방병원임상시험심사위원회 (IRB) 에서승인 ( 승인번호 djomc-126) 을획득한후에후향적관찰을실시하였다. 2011년 1월 1일부터 2013년 11월 4일까지대전대학교부속대전한방병원한방재활의학과에일주일이내의교통사고로발생한경항통과요통을주소로내원하여경추부염좌또는요추부염좌를주상병으로진단되어 3일이상입원한환자를대상으로교통사고후발생한不安, 心悸亢進, 반복적인사고의회상, 그로인한憂鬱, 不眠, 주의력장애등을호소하여급성스트레스장애가추가진단되어 26,27) 歸脾湯에柴湖, 梔子를가미한처방을복용한 Group A 45명과급성스트레스장애가추가진단되지않아當歸鬚散을처방하여복용한 Group B 74명을나누어배정하였다. 한국표준질병사인분류 (KCD-6) 에서경추부염좌, 요추부염좌, 급성스트레스장애해당하는상병명은경추의염좌및긴장 (S134), 요추의염좌및긴장 (S3350), 급성스트레스반응 (F430) 이다. 2) 제외대상 X-ray 상골절소견이있는경우, 추간판탈출증또는척추관협착증을동반한경우, 감염이있는경우, 중추신경장애가있는환자, 임산부, 입원기간이 3일미만인경우, 급성스트레스반응으로진단되었으나歸脾湯을처방하지않은경우, 급성스트레스반응으로진단되지않았으나歸脾湯을처방하였거나當歸鬚散을처방하지않은경우는제외하였다. 2. 치료방법 1) 군분류입원환자를대상으로 Group A는歸脾湯, Group B는當歸鬚散을처방하였고, 두그룹모두한약처방이외치료는동일하게침치료, 한방물리요법을병행하였다. 82 J Korean Med Rehab 2015;25(3):81-90
급성경ㆍ요추염좌로진단된교통사고환자에서歸脾湯과當歸鬚散의효과에대한임상연구 2) 한약처방두군모두입원당일부터 3일간 1일 2첩 3팩을기준으로한약재와물 1,000 cc를넣고전탕하여 120 cc씩 1 일 3회투약하였다. (1) 歸脾湯처방본실험에사용한歸脾湯 (Gwibi-tang) 의처방구성은東醫寶鑑 11) 의歸脾湯을기준으로하여우울증과신경퇴행성질환에효과 28), 수면면의질을높여주는효과가연구결과입증된 29) 梔子를 6 g, dopamine, serotonine 및 GABA receptor 에작용하여우울증에치료에효과가있다고보고된바있는 30,31) 柴湖를 6 g을첨가하고, 기존약재를가감한것으로, 약제는대전대학교부속한방병원에서구입한후정선하여사용하였다. 처방 1첩의내용과용량은다음과같다 (Table I). (2) 當歸鬚散처방본실험에사용한當歸鬚散 (Danggwisusan) 의처방구성은東醫寶鑑 11) 의當歸鬚散을기준으로하여기존약재를가감한것으로, 약제는대전대학교부속한방병원에서구입한후정선하여사용하였다. 처방 1첩의내용과용량은다음과같다 (Table II). 3) 침치료침은 0.25 mm 40 mm stainless steel 멸균호침 ( 동방침구사, 한국 ) 을사용하여 1일 2회를원칙으로시행하고 20분간유침하였다. Table I. Prescription of Gwibi-tang Herb Scientific name Quantity (g) 자침혈위는두그룹모두상부승모근, 흉추및요추부척추기립근의경혈위주로자침하였다. 4) 한방물리요법한방이학요법으로는부항술 ( 건식부항 )-유관법, 경피적외선조사요법 (Infrared), 경피경근온열요법 (Hot pack), 경근중주파요법 (ICT) 등을시행하였다. 3. 평가방법 1) 숫자평가척도 (Numerical Rating Scale, NRS) 숫자평가척도는환자스스로통증정도를숫자로표현하여통증강도를평가하는방법으로, 통증이없는상태인 0부터본인이상상할수있는가장심한통증정도인 10까지의숫자를사용한다. 이방법은본인이선택한숫자를점수로삼아환자가쉽게이해할수있어, 적용이매우간편한방법으로, 입원당시와입원후 3일이경과한날오전 7시경에구두로측정하여전후를비교하였다. 2) 입원기간및외래진료횟수연구대상으로선정된환자들의입원기간과외래진료횟수데이터를분석하였다. 3) 통계분석본연구에서는분석에 119명을대상으로인구통계학적변인에대한빈도분석, 기술통계를사용하였다. 집단내의치료전후의차이를알아보기위하여 paired t-test를사용하였으며, 치료전후의집단간에차이, 입원기간및외래진료횟수의집단간에차이를알아보기위해 independent samples t-test를실시하였다. 當歸龍眼肉酸棗仁 ( 炒 ) 遠志 ( 製 ) 人蔘黃芪白朮白茯神木香甘草生薑大棗梔子柴湖 Angelicae Gigantis Radix Longanae Arillus Zizyphi Spinosae Semen Polygalae Radix Ginseng Radix Astragali Radix Atractylodis Macrocephalac Rhizma Poria Cocos Aucklandiac Radix Glycyrrhizae Radix Zingiberis Rhizoma Recens Jujubae Fructus Gardeniae Fructus Bupleuri Radix Total amount 1.5 4.5 3.0 75.0 Table II. Prescription of Danggwisusan Herb Scientific name Quantity (g) 當歸烏藥蘇木桃仁甘草赤芍藥香附子紅花桂心 Angelicae Gigantis Radix Linderae Radix Sappan Lignum Persicae Semen Glycyrrhizae Radix Paeoniae Radix Rubra Cyperi Rhizoma Carthami Flos Cinnamomi Cortex Interior Total amount 4.0 4.0 3.0 2.0 4.0 4.0 3.0 2.0 32.0 www.e-jkmr.org 83
박정오 정훈 허동석 최종적으로본분석은 SPSS 17.0 for window 프로그램을이용하여시행되었으며, 모든통계결과는유의수준을 p<0.05로하였다. 결과»»» 1. 전체환자및그룹간 NRS 비교 1) 일반적인특성총 119명중남자가 58명 (48.7%), 여자가 61명 (51.3%) 이었고, 연령대로는 30대이하가 16명 (13.4%), 30대 31명 (26.1%), 40대 31명 (26.1%), 50대 28명 (23.5%), 60대이상이 13명 (10.9%) 이었다. 歸脾湯을처방한 Group A는 45 명이었고, 當歸鬚散을처방한 Group B는 74명이었다. 2) NRS 비교전체환자에서경항통 NRS는치료전 7.13±0.958에서 치료후 4.83±1.870로유의성 (p<0.001) 있게감소하였고, 요통 NRS 는치료전 7.01±1.268에서치료후 4.63±1.831 로유의성 (p<0.001) 있게감소하였다 (Table III). 치료전후그룹간경항통 NRS 값을비교하여본결과두그룹간에경계수준의유의성 (p=0.067) 을보였다. 하지만요통 NRS 값을비교하여본결과두그룹간에유의한차이가없었다. 즉, 치료전후그룹간경항통 NRS 값은두그룹간에경계수준의유의한차이가있었다 (Table III). 2. 그룹간성별, 연령에따른비교 1) 성별에따른비교성별에따른치료전후경항통및요통의 NRS 값은유의한차이를보이지않았다. 남자에서그룹간치료전후요통 NRS, 경항통 NRS 에서는그룹간유의한차이가없었다. 여자에서그룹간치료전후요통 NRS 에서는경계수준의유의성 (p=0.068) 을 Table III. Comparison of NRS between Pre-Tx. and Post-Tx. Group A and Group B Pre-Tx. Post-Tx. p-value NRS (Nuchal pain) 7.13±0.958 4.83±1.870 <0.001 Group A 7.18±0.903 4.50±1.617 0.067 Group B 7.10±0.995 5.10±2.007 NRS (Low back pain) 7.01±1.268 4.63±1.831 <0.001 Group A 6.96±1.527 4.29±1.584 0.279 Group B 6.92±1.256 4.78±2.124 Data is presented as mean±sd. Statistically significance evaluated by independent samples t-test (between Group A and B) and paired t-test(between pre-tx. and post-tx.). Group A: treated with Gwibi-tang, Group B: treated with Danggwisusan. NRS: Numerical Rating Scale, Tx.: Treatment. Table IV. Comparison of NRS between Group A and Group B according to Sex Pre-Tx. Post-Tx. p-value Female NRS (Nuchal pain) Group A 7.28±0.702 4.48±1.479 0.133 Group B 7.23±0.710 5.19±2.136 NRS (Lumbago) Group A 7.15±1.387 4.35±1.725 0.068 Group B 6.67±1.592 4.95±2.291 Data is presented as mean±sd. Statistically significance evaluated by independent samples t-test (between Group A and B) and paired t-test (between pre-tx. and post-tx.). Group A: treated with Gwibi-tang, Group B: treated with Danggwisusan. NRS: Numerical Rating Scale, Tx.: Treatment. 84 J Korean Med Rehab 2015;25(3):81-90
급성경ㆍ요추염좌로진단된교통사고환자에서歸脾湯과當歸鬚散의효과에대한임상연구 Table V. Comparison of NRS between Group A and Group B according to Age Pre-Tx. Post-Tx. p-value Under 30 NRS (Nuchal pain) Group A 7.00±1.414 3.86±1.345 0.054 Group B 7.44±1.424 6.27±2.796 Data is presented as mean±sd. Statistically significance evaluated by independent samples t-test (between Group A and B) and paired t-test (between pre-tx. and post-tx.). Group A: treated with Gwibi-tang, Group B: treated with Danggwisusan. NRS: Numerical Rating Scale, Tx.: Treatment. 보였고, 경항통 NRS 에서는통계적유의성이없었다 (Table IV). 2) 연령에따른비교연령에따른경항통및요통 NRS 값은유의한차이를보이지않았다 30대미만에서그룹간치료전후경항통 NRS 에서는경계수준의유의성 (p=0.054) 을보였다. 그외의항목에대하여는그룹간치료전후비교에서유의한차이가없었다. 타연령대에서는그룹간치료전후경항통및요통 NRS 비교에서유의한차이가없었다 (Table V). 3. 입원기간및퇴원후외래진료횟수비교입원기간은 6-10일이 54례로가장많았고, 1 5일이 41례, 11 15일이 20례, 16 20일과 21 25일이각각 2 례순이었다. 주소증, 성별로살펴본그룹간평균입원기간비교에서유의한차이가없었다. 퇴원후외래진료횟수는 0회가 76례로가장많았고, 1 2회가 14례, 3 4 회가 11례, 9회이상이 10례, 5 6 회가 5 례, 7 8 회가 3례순이었다. 주소증, 성별로살펴본그룹간퇴원후외래진료횟수비교에서유의한차이가없었다. 고찰»»» 현대사회에들어서자동차의수가증가하고, 경제성장이급속도로진행되며물류량이증가하여교통량이증가하면서교통사고가증가하는것은피할수없는문제이다 32). 최근들어교통사고로인한부상자역시증가하고있으며그중사망자및중상자수는줄어들고있으나경상자수 는매년증가하는추세이다 33). 이러한사회적추세에따라교통사고부상자에대한한의학적치료의필요성이증대되었으며, 1999년자동차손해배상보장법개정으로교통사고에대한한방자동차보험적용이가능해졌고 34), 수술치료가필요치않은환자군에서침치료, 한약치료, 추나치료등한방의료에대한만족도높다 35). 교통사고로발생할수있는증상은두통, 경추부나요추부의통증, 관절각부위의저림, 어지러움등신체적손상과관련된것부터, 불안, 우울, 수면장애, 집중력저하, 과민성등정신의학적양상을띠는것에이르기까지심신전반에걸쳐다양한소견을나타내는특징을갖는다 36). 한의학에서는교통사고로인한외과적증후군에대하여落傷, 落馬, 打撲, 蓄血, 血結, 脫臼, 瘀血骨折로분류하여다루어왔으며, 이들증상에대하여氣와血과의관계및瘀血이라는병적개념을도입하여하나의질환으로인식하고치료해왔으며 37), 대표적인氣滯瘀血변증의대표적인처방으로當歸鬚散이사용되어왔다 13-15). 하지만김 38) 의연구에서볼수있듯이, 모든환자에게일관되게어혈변증만을적용하기는어려운부분이있다. 교통사고는심한스트레스를유발할수있는갑작스런재난이다. 교통사고는생명과신체에대한손상및위협을주는외상적사건이지만, 신체상의변화와예전의건강한생활로의복귀에대한두려움이나사건에대한공포및스트레스등으로정신적손상및위협의가능성이높은정신적사고로볼수있다 39). 따라서치료적접근에서도환자들이신체적으로호소하는내ㆍ외과적인의학적치료와더불어정신적인충격에의한스트레스등의정신과적치료에대해서도관심을가져야한다. 교통사고직후나타나는정신과적인증상으로는우울, 불안, 자극과민성, 운전공포, 분노, 수면장애, 두통등이있으며 40), 歸脾湯은補益心脾, 養血安神작용으로心悸怔 www.e-jkmr.org 85
박정오 정훈 허동석 忡, 健忘失眠을治하는龍眼肉과, 補肝, 寧神, 斂汗, 生津작용으로虛煩不眠, 驚悸多夢을治하는酸棗仁이君藥으로되어있으며 41), 人蔘, 黃芪, 白朮, 甘草, 大棗등은補脾益氣하고當歸, 茯神, 遠志등은養心血安神하여전체적으로養心安神, 補氣益血의효능이있다고할수있으며 42), 이미실험적으로항스트레스작용이있다는연구 21) 가있다. 여기에실험적으로우울증, 수면장애개선에효과가입증된 28-31) 梔子, 柴湖등을가미하여교통사고후급성스트레스장애환자에게사용할수있을것으로판단하였다. 한의학계에서는 2000년대부터교통사고와스트레스에관한연구가지속적으로발표되고있으나 20,39,40,43-47), 한약처방이중심이된논문은찾아보기어려웠다. 본연구는교통사고로인해급성경ㆍ요추염좌로진단받은환자에대하여항스트레스효과가실험적으로입증된대표적인安神之劑인歸脾湯 21) 과교통사고환자의통 13-15) 증조절효과가입증된대표적인瘀血之劑인當歸鬚散을비교하여보다효과적인치료법선택에기준을제시하고자하였다. 이에저자는교통사고로인해경ㆍ요추염좌로진단받은환자 119명의의무기록을중심으로급성스트레스장애가추가진단되어歸脾湯을처방한환자와급성스트레스장애가추가진단되지않아當歸鬚散을처방한환자에대하여경추부및요추부의통증변화를분석하였다. 그리고환자의성별, 연령분류에따라치료전후통증의변화분석및그룹간비교를실시하고입원기간과외래진료횟수를분석하여예후판별에도움을줄수있게하였으며, 처방시환자의성별, 연령에따라효과적인처방선택하는데참고할수있도록하였다. 통증질환의병력기간은통증지속시간이 6주이하인경우를급성, 6 12 주까지를아급성, 12주이상통증이지속된경우를만성으로분류하나 48), 급성염좌의경우적절한휴식을통해회복될수있고약 45% 는 1주일이내에좋아지기도하므로 49), 본연구는한약처방의빠른치료효과를알아보기위해발병한지일주일이내의급성경ㆍ요추염좌환자를연구대상으로하였다. 연구대상자는남자가 58명, 여자가 61명이었고연령으로는 30대와 40대가 31명으로가장많았다. 이는 2012 년연령별교통사고발생현황에서 40대가 246,011 건, 30 대가 223,665 건순으로많은것과일치하며 32), 비교적사회적활동이많은사람들이교통사고의위험에가장많이 노출되기때문이라추정된다 50). 환자들의처방에따라歸脾湯을처방한 Group A는총 45명이었고, 當歸鬚散을처방한 Group B는총 74명이었다. 전체환자에서치료전후경항통및요통의 NRS 값은유의한차이로감소하였다 (Table III). 상기결과로보아급성경ㆍ요추염좌환자의경항통및요통호전에서歸脾湯처방과當歸鬚散처방이모두유의한효과를나타낸것을알수있다. 전체환자에서성별, 연령에따른경항통및요통의 NRS 값은유의한차이를보이지않았다. 입원기간별분포는 6 10일이 54명, 1 5일이 41명, 11 15일이 20명순으로나타나는데, 이는교통사고보험관련사항에합의하는시점이병증예후와치료종결에미치는영향때문인것으로추정된다 51). 치료전후그룹간 NRS 값을비교해보면, 경항통 NRS 값에서두그룹간에경계수준의유의한차이가있었다 (Table III). 이는歸脾湯을처방한환자들이當歸鬚散을처방한환자들에비해초기통증감소에더높은효과가있는것으로보인다. 이는스트레스의강도가클수록, 그리고일상생활에서경험하는괴로움이많을수록통증을경험할확률이높아진다는연구 52) 와심리적안정및스트레스의감소가통증을감소시키는데유의한효과가있다는연구 53) 등으로알수있듯이 Group A에는歸脾湯을처방하여심리적안정효과가더해졌기때문일것으로추정된다. 성별에따라치료전후그룹간 NRS 값을비교해보면, 남자에서는모두유의성이없었다. 여자에서는요통 NRS 에서는경계수준의유의성을보였다 (Table VI). 이는여성이남성에비해스트레스에더민감하고 54), 이를해소할수있는歸脾湯을처방하였을때남자에비해여자에서통증감소에유의한효과가있었다 (Table VI). 연령에따라치료전후그룹간 NRS 값을비교해보면, 30대미만에서경항통 NRS 값이그룹간경계수준의유의한차이가있었다. 즉, 歸脾湯처방이當歸鬚散처방비해 30대미만의경항통치료에서통증감소에유의한경향성이있었다 (Table V). 이는 30대이하의연령층이 40 대이상의연령층에비하여근골격계질환의기왕력도적고, 신체적기능도뛰어나서심리적안정을동시에취할경우신체적회복이빠른것으로추정된다. 그룹간주소증및성별에따른입원기간에따른분포, 86 J Korean Med Rehab 2015;25(3):81-90
급성경ㆍ요추염좌로진단된교통사고환자에서歸脾湯과當歸鬚散의효과에대한임상연구 외래진료횟수에따른분포는통계적유의성이없었다. 이는교통사고보험관련사항에합의하는시점이병증예후와치료종결에미치는영향때문인것으로추정된다 50). 본연구의대상은교통사고이후로발생한급성경ㆍ요추염좌환자로한정하였는데, 일반적으로교통사고후두통, 상지통, 하지통, 견비통, 어지럼증, 오심등의제반증상에대하여한의학에서는외상및편타손상으로氣血이凝滯되고經絡이沮礙된것으로보고蓄血, 血結, 瘀血의개념으로인식하여 55-58) 치료에있어서주로行氣活血, 通經活絡등의治法을적용하며 59), 이미치료효과또한입증이되었다 8,9). 하지만모든환자를기체어혈로변증하기에는한계가있으며, 스트레스가통증과밀접한관련이있고 60), 스트레스가경감되면통증도줄어든다는연구 52) 를바탕으로스트레스에노출되기쉬운교통사고이후환자들에게신체적인문제뿐만아니라스트레스와같은정신적인측면도고려하여치료하였을경우효과가더우수하거나동일수준의진통효과가있음을알수있었다. 본연구의결과로서歸脾湯처방과當歸鬚散처방모두교통사고로인한급성경ㆍ요추염좌환자의치료에유효하다는것과, 교통사고환자의신체적, 심리적요인을고려하여처방했을경우歸脾湯처방이當歸鬚散처방에비하여증상발생후급성기염좌질환의통증감소에더유의한효과가있음을알수있었다. 또한성별그룹간비교에서는여자에서요통, 30대미만의경항통통증감소에歸脾湯처방이當歸鬚散에비하여유의한효과가있었다. 본연구의제한점은두그룹모두침치료, 물리치료가병행되었고한약처방이배제된다른그룹과의비교연구가시행되지않았기에한약처방만의효과라고단언하기는한계가있었다. 그리고입원기간과외래진료기간을치료기간단축및예후판정에이용하는것은부족한점이있어, 이부분은더정확한지표로추가적인연구가필요할것으로생각된다. 따라서교통사고후급성기환자에게歸脾湯처방이후지속적인통증감소및기능적회복효과에대한연구가필요하며, 스트레스와관련된한약처방과다른치료법과의비교연구가필요하리라사료된다. 결론»»» 2011 년 1 월 1 일부터 2013 년 11 월 4 일까지대전대학교 부속대전한방병원에입원한 119명의교통사고로인한급성경ㆍ요추염좌환자를대상으로급성스트레스장애가추가진단된경추부염좌환자 40명, 요추부염좌환자 29명에게歸脾湯을처방하였으며, 급성스트레스장애가추가진단되지않은경추부염좌환자 69명, 요추부염좌환자 49명에게當歸鬚散을처방한결과다음과같은결론을얻었다. 1. 전체환자의치료전후경항통및요통의 NRS 값은유의성있게감소하였다. 2. 전체환자에서성별, 연령따른치료전후 NRS 값의비교에서는유의한차이가없었다. 3. 경항통 NRS 값의그룹간비교에서歸脾湯처방이當歸鬚散처방에비해경계수준의유의성을보였다. 4. 성별에따른그룹간비교에서歸脾湯처방이當歸鬚散처방에비해여자에게요통의 NRS 값이경계수준으로유의성있게감소하였다. 여자에게경항통의 NRS 값과남자에게경항통및요통의 NRS 값은그룹간비교에서유의한차이가없었다. 5. 연령에따른그룹간비교에서歸脾湯처방이當歸鬚散처방에비해 30대미만에서경항통 NRS 값이경계수준으로유의성있게감소하였다. 그외의항목에관하여서는유의한차이가없었다. 6. 입원기간과퇴원후외래진료횟수에따른분포는그룹간에유의한차이가없었다. 따라서교통사고로인한급성경ㆍ요추염좌환자를치료하는데있어서신체적ㆍ정신적문제점을고려하고, 환자의성별과연령대등을고려하여처방하여야할것으로사료된다. References»»» 1. Traffic Accident Analysis System. Traffic Accident Statistical Analysis. Seoul:the Road Traffic Authority. 2013:7,351. 2. Seo Young Park, Yun Kyu Lee, Jae Su Kim, Seong Chul Lim, Bong Hyo Lee, Tae Young Jung, Il Do Ha, Sang Won Han, Kyung Min Lee. Survey of Oriental Medical Care for Traffic Accident Patients with Automobile insurance; 544 Cases Report. Journal of Korean acupuncture & moxibustion medicine society. 2009;26(3):2. 3. The Society of Korean Medicine Rehabilitation. Korean Rehabilitation Medicine. 3rd edition. Seoul:Gunja Publisher. www.e-jkmr.org 87
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