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림프부종을 예방하는 방법

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림프부종은 림프절의 제거 또는 폐색으로 인해 연조직(피하)에 림프액이 저류된 상태로, 암 치료를 위해 림프절을 제거한 뒤에 흔하게 나타나는 질환입니다. 수술로 림프절을 제거하였거나 외상으로 림프관이 손상되었을 때 림프액의 흡수 및 순환이 장애를 받아서 림프부종이 발생할 수 있고, 감염이 반복되면서 림프(액)이 많아지게 되어 림프부종이 발생할 수도 있습니다.

암과 관련된 림프부종의 위험 요인에는 암이 직접적으로 림프절을 누르거나, 림프절로 암이 전이된 경우와, 치료와 관련하여 림프절을 절제하는 수술을 한 경우 등이 있습니다. 아직 논란의 여지가 있으나 방사선 치료나 항암 치료, 호르몬 치료도 림프부종의 위험 요인으로 생각되고 있습니다.

유방암 수술 후 20~30%에서 증상이 발생하는 것으로 알려져 있습니다. 대개 완치되지는 않으며, 지속적인 관리가 필요합니다. 주로 팔과 유방, 흉벽에 발생하며 치료직후는 물론 치료종료 수년 후에도 발생할 수 있습니다.

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림프부종의 초기 단계는 대부분 피부를 손끝으로 누르면 쉽게 눌리는 함요 부종 상태로 아침이나 휴식 후 저절로 회복되지만, 이후에는 점차 피부 조직이 섬유화되면서 단단해지고 두꺼워져서 부종이 자연적으로 회복되지 않는 상태로 진행되게 됩니다. 이 상태의 림프부종이 치료되지 않은 채 지속되면 무겁고 불편한 느낌이 들 뿐만 아니라 단백질이 풍부한 림프액의 저류로 인해 감염이 쉽게 올 수 있으며, 팔, 다리의 기능적 운동 능력이 저하됩니다.

림프부종의 대표증상

팔, 다리가 당기는 느낌이 든다.

통증, 쑤시는 느낌 또는 무거운 느낌이 든다.

반지나 신발 등을 착용할 때 조이는 느낌이 든다.

피부가 붉어지거나 부종 또는 염증 증상이 있다.

팔과 다리의 힘이 약하다고 느껴진다.

림프부종을 빨리 발견하면 회복이 좀 더 쉬울 수 있습니다. 따라서 환자는 위의 대표적 증상이 나타나면 담당 의사와 상담하여 림프부종의 진단을 신속히 받아야 합니다.

국제림프학회(International Society of Lymphology)는 림프부종의 중증도를 4단계로 분류하고 있습니다.

0기

국제림프학회(International Society of Lymphology)는 림프부종의 중증도를 4단계로 분류하고 있습니다.

1기

이환된 팔을 높이는 것 같은 치료로 대개 24시간 이내에 호전됩니다.

2기

팔 높이기 같은 단독치료만으로는 호전되지 않고, 피부 섬유화가 점차 진행되는 중등도 림프부종입니다.

3기

일명 ‘코끼리 다리’라고 언급하기도 하는 상태로 지방침착, 색소침착 같은 피부변화가 발생하는 심한 단계입니다. 치료는 대부분 대증치료이며, 효과가 뚜렷한 약물치료는 없습니다. 림프부종이 발생한 팔을 높이고, 마사지나 압박스타킹, 림프배출운동을 시행하게 됩니다. 치료받은 쪽 팔에서는 채혈, 주사, 혈압 측정 등을 피하고, 상처가 나지 않게 주의하며 체중이 증가하지 않도록 관리해야합니다.

자가진단법

약 200ml의 물을 채운 그릇에 팔이나 다리를 담가 물이 넘치는 정도를 비교할 수도 있습니다.

양쪽 팔과 다리 둘레가 2cm 이상 차이가 나면, 림프부종을 의심해봐야 합니다.
(부종 둘레 측정 시에는 같은 시간, 같은 부위를 같은 자세로 측정합니다.)

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림프부종은 림프계 순환의 문제로 발생되어 붓는 증상으로 몸의 신진대사나 신장의 문제 등으로 나타나는 부종의 증상과는 다른 질환입니다. 따라서 림프부종에 좋지 않는 영향을 미칠 수 있는 것들은 피하고, 주의해야 할 사항들을 숙지해야 합니다.

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1. 팔, 다리를 심장보다 높게 유지하기

수면 시 베개나 쿠션을 팔, 다리 아래에 받쳐서 심장보다 높은 상태로 유지합니다. 중력을 이용하여 림프액이 심장 방향으로 흐르도록 해 림프액의 흡수를 촉진시켜주는 습관입니다. 특히 팔과 손, 손가락의 림프부종 예방에 효과적입니다.

2. 자세 자주 바꾸기

공부나 업무 중 한 자세로 너무 오래 앉거나 서지 않고, 주기적으로 자세를 바꿔줍니다. 또한, 의자에 앉을 때는 다리를 꼬지 않고, 침대에서도 허리를 펴고 정자세를 취하는 것이 바람직합니다. 특히 침대에서 자세를 똑바로 취하면 체액이 쌓이지 않게 하는 데 도움이 됩니다. 핸드폰이나 시계 알람을 맞춰 주기적으로 자세를 바꾸는 것도 좋은 방법입니다. TV를 시청할 때도 중간 광고가 나오면 자세를 바꾸는 등 자세 바꾸기 습관을 들이는 노력이 필요합니다.

3. 몸을 보호하는 옷 입기

자상, 일광화상 또는 기타 화상, 벌레물림, 교상 등은 해당 부위에 체액이 몰리게 해 림프부종의 위험을 증가시킬 수 있습니다. 가급적 긴 소매 옷과 바지를 입어 피부 부상을 최대한 막도록 합니다. 이때 옷은 너무 조이지 않아야 하며, 팔에 압박이 갈 수 있는 팔토시는 금합니다.

4. 균형이 잘 잡힌 저염 식단

매일 과일과 채소를 골고루 섭취하는 것이 좋습니다. 가급적 통밀빵, 시리얼, 파스타, 쌀, 신선한 과일과 채소 등 섬유질 함량이 높은 음식을 먹는 것이 좋습니다. 또한 알코올 섭취를 피하거나 하루에 한 잔으로 제한합니다. 패스트푸드나 정크푸드 등 영양의 균형이 맞지 않고 고칼로리인 음식은 피하고, 붉은 육류와 핫도그, 소시지, 베이컨 등 가공 육류의 섭취도 줄여 나갑니다.

5. 적정 체중 유지하기

과체중, 비만인 사람은 림프부종의 위험이 더욱 높은 편입니다. 이미 부어있는 곳에 추가로 압력이 가해지고 림프액의 정상적인 흐름에 지장을 주기 때문입니다. 따라서 적절한 식단, 운동, 마음가짐으로 이상적인 체중을 유지하도록 노력합니다.

6. 규칙적이고 건강한 생활하기

건강한 식습관과 주기적인 운동을 통해 건강을 챙기도록 합니다. 또, 규칙적인 시간에 수면을 충분히 취하는 것은 면역력 향상에 도움이 되며, 림프부종의 위험을 낮춰줄 수 있습니다. 고강도 운동은 피하고, 최대한 일과에 운동을 포함시키도록 합니다.

7. 보습과 청결에 신경쓰기

피부를 깨끗하게 유지하고 피부가 건조해지지 않도록 합니다. 저자극성 비누를 사용하여 피부를 청결하게 한 후 항균성 연고나 로션을 발라줍니다. 단, 발은 건조하게 유지하는 것이 좋습니다. 땀 흡수가 잘되는 면제품 의류를 착용하며, 햇볕에 노출될 때에는 자외선 차단제를 사용하는 것도 잊지 않습니다.

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1. 더운 환경에 오래 노출되지 않기

수면 시 베개나 쿠션을 팔, 다리 아래에 받쳐서 심장보다 높은 상태로 유지합니다. 중력을 이용하여 림프액이 심장 방향으로 흐르도록 해 림프액의 흡수를 촉진시켜주는 습관입니다. 특히 팔과 손, 손가락의 림프부종 예방에 효과적입니다.

2. 림프부종의 위험 부위는 마사지를 받지 않기

열과 마찬가지로 마사지 역시 해당 부위로 가는 체액을 증가시키며, 이는 림프부종의 원인이 될 수 있습니다.

3. 무거운 물건을 들거나 숄더백 매지 않기

수술 후 또는 암 치료 후 회복 기간 동안에는 치료를 받은 쪽으로 무거운 물건을 들지 않아야 합니다. 팔에 무게를 가하면 림프부종의 위험도 따르므로 주의해야 합니다. 어쩔 수 없이 무거운 물체를 들어야 한다면 팔을 허리 위까지 올려서 들어야 조금이나마 무리가 가지 않습니다.

4. 조이는 옷이나 장신구 착용하지 않기

심하게 조이는 시계나 반지, 팔찌 또는 장신구는 착용하지 않고, 코르셋이나 레깅스처럼 딱 붙는 옷 역시 피합니다. 목이 답답하거나 조이는 상의를 입으면 머리나 목에 림프부종이 발생할 수 있습니다. 목과 팔, 다리, 손목 등 체액이 쌓일 수 있는 부위에 압박이 가해지지 않도록 주의합니다. 장시간 비행을 하는 것도 가급적 삼갑니다.

5. 담배 피우지 않기

흡연은 모세혈관을 포함한 작은 혈관들을 좁게 만들어 체액이 체내에서 원활히 흐르지 못하게 합니다. 혈액이 건강하게 흐르지 않으면 피부에 산소와 각종 필수 영양분이 부족해지며, 피부의 탄성을 약화시킵니다.

6. 팔과 다리에 부상을 입지 않도록 보호하기

부종이 있는 팔, 다리에 상처를 입으면 쉽게 아물지 않고 부종이 심해질 수 있습니다. 따라서 자상, 열린 상처, 찰과상, 화상 등에 주의합니다. 날카로운 물체에 찔리지 않기 위해 바느질을 할 때는 골무를 착용하고, 요리나 작업 시 장갑을 끼는 것이 좋습니다. 외출을 할 때는 방충제를 사용하여 벌레로부터 피하는 것도 중요합니다. 야외 활동 시 양말, 신발을 꼭 신으며 맨발로 다니지 않습니다. 또한, 손발톱 정리 시 큐티클을 자르지 않으며, 발톱은 일자로 잘라줍니다. 제모가 필요한 경우 전기면도기를 사용하는 것도 추천합니다.

7. 부어있는 팔에 자극 주지 않기

부어 있는 팔, 다리에 주사를 맞지 않도록 합니다. 한의원에서 침, 부황, 뜸 등의 시술을 받을 때도 주의가 필요합니다. 상처가 나면 밴드보다는 거즈를 사용해 부종 부위가 조이지 않도록 합니다. 혹시나 발진이 나타나면 반드시 담당의사와 상의하여 치료해야 합니다.

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림프부종의 치료는 도수림프 배출법으로 림프액의 배출을 시키는 방법이 있습니다. 압박 요법은 성공적인 림프부종 치료를 위해 매우 중요한데, 압박 붕대법, 압박 스타킹과 의복, 공기 압박 펌프 요법 등이 대표적입니다.
손가락을 폈다 구부리기, 손목에 힘주기, 전완부 회내, 회의 운동을 압박 붕대나 스타킹 착용과 병행하여 시행할 수 있습니다.

도수 림프 배출법(MLD)

림프흡수 마사지는 부종 환자들에게 가장 효과적인 치료법으로 알려져 있습니다. 마사지는 부드럽고 천천히 해야 하며 림프액을 정확한 방향으로 이동시키는 것이 중요합니다.

팔 도수 림프 배출법

1.목 부위를 위에서 아래 방향으로 마사지해준다.

2.부종 부위의 겨드랑이에서 반대편 겨드랑이 방향으로 마사지해준다.

3.부종 부위의 겨드랑이에서 같은 쪽 서혜부(아랫배와 허벅지 사이) 방향으로 마사지해준다.

4.등 쪽도 부종 부위의 겨드랑이에서 반대편 겨드랑이 쪽으로 마사지해준다.

5. 팔꿈치에서 겨드랑이 쪽으로 위쪽 팔을 마사지해준다.

6. 손목에서 팔꿈치 쪽으로 아래쪽 팔을 마사지해준다.

7. 손등을 위 방향으로 마사지해준다.

다리 도수 림프 배출법

1. 목 부위를 위에서 아래 방향으로 마사지해준다.

2. 부종 부위의 서혜부에서 반대편 서혜부 방향으로 마사지해준다.

3. 부종 부위의 서혜부에서 같은 쪽 겨드랑이 방향으로 마사지해준다.

4. 등 쪽도 부종 부위의 서혜부에서 반대편 서혜부방향으로 마사지해준다.

5. 무릎에서 서혜부 방향으로 허벅지를 마사지해준다.

6. 발목에서 무릎 방향으로 아래쪽 다리를 마사지해준다.

7. 발등을 위 방향으로 마사지해준다.

a

DR CATHERINE CASTILLO

Neurologist

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