3种量表评估新生儿术后机械通气和非机械通气状态下疼痛的比较

Comparison of three scales for postoperative pain assessment between neonates with and without mechanical ventilation after surgery

目的比较新生儿舒适量表、新生儿疼痛、激惹与镇静量表、兰氏新生儿疼痛评估量表的机械通气疼痛版或术后疼痛版评估新生儿术后机械通气或非机械通气状态下疼痛的信度和效度。方法以48例择期手术新生儿为研究对象。每例新生儿术前及术后48 h内录制7份视频,2名研究者回放视频,使用3种量表独立进行疼痛评估,分别比较量表用于新生儿术后机械通气和非机械通气时的内部一致性、评估者间信度、重测信度和结构效度。结果用于术后机械通气新生儿时,新生儿舒适量表、新生儿疼痛、激惹与镇静量表、兰氏新生儿疼痛评估量表-机械通气疼痛版的Cronbach's α系数分别为0.819、0.665、0.627;评估者间信度系数分别为0.854、0.957、0.956;重测信度系数分别为0.977、0.983、0.994;探索性因子分析分别提取出1、1、2个因子,累计方差贡献率分别为57.042%、62.953%、85.872%。用于术后非机械通气新生儿时,新生儿舒适量表、新生儿疼痛、激惹与镇静量表、兰氏新生儿疼痛评估量表-术后疼痛版的Cronbach's α系数分别为0.885、0.813、0.735;评估者间信度系数分别为0.842、0.934、0.973;重测信度系数分别为0.968、0.994、0.985;探索性因子分析分别提取出1、1、2个因子,累计方差贡献率分别为66.378%、64.288%、75.902%。结论3种量表用于新生儿术后疼痛评估均有较好的信度和效度。术后机械通气时推荐使用新生儿舒适量表,非机械通气时推荐使用兰氏新生儿疼痛评估量表-术后疼痛版。

Objective To compare the reliability and validity of the COMFORTneo Scale,the Neonatal Pain,Agitation and Sedation Scale,and mechanical ventilation or postoperative pain version of the Lan's Neonatal Pain Scale for pain assessment in neonates with or without mechanical ventilation after surgery.Methods Forty-eight neonates with scheduled surgery were recruited.Seven videos were recorded for each neonates before and 48 hours after surgery,and two researchers scored independently using the three pain scales while viewing the video clips.Internal consistency,inter-assessor reliability coefficient,test-retest reliability,and construct validity of the three scales were compared between neonates with and without mechanical ventilation,respectively.Results In mechanically ventilated neonates,the Cronbach's α coefficients of the COMFORTneo Scale,the Neonatal Pain,Agitation and Sedation Scale,and the Lan's Neonatal Pain Scale-Mechanical Ventilation Pain were 0.819,0.665,and 0.627,respectively.Inter-assessor reliability coefficients were 0.854,0.957,and 0.956,respectively.Test-retest reliability coefficients were 0.977,0.983,and 0.994,respectively.Exploratory factor analysis extracted one,one,two factors,and cumulative variance contribution rates were 57.042%,62.953%,and 85.872%,respectively.In neonates without mechanical ventilation,the Cronbach's α coefficients of the COMFORTneo scale,the Neonatal Pain,Agitation and Sedation Scale,and the Lan's Neonatal Pain Scale-Postoperative Pain were 0.885,0.813,and 0.735,respectively.Inter-assessor reliability coefficients were 0.842,0.934,and 0.973,respectively.Test-retest reliability coefficients were 0.968,0.994,and 0.985,respectively.Exploratory factor analysis extracted one,one,two factors,and cumulative variance contribution rates were 66.378%,64.288%,and 75.902%,respectively.Conclusion All three scales show good reliability and validity for assessing postoperative pain in neonates.It is recommended that the COMFORTneo Scale and the Lan's Neonatal Pain Scale-Postoperative Pain for pain assessment in mechanically ventilated or non-mechanically ventilated neonates after surgery,respectively.