2种疼痛评估工具在口腔颌面外科ICU患者中的信度和效度评价

Comparison of two kinds of pain assessment tools for ICU patients in oral and maxillofacial surgery

目的:探讨2种疼痛评估工具在口腔颌面外科ICU患者中的信度和效度。方法:选取上海交通大学医学院附属第九人民医院ICU收住的30例口腔颌面外科患者,分别由2名评估者在进行密闭式吸痰和非侵入性测量血压的护理干预时,采用中文版危重症患者疼痛观察量表(CPOT)和疼痛评估量表(BPS)对患者进行疼痛评估,采集患者操作前5 min、操作时和操作后20 min的疼痛评分。对意识清醒且配合者,由研究人员采集密闭式吸痰操作后患者主诉的数字疼痛评分。采用SPSS17.0软件包对数据进行信度和效度校验。结果:中文版CPOT和BPS的内部一致性Cronbachα系数分别为0.809和0.878。在区分效度方面,2种评估工具在侵入性操作中的得分显著高于其他评估过程的得分(P<0.05);在校标效度方面,在侵入性操作过程中危重症患者疼痛观察量表(CPOT)和疼痛评估量表(BPS)与患者主诉的数字疼痛评分Spearman相关系数分别为0.542(P=0.000)、0.461(P=0.000),均呈正相关。在灵敏度和特异度方面,当CPOT的最佳疼痛节点为3.5分时,灵敏度和特异度分别为55%、96.7%, ROC曲线下面积(AUC)为0.799;当BPS的最佳疼痛节点为7分时,灵敏度和特异度分别为50%、100%,ROC曲线下面积为0.743。结论:中文版CPOT和BPS都有良好的信度和效度,均适合于口腔颌面外科患者的疼痛评估。

PURPOSE:To explore the validity of two kinds of pain assessment tools for ICU patients after oral and maxillofacial surgery.METHODS:A total of 30 ICU patients post oral and maxillofacial surgery were included,and the patients' pain was assessed by 2 independent research nurses with 2 kinds of pain assessment tools (CPOT and BPS) at the same time under non-pain stimulations and pain stimulation (non-invasive blood pressure measurement and closed endotracheal intubation suction).The repeated assessment point included rest state,during intervention,20 minutes after intervention.For conscious patients,pain score was also obtained by 1 researcher with numerical rating scale (NRS) after closed endotracheal intubation suction.The data were analyzed by reliability and validation test using SPSS 17.0 software package.RESULTS:The internal consistency of CPOT and BPS was 0.809 and 0.878,respectively.In the analysis of discriminant validity,the pain stimulations scores of 2 scales were significantly higher than those in other assessment point (P<0.05); In the criterion validity,Spearman correlation coefficient between CPOT score and NRS score was 0.542,0.461 between BPS score and NRS score during pain stimulation process.The results of sensitivity and specificity analysis revealed that when the CPOT score was cut by 3.5 point,the sensitivity and specificity were 55% and 96.7%,respectively,the area under ROC curve (AUC) was 0.799; when the BPS score was cut by 7 point,the sensitivity and specificity respectively were 50% and 100%,respectively,the area under ROC curve (AUC) was 0.743.CONCLUSIONS:Both CPOT and BPS have good reliability and validity,which may be used to assess the pain of ICU patients in oral and maxillofacial surgery.