两种非语言疼痛评估工具在ICU机械通气病人中的应用研究

Application research on two kinds of nonverbal pain assessment tools for mechanical ventilation patients in ICU

[目的]探讨两种中文版的非语言疼痛评估工具用于评估危重症病人疼痛的信度和效度。[方法]选取某三级甲等医院86例入住ICU的危重症病人,分别由2名评估者同时用两种评估工具在两种不同的刺激(非侵入性血压测量、密闭式吸痰)下对病人进行疼痛评估,收集病人休息状态、操作中、操作15min^20min后的疼痛得分。对有意识且配合的病人,由1名研究者在疼痛刺激后使用数字疼痛强度量表(NRS)获得病人主诉的疼痛得分。[结果]判别效度方面,两种量表在疼痛刺激中的量表得分都高于其他评估过程的得分(P<0.001);效标效度方面,在有疼痛刺激操作过程中的疼痛评估量表(BPS)和危重症病人疼痛观察量表(CPOT)得分与主诉的NRS得分的Pearson相关系数分别为0.509,0.521。敏感度和特异度分析,当CPOT的最佳疼痛节点为3.5分时,敏感度和特异度分别为70.0%、60.5%,所获得的ROC曲线下的面积(AUC)为0.712;当BPS的最佳疼痛节点为7.5分时,敏感度和特异度分别为85.7%、87.3%,所获得ROC曲线下的面积为0.843。[结论]BPS和CPOT都有良好的信效度,可用于评估危重症病人的疼痛;BPS在诊断疼痛方面的性能优于CPOT,但CPOT与病人主诉的疼痛得分(金标准)相关性高于BPS。

Objective：To probe into the reliability and validity of two kinds of nonverbal pain assessment tools in evaluation of pain in critically ill patients.Methods：A total of 86 critically ill patients in ICU in a third grade A hospital were selected,and the patients＇ pain was evaluated by using the two kinds of Chinese version of nonverbal pain assessment tools under two different stimulations（non invasive blood pressure measurement,closed suction）at the same time,then respectively to collect the patients＇ pain score.The evaluation time included resting state,during operation,15~20min after operation.Respectively at each time point 2raters each hold an assessment tool to evaluate patients.For the conscious and matched patients,pain score was gained by a researcher by using NRS after pain stimualtion.Results：In the discriminant validity,the pain stimulations scores of two scales were higher than those in other evaluation process（P〈0.001）.In the criterion validity,the Pearson correlation coefficient between BPS score and NRS score was 0.509,Pearson correlation coefficient between CPOT score and NRS score was 0.521 during pain stimulation operation.The sensitivity and specificity analysis showed that when the CPOT best pain node was 3.5,the sensitivity and specificity respectively were 70.0%and60.5%,the gained area under the ROC curve（AUC）was 0.712;when the BPS best pain node was 7.5,the sensitivity and specificity respectively were 85.7% and 87.3%,the area under the ROC curve（AUC）was 0.843.Conclusion：Both BPS and CPOT had good reliability and validity,which could be used to assess the pain of critically ill patients;In comprehensive analysis,the performance of BPS in pain diagnosis was better than that of the CPOT,but correlation between the CPOT and the patients＇ complained pain score（gold standard）was higher than that of BPS.