重症监护疼痛观察量表用于内科机械通气患者的适用性研究

The study of application of the Critical Care Pain Observation Tool among medical patients with mechanical ventilation

目的评价重症监护疼痛观察量表在内科机械通气患者中的适用性。方法采用方便抽样法选取北京协和医院监护病房住院治疗的110例内科机械通气患者，其中清醒组53例，非清醒组57例，清醒组中，疼痛组34例，非疼痛组19例，量表的适用性采用信度、效度、反应度、灵敏度、特异度及ROC曲线下面积共6项指标进行评价。结果量表的Cronbachd系数为0．865，组内相关系数值为0．883（P〈0．05），内容效度指数值为1．00，量表与视觉模拟评分（VAS）的Spearman相关系数为0．544（P〈0．01）；已知族群效度显示，意识清醒患者疼痛得分较非清醒患者高；反应度显示，量表在气管插管内吸痰时得分最高；量表的灵敏度为94．1％，特异度为42．1％，ROC曲线下面积为0．716。结论量表具有较好的内部一致性信度、评定者问信度、内容效度及反应度；量表与VAS评分具有中等强度的效标关联效度。量表区分疼痛与其他症状的特异度较低。建议扩大样本量进一步验证其适用性。

Objective To evaluate the applicability of the Critical Care Pain Observation Tool （CPOT） in medical patients with mechanical ventilation. Methods A descriptive design was chosen for this study. A convenience sample of 110 medical patients with mechanical ventilation in ICU was selected, among which, 53 cases were sober （including 34 patients with pain and 19 patients without pain）, 57 cases were non-sober. The CPOT was applied for evaluating the reliability, validity, reactive degree, sensitivity, specificity and ROC curve analysis. Results Cronbach alpha coefficient was 0.865. Intraclass correlation coefficient was 0.883. CVI was 1.00. Spearman correlation with Visual Analogue Scale （VAS） was 0.544. In known-group technique, only pain score was statistically significant in Ramsay score. In reactive degree, score was statistically significant in three testing points. The CPOT had a sensitivity of 94.1% and a specificity of 46.7%. The area under the ROC curve was 0.716. Conclusions The CPOT has good internal consistency, interrater reliability, content validity, reactivity, moderate criterion validity. Speciality in distinguishing pain and other symptoms is worse. Future research is warranted to further verify the applicability of the CPOT.