重症监护疼痛观察工具在机械通气患者中的适用性研究

Study on the applicability of intensive care pain observation tool in patients with mechanical ventilation

目的探讨CPOT在机械通气患者中的临床适用性。方法本研究前瞻性纳入机械通气患者,评估并记录患者翻身前和翻身时,更换深静脉敷料前和更换深静脉敷料时的CPOT评分,同时分别比较CPOT在外科术后、内科机械通气患者中的适用性。结果给予非疼痛刺激更换深静脉敷料时,观察机械通气患者CPOT总分为(0.71±0.08)分,较更换深静脉敷料前CPOT评分(0.57±0.07)无显著差异性;给予疼痛刺激翻身时,观察机械通气患者CPOT总分为(4.46±0.14)分,较翻身前CPOT评分(0.60±0.08)显著升高;同时镇静组CPOT评分(4.64±0.21)与非镇静组CPOT评分(4.25±0.17)无显著差异性。外科术后机械通气患者在换深静脉敷料前CPOT评分为(0.62±0.08)分,给予非疼痛刺激更换深静脉敷料,观察CPOT总分为(0.78±0.06)分,两者无统计学差异;外科术后机械通气患者在翻身前CPOT评分为(0.65±0.07)分,给予疼痛刺激翻身时,观察CPOT总分为(4.58±0.12)分,较翻身前显著增加(P<0.05)。内科机械通气患者在换深静脉敷料前CPOT评分为(0.49±0.06)分,给予非疼痛刺激更换深静脉敷料,观察CPOT总分为(0.68±0.07)分,两者无统计学差异;内科机械通气患者在翻身前CPOT评分为(0.59±0.08)分,给予疼痛刺激翻身时,观察CPOT总分为(4.32±0.09)分,较翻身前显著增加(P<0.05)。结论 CPOT在外科术后和内科机械通气患者中均有较好的临床适用性,且与镇静程度无关。

Objective To investigate the clinical applicability of Critical-Care Pain Observation Tool（ CPOT） in patients with mechanical ventilation.Methods This study was prospectively including patients with mechanical ventilation,and the CPOT scores were evaluated and recorded before and after the patients were turned over,before and after the replacement of deep venous dressings. At the same time,the applicability of CPOT in patients with mechanical ventilation after surgery was compared. Results When giving a non-pain stimulus to replace deep venous dressing,the total CPOT score of patients with mechanical ventilation was 0.71±0.08,which was not significantly different from that before（ 0. 57 ± 0. 07）. When giving a pain stimulus to turn over,the total CPOT score of patients with mechanical ventilation was 4.46 ± 0.14,which was significantly higher than that before（ 0.60 ± 0. 08）. In addition,there was no significant difference in CPOT score between sedation group（ 4. 64 ± 0. 21） and non-sedation group（ 4. 25 ± 0. 17）. The CPOT score of the patients with surgical postoperative mechanical ventilation was 0.62±0.08 before replacing deep venous dressings,while the CPOT score was 0.78±0.06 when giving a non-pain stimulus to replace deep venous dressing,and there was no significant difference between the two groups. The CPOT score of the patients with surgical postoperative mechanical ventilation was 0.65±0.07 before turning over. When giving a pain stimulus to turn over,the total CPOT was 4.58±0.12,which was significantly higher than that before turning over（ P〈0. 05）. The CPOT score of the patients with internal medical ventilation was 0.49±0.06 before replacing the deep vein dressing; when giving a non-pain stimulus to replace the deep vein dressing,the score was 0.68±0.07,and none significant difference between the two groups was found. The CPOT score of the patients with internal medical ventilation was 0. 59 ± 0. 08 before turning over; when giving a pain stimulus to turn over,the total CPOT was 4. 32 ± 0. 09,which was significantly higher than that before turning over（ P〈0. 05）. Conclusions CPOT has good clinical applicability in postoperative and mechanical ventilation patients,and has nothing to do with the degree of sedation.