新生儿面部表情疼痛量表的设计与评价

Development and evaluation of a novel neonatal faces pain scale

目的设计适用于我国新生儿的疼痛评估量表,提高临床评估效应和实用价值。方法选取新生儿重症监护病房(NICU)拟动脉穿刺采血的新生儿123例,其中20例于动脉穿刺操作过程中,以每隔3s1张的速度连续视频截图共1053幅,用于设计新生儿面部表情疼痛量表;另103例于动脉穿刺操作前、中、后3个时间点录像,用于评价该量表信度、效度及一致性。选取新生儿面部编码系统、新生儿疼痛量表进行参照评价。选取NICU43名护士对3种量表的可行性及临床实用性进行评价。结果新生儿面部表情疼痛量表包括面部表情和生理指标两部分,总分0~10分。评估者间一致性ICC为0.994,重测信度r值为0.989,面部表情、生理指标的Cronbach′sα系数分别为1.000、0.717,聚集效度r值为0.530~0.951,效标效度r值为0.952、0.944;与新生儿面部编码系统、新生儿疼痛量表差值的95%一致性界限分别为(-0.78,1.47)、(-2.05,1.52)。新生儿面部表情疼痛量表可行性和临床实用性评分得分高于另2种量表(P<0.05),临床护士应用首选率为79.1%。结论新生儿面部表情疼痛量表具有良好的信度、效度和临床实用性,可用于评估新生儿的操作性疼痛。

Objective To develop a pain assessment scale for Chinese neonates and to evaluate its validity and utility. Methods One hundred and twenty three neonates receiving arterial puncture for blood sample collection were recruited in a Neonatal Intensive Care Unit (NICU). Twenty of them were videotaped during arterial puncture, and 1 053 screenshots were taken every three seconds for developing the Neonatal Faces Pain Scale (NFPS). The other 103 neonates were also videotaped before, during, and after the arterial puncture procedure, for evaluating reliability, validity and consistency of the NFPS. The Neonatal Facial Coding System (NFCS) and the Neonatal Infant Pain Scale (NIPS) were used as the criteria. Forty-three NICU nurses were invited to evaluate the feasibility and clinical utility of the three scales. Results The NFPS included facial expression and physiological indicators, with a total score of 0 to 10 points. The inter-rater correlation coefficient and test-retest reliability of the NFPS were 0.994 and 0.989, respectively. The Cronbach′s α coefficients of facial expression and physiological indicators were 1.000 and 0.717, respectively. The convergent validity coefficients ranged from 0.530 to 0.951 and the criterion validity coefficients were 0.952 and 0.944 , respectively. The 95% limits of agreement in difference between the NFPS and NFCS were (-0.78, 1.47) and between the NFPS and NIPS were (-2.05 , 1.52). Nurses scored the highest on the NFPS for feasibility and clinical utility than on the NFCS and NIPS ( P < 0.05 ), and 79.1% of them gave priority to use the NFPS. Conclusion The NFPS had good reliability, validity, and utility to assess procedural pain in neonates.