不同评估方法在肺切除术患者围手术期疼痛测量中的心理测量学特征

Psychometric properties of different pain measuring scales in patients during perioperative period of lung resection

目的探讨肺切除术患者围手术期使用4种疼痛评估方法进行疼痛测量时的心理测量学特性,选择肺切除术患者围手术期疼痛管理的最适评估方法。方法选取2021年10月至2022年4月四川省肿瘤医院410例肺切除术患者,分别在术前、术后住院期间(最长6 d)以及出院当天,同时采用4种方法[0~10数字疼痛评估法(numerical rating scale,NRS)、语言分级评估法(verbal rating scale,VRS)、视觉模拟评估法(visual analog scale,VAS)和修订版表情疼痛评估法(face pain scale revised,FPS-R)进行疼痛评估。使用Spearman相关性分析、独立样本t检验以及Cohen’s d效应值,对4种疼痛评估方法的信效度和反应度进行检验,采用χ2检验分析不同疼痛评估方法在患者首次填写时的错误率。结果各测量标尺间相关系数r在0.468~0.851之间,且所有相关系数均有统计学意义(P<0.001)。其中,VRS与FPS-R之间相关性最强(r=0.610~0.818),而NRS与VAS之间相关性最弱(r=0.553~0.791)。已知分组效度分析表明,NRS和VAS在区分能力上优于VRS及FPS-R。各方法评估术后疼痛变化的Cohen’d效应尺度均>0.7,其中,NRS对疼痛变化反应最为灵敏(Cohen’s d=0.80)。NRS的首次错误率最低(9.76%),VAS最高(30.73%)。结论4种评估方法都有较好的信效度及反应度,但在肺切除术围手术期患者常用的疼痛评估方法中,NRS错误率低、最灵敏、区分度良好,是综合应用效果最优的选择。

Objective To investigate the psychometric properties by 4 pain measurement scales in assessment of perioperative patients undergoing lung resection during pain assessment in order to obtain the most appropriate evaluation scale for perioperative pain management.Methods A total of 410 lung resection patients admitted in Sichuan Cancer Hospital from October 2021 and April 2022 were recruited in this study.The 4 pain assessment scales commonly used in clinical practice,that is,Numeric Rating Scale(NRS,0~10 points),Verbal Rating Scale(VRS),Visual Analogue Scale(VAS),and Faces Pain Scale-Revised(FPS-R),were used at the same time to evaluate their pain levels during the preoperative period,postoperative hospitalization(up to 6 d),and on the day of discharge.Spearman correlation analysis,independent samples t test and Cohen's d effect value were adopted to test the reliability and responsiveness of the 4 scales,and Chi-square test was performed to analyze the first-fill error rate of the different pain assessment methods.Results The correlation coefficients r between each measurement scale ranged from 0.468 to 0.851,and all of them were statistically significant(P0.001).The strongest correlation was found between the results of VRS and FPS-R(r=0.610~0.818),while the weakest was observed between NRS and VAS(r=0.553~0.791).Known-group validity analysis showed that NRS and VAS were superior to VRS and FPS-R in their ability to differentiate.The Cohen's d effect scale for each scale in assessing postoperative pain changes was all 0.7,with NRS being most sensitive to pain changes(Cohen's d=0.80).NRS had the lowest first-time error rate(9.76%),while VAS had the highest(30.73%).Conclusion All 4 assessment scales have good reliability and responsiveness,but in assessing pain in perioperative patients undergoing pulmonary resection,NRS is the optional choice with the best overall results because of its lowest error rate,highest sensitivity,and good discriminability.