2种疼痛评估工具在口腔颌面外科ICU患者中的信度和效度评价

doi:10.19439/j.sjos.2018.06.012

上海口腔医学 ›› 2018, Vol. 27 ›› Issue (6): 624-628.doi: 10.19439/j.sjos.2018.06.012

2种疼痛评估工具在口腔颌面外科ICU患者中的信度和效度评价

殷琦, 黄瑶, 李燕, 杨悦来^*, 茅越丽^*

上海交通大学医学院附属第九人民医院重症监护室,上海 200011

收稿日期:2017-12-08 出版日期:2018-12-25 发布日期:2019-01-11
通讯作者: 杨悦来,E-mail：yangyuelai@163.com;茅越丽,E-mail：maoyl94@163.com。^*共同通信作者
作者简介:殷琦（1981-）,女,本科,主管护师,E-mail: yinqi920@163.com

Comparison of two kinds of pain assessment tools for ICU patients in oral and maxillofacial surgery

YIN Qi, HUANG Yao, LI Yan, YANG Yue-lai, MAO Yue-li

Department of Intensive Care Unit, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China

Received:2017-12-08 Online:2018-12-25 Published:2019-01-11
Supported by:
上海市教育委员会护理高原学科建设项目(hlgy17083qnhb); 上海交通大学医学院附属第九人民医院护理院级基金(JYHL20151712,JYHL20161915,JYHL20170805)

摘要/Abstract

摘要： 目的: 探讨2种疼痛评估工具在口腔颌面外科ICU患者中的信度和效度。方法: 选取上海交通大学医学院附属第九人民医院ICU收住的30例口腔颌面外科患者,分别由2名评估者在进行密闭式吸痰和非侵入性测量血压的护理干预时,采用中文版危重症患者疼痛观察量表（CPOT）和疼痛评估量表（BPS）对患者进行疼痛评估,采集患者操作前5 min、操作时和操作后20 min的疼痛评分。对意识清醒且配合者,由研究人员采集密闭式吸痰操作后患者主诉的数字疼痛评分。采用SPSS17.0软件包对数据进行信度和效度校验。结果: 中文版CPOT和BPS的内部一致性Cronbach α系数分别为0.809和0.878。在区分效度方面,2种评估工具在侵入性操作中的得分显著高于其他评估过程的得分（P<0.05）;在校标效度方面,在侵入性操作过程中危重症患者疼痛观察量表（CPOT）和疼痛评估量表（BPS）与患者主诉的数字疼痛评分Spearman相关系数分别为0.542（P=0.000）、0.461（P=0.000）,均呈正相关。在灵敏度和特异度方面,当CPOT的最佳疼痛节点为3.5分时,灵敏度和特异度分别为55%、96.7%, ROC曲线下面积(AUC)为0.799;当BPS的最佳疼痛节点为7分时,灵敏度和特异度分别为50%、100%,ROC曲线下面积为0.743。结论: 中文版CPOT和BPS都有良好的信度和效度,均适合于口腔颌面外科患者的疼痛评估。

关键词: 口腔颌面外科, ICU, 疼痛, 评估工具, 信效度

Abstract: PURPOSE: To explore the validity of two kinds of pain assessment tools for ICU patients after oral and maxillofacial surgery. METHODS: A total of 30 ICU patients post oral and maxillofacial surgery were included, and the patients' pain was assessed by 2 independent research nurses with 2 kinds of pain assessment tools (CPOT and BPS) at the same time under non-pain stimulations and pain stimulation (non-invasive blood pressure measurement and closed endotracheal intubation suction). The repeated assessment point included rest state, during intervention, 20 minutes after intervention. For conscious patients, pain score was also obtained by 1 researcher with numerical rating scale (NRS) after closed endotracheal intubation suction. The data were analyzed by reliability and validation test using SPSS 17.0 software package. RESULTS: The internal consistency of CPOT and BPS was 0.809 and 0.878, respectively. In the analysis of discriminant validity, the pain stimulations scores of 2 scales were significantly higher than those in other assessment point (P<0.05); In the criterion validity, Spearman correlation coefficient between CPOT score and NRS score was 0.542, 0.461 between BPS score and NRS score during pain stimulation process. The results of sensitivity and specificity analysis revealed that when the CPOT score was cut by 3.5 point, the sensitivity and specificity were 55% and 96.7%, respectively, the area under ROC curve (AUC) was 0.799; when the BPS score was cut by 7 point, the sensitivity and specificity respectively were 50% and 100%, respectively, the area under ROC curve (AUC) was 0.743. CONCLUSIONS: Both CPOT and BPS have good reliability and validity, which may be used to assess the pain of ICU patients in oral and maxillofacial surgery.

Key words: Oral and maxillofacial surgery, ICU, Pain, Assessment tool, Reliability and validity

中图分类号:

R473.78

殷琦, 黄瑶, 李燕, 杨悦来, 茅越丽. 2种疼痛评估工具在口腔颌面外科ICU患者中的信度和效度评价[J]. 上海口腔医学, 2018, 27(6): 624-628.

YIN Qi, HUANG Yao, LI Yan, YANG Yue-lai, MAO Yue-li. Comparison of two kinds of pain assessment tools for ICU patients in oral and maxillofacial surgery[J]. Shanghai Journal of Stomatology, 2018, 27(6): 624-628.

参考文献

[1] Lynch M.Pain as the fifth vital sign[J]. J Intraven Nurs,2001,24(2): 85-94.
[2] Montgomery R, McNamara SA. Multimodal pain management for enhanced recovery: reinforcing the shift from traditional pathways through nurse-led interventions[J]. AORN J, 2016, 104(6S): S9-16.
[3] 胡格吉胡, 拉布. 右美托咪定复合瑞芬太尼镇痛对老年颌面外科手术患者围术期疼痛的疗效[J]. 中国老年学杂志, 2013, 33(4): 961-962.
[4] 孙宇, 方舒东, 康华, 等. 氟比洛芬酯复合芬太尼用于口腔颌面外科术后静脉镇痛的研究[J].临床麻醉学杂志, 2008, 24(3): 256-257.
[5] 张国良, 羊玉荣, 陆斌, 等. 颌面外科术后疼痛的调查研究[J]. 实用口腔医学杂志, 2003, 19(5): 496-498.
[6] Barr J, Fraser GL, Puntillo K, et al.Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit[J]. Crit Care Med, 2013, 41(1): 263-306.
[7] Azzam PN, Alam A.Pain in the ICU: a psychiatric perspective[J]. J Intensive Care Med, 2013,28(3): 140-150.
[8] Flynn Makic MB.Pain management in the nonverbal critically ill patient[J].J Perianesth Nurs, 2013, 28(2): 98-101.
[9] 殷琦, 杨悦来, 李燕, 等. 2种非语言疼痛评估工具的应用现状分析[J]. 国际护理学杂志, 2016, 35(16): 2191-2193.
[10] Gélinas C, Fillion L, Puntillo KA, et al.Validation of the critical care pain observation tool in adult patients[J]. Am J Crit Care, 2006, 15(4): 420-427.
[11] 陈惠君. 中文版重症照护疼痛观察工具之效度检定[D]. 台中: 中国医药大学, 2010.
[12] Payen JL, Bosson A, Lagrasta, et al. Assessing pain in critically ill sedated patients by using a behavioral pain scales [J]. Crit Care Med,2001,29(12):2258 2263.
[13] 陈燕雅. 中文版本疼痛行为量表之建立与信效度检测 [D]. 台北: 台湾大学, 2008.
[14] American Pain Society.Principles of analgesic use in the treatment of acute pain and cancer pain[M]. 4th Ed. Glenview: Ameican Pain Society,1999.
[15] Chanques G, Pohlman A, Kress JP, et al.Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report[J]. Crit Care, 2014, 18(5): R160.
[16] Marmo L, Fowler S.Pain assessment tool in the critically ill post-open heart surgery patient population[J].Pain Manag Nurs, 2010, 11(3): 134-140.
[17] Aïssaoui Y, Zeggwagh AA, Zekraoui A, et al.Validation of a behavioral pain scale in critically ill, sedated, and mechanically ventilated patients[J]. Anesth Analg, 2005, 101(5): 1470-1476.
[18] Paulson-Conger M, Leske J, Maidl C, et al.Comparison of two pain assessment tools in nonverbal critical care patients[J].Pain Manag Nurs, 2011, 12(4): 218-224.
[19] 张盼, 张春华, 朱小平. 2种非语言疼痛评估工具在ICU机械通气病人中的应用研究[J]. 护理研究, 2016, 30(6): 1961-1965.
[20] 中华医学会重症分会. 重症加强治疗病房病人镇痛和镇静治疗指南(2006)[J]. 中国实用外科杂志, 2006,26(12): 893-901.
[21] Topolovec-Vranic J, Gelinas C, Li Y, et al.Validation and evaluation of two observational pain assessment tools in a trauma and neurosurgical intensive care unit[J].Pain Res Manag, 2013, 18(6): e107-114.
[22] Ahlers SJ, van Gulik L, van der Veen AM, et al. Comparison of different pain scoring systems in critically ill patients in a general ICU[J]. Crit Care, 2008, 12(1): R15.
[23] Gelinas C, Harel F, Fillion L, et al.Sensitivity and specificity of the critical-care pain observation tool for the detection of pain in intubated adults after cardiac surgery[J]. J Pain Symptom Manage, 2009, 37(1): 58-67.

2种疼痛评估工具在口腔颌面外科ICU患者中的信度和效度评价

Comparison of two kinds of pain assessment tools for ICU patients in oral and maxillofacial surgery

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	刘玥旻, 柴盈, 魏文斌, 刘芷扬, 韩孜祥, 陈敏洁. 大鼠三叉神经病理性疼痛致病关键转录分子分析[J]. 上海口腔医学, 2023, 32(1): 33-39.
[2]	董翔, 劳蔚, 刘锦星, 纪均. 右美托咪定对口腔颌面外科清醒插管患者吞咽功能的影响[J]. 上海口腔医学, 2021, 30(2): 206-209.
[3]	宋勇, 李想, 蔡嫚, 王耀辉. 2种阻生牙拔除法联合即刻种植的效果评价[J]. 上海口腔医学, 2019, 28(6): 632-635.
[4]	肖玲, 陈瑞霞, 罗娜. 单次低剂量激光疗法对固定正畸治疗初期疼痛的影响[J]. 上海口腔医学, 2019, 28(5): 549-552.
[5]	周磊, 王佳, 臧艳君. Er,Cr:YSGG水激光用于根管治疗约诊间疼痛的疗效观察[J]. 上海口腔医学, 2019, 28(2): 184-186.
[6]	舒怡, 罗业姣. 热牙胶充填技术联合不同封闭剂在根管充填治疗中的疗效评价[J]. 上海口腔医学, 2018, 27(6): 645-648.
[7]	张凌怡, 滕梅荣. 疼痛管理对口腔种植围术期患者的影响[J]. 上海口腔医学, 2017, 26(3): 346-348.
[8]	闫磊, 王新迎, 万娜, 尹艳娇, 吴佩玲. 汉族与维吾尔族慢性根尖周炎患者根管治疗后疼痛差异及口服布洛芬后镇痛效果比较[J]. 上海口腔医学, 2017, 26(2): 217-221.
[9]	刘小涵, 张善勇, 郑家伟, 杨驰. 世界口腔颌面外科发展回顾与展望[J]. 上海口腔医学, 2016, 25(4): 507-506.
[10]	杨红丽，唐睿，龚瑜，张玉皓. 根管预备及根管消毒期间诊间疼痛的临床观察[J]. 上海口腔医学, 2016, 25(2): 227-230.
[11]	郑茜，张利华，黄丽，王光平，袁小平，徐晓梅. 不同心理干预对不同人格患者正畸疼痛的缓解效果评价[J]. 上海口腔医学, 2016, 25(1): 91-96.
[12]	蔡鸣，曹霞，房笑，王旭东，张丽莉，郑家伟，沈国芳. 翻转课堂教学法在口腔颌面外科本科教学中的应用[J]. 上海口腔医学, 2015, 24(6): 758-762.
[13]	陆川, 何冬梅, EdwardEllisⅢ. 美国口腔颌面外科专业发展历史和现状[J]. 上海口腔医学, 2015, 24(5): 460-464.
[14]	卢俊钦, 孙坚. 舌瓣重建口腔软组织缺损研究进展[J]. 上海口腔医学, 2015, 24(5): 465-469.
[15]	张彩娣,滕蕊,卢蓁,乔虎,钱甜,周洪. 大鼠正畸牙移动过程中TRPV1和CGRP在三叉神经节中的表达变化[J]. 上海口腔医学, 2015, 24(1): 6-7.