Assessing pain in critically ill sedated patients by using a behavioral pain scale
Assessing pain in critically ill sedated patients by using a behavioral pain scale
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DOI：
10.1097/00003246-200112000-00004
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发表时间：
2001-12-01
影响因子：
8.8
通讯作者：
Jacquot, C
中科院分区：
文献类型：
--
作者：
Payen, JF;Bru, O;Jacquot, C
目的：建立一个新的行为疼痛量表（BPS）的有效性和可靠性的危重病人镇静成人。设计：前瞻性评价。设置。一所大学教学医院的创伤和外科重症监护病房。30例接受镇痛和镇静的机械通气患者。干预：BPS的评估在标准化时间（上午，下午，晚上）由成对的评估者（护士和护士的助手）连续完成。他们在护理程序之前和期间收集生理参数和BPS结果：非伤害性（第1组，加压袜应用和中心静脉导管敷料更换），伤害性（第2组，气管内抽吸和动员）和重新测试伤害性（第3组）。BPS评分是范围评分为1-4的三个项目的总和：面部表情、上肢运动和机械通气的依从性。完成了269项评估，其中第1、2和3组分别进行了104、134和31次测量。三组之间的Ramsay量表评分无差异（Ramsay 4-6）。伤害性刺激（第2组）导致比非伤害性刺激显著更高的BPS值（第1组，4.9对3.5，p <0.01），而两组在刺激前具有可比的BPS值（3.1对3.0）。第2组的镇静/镇痛剂量与BPS之间存在一种趋势：剂量越高，BPS值越低，BPS对伤害性刺激的变化越大。第3组的BPS值与第2组在休息时（3.2 vs. 3.2）和手术期间（4.4 vs. 4.5）相似，具有良好的评分者间相关性（r（2）= 0.71和0.50，分别）。结论：这些结果表明，在镇静，机械通气患者中使用BPS可以有效和可靠地评分疼痛的表达。关于BPS在重症监护室使用镇痛药物的临床决策中的效用，需要进一步研究。
Objective: To establish the validity and reliability of a new behavioral pain scale (BPS) for critically ill sedated adult patients.Design: Prospective evaluation.Setting. Ten-bed trauma and surgical intensive care unit in a university teaching hospital.Patients. Thirty mechanically ventilated patients who were receiving analgesia and sedation.Intervention: Assessments with the BPS were completed consecutively at standardized times (morning, afternoon, night) by pairs of evaluators (nurse and nurse's aide). They collected physiologic parameters and BPS results before and during care procedures: nonnociceptive (group 1, compression stockings application and central venous catheter dressing change), nociceptive (group 2, endotracheal suctioning and mobilization), and retested nociceptive (group 3). The BPS score was the sum of three items that had a range score of 1-4: facial expression, movements of upper limbs, and compliance with mechanical ventilation.Measurements and Main Results., Two hundred and sixty nine assessments were completed, including 104, 134, and 31 measurements in groups 1, 2 and 3, respectively. There was no difference in Ramsay scale scores between the three groups (Ramsay 4-6). Nociceptive stimulations (group 2) resulted in significantly higher BPS values than nonnociceptive ones (group 1, 4.9 vs. 3.5, p < .01), whereas the two groups had comparable BPS values before stimulation (3.1 vs. 3.0). A trend was found in group 2 between the dosage of sedation/analgesia and BPS: the higher the dosage, the lower BPS values and BPS changes to nociceptive stimulation. Group 3 had BPS values similar to group 2 at rest (3.2 vs. 3.2) and during the procedure (4.4 vs. 4.5), with good interrater correlations (r(2) = .71 and .50, respectively).Conclusions: These results indicate that the expression of pain can be scored validly and reliably by using the BPS in sedated, mechanically ventilated patients. Further studies are warranted regarding the utility of the BPS in making clinical decisions about the use of analgesic drugs in the intensive care unit.