Behavioral and physiologic indicators during a nociceptive procedure in conscious and unconscious mechanically ventilated adults: Similar or different?
Behavioral and physiologic indicators during a nociceptive procedure in conscious and unconscious mechanically ventilated adults: Similar or different?
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DOI：
10.1016/j.jcrc.2009.01.013
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发表时间：
2009-12-01
影响因子：
3.7
通讯作者：
Arbour, Caroline
中科院分区：
文献类型：
--
作者：
Gelinas, Celine;Arbour, Caroline
目的：本研究的目的是描述有意识和无意识机械通气成人的伤害性过程的行为和生理指标，并检查它们与患者自我报告的疼痛的关系。材料和方法：来自加拿大4个临床环境的257名重症监护病房患者（144名有意识，113名无意识）参与了研究。观察患者在休息时，在伤害性手术过程中，以及手术后20分钟。行为指标采用重症监护疼痛观察工具（CPOT）测量，生理指标从可用的监测中记录。结果：与无意识患者相比，有意识患者在所有测量中表现出更强烈的行为和更高的平均动脉压。与没有疼痛的患者相比，在手术过程中自我报告疼痛的有意识患者表现出更强烈的行为。只有CPOT评分可以根据患者在手术过程中的自我报告来预测疼痛的存在或不存在。结论：强烈建议使用行为来评估无意识患者的疼痛，本研究的结果支持这一临床指南。在检测疼痛时应谨慎使用生命体征，因为生命体征可受疼痛以外的其他因素影响。(C) 2009爱思唯尔公司版权所有。
Purpose: The purpose of this study was to describe behavioral and physiologic indicators to a nociceptive procedure in conscious and unconscious mechanically ventilated adults and to examine their association with the patients' self-reports of pain.Materials and methods: A total of 257 intensive care unit patients (144 conscious and 113 unconscious) from 4 clinical settings in Canada participated. Patients were observed at rest, during a nociceptive procedure, and 20 minutes postprocedure. Behavioral indicators were measured with the Critical Care Pain Observation Tool (CPOT), and physiologic indicators were documented from the available monitoring.Results: Conscious patients showed more intense behaviors and a more elevated mean arterial pressure compared with unconscious patients at all measurements. Conscious patients who self-reported being in pain during the procedure showed more intense behaviors compared with patients without pain. Only the CPOT score could predict the presence or the absence of pain on the basis of the patient's self-report during the procedure.Conclusions: The use of behaviors is strongly recommended for pain assessment in unconscious patients, and results from this study support this clinical guideline. Vital signs should be used with caution for the detection of pain as they can be influenced by other factors besides pain. (C) 2009 Elsevier Inc. All rights reserved.