Are vital signs valid indicators for the assessment of pain in postoperative cardiac surgery ICU
Are vital signs valid indicators for the assessment of pain in postoperative cardiac surgery ICU
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DOI：
10.1016/j.iccn.2009.11.003
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发表时间：
2010-04-01
影响因子：
5.3
通讯作者：
Gelinas, Celine
中科院分区：
文献类型：
--
作者：
Arbour, Caroline;Gelinas, Celine
本研究的目的是检查生命体征（平均动脉压[MAP]、心率[HR]、呼吸频率[HR]、经皮血氧饱和度[SpO（2）]和潮气末CO2）用于心脏手术后ICU成人疼痛评估的判别和标准有效性。采用重复测量受试者内设计。来自加拿大心脏病健康中心的105名患者参加了便利样本。在三个测试期间观察患者：（1）无意识和机械通气，（2）有意识和机械通气和（3）拔管后。对于这些测试阶段中的每一个，使用ICU监测在休息时、伤害感受程序期间和程序后20分钟评估生命体征。获得了清醒患者的疼痛自我报告。在伤害性过程中，大多数生命体征的显着变化支持判别效度。一些生命体征（HR、RR和SpO（2））与患者自我报告的疼痛相关，但取决于患者的状态（是否机械通气）。关于使用生命体征进行疼痛评估的结果并不一致，应谨慎考虑。根据专家的建议，只有在机械通气或无意识的患者中不再有行为指标时，才应将生命体征用作提示。皇冠版权所有（C）2009由爱思唯尔有限公司出版。保留所有权利。
The aim of this study was to examine the discriminant and criterion validity of vital signs (mean arterial pressure [MAP], heart rate [HR], respiratory rate [HR], transcutaneous oxygen saturation [SpO(2)], and end-tidal CO2) for pain assessment in postoperative cardiac surgery ICU adults. A repeated-measure within-subject design was used. A convenience sample of 105 patients from a cardiology health center in Canada participated. Patients were observed during three testing periods: (1) unconscious and mechanically ventilated, (2) conscious and mechanically ventilated and (3) after extubation. For each of these testing periods, vital signs were assessed using the ICU monitoring at rest, during a nociceptice procedure and 20 min post-procedure. Conscious patients' self-reports of pain were obtained. Discriminant validity was supported with significant changes in most vital signs during the nociceptive procedure. Some of the vital signs (HR, RR, and SpO(2)) were associated with the patients' self-reports of pain but were dependent on the patients' status (mechanically ventilated or not). Findings regarding the use of vital signs for pain assessment are not consistent and should be considered with caution. As recommended by experts, vital signs should only be used as a cue when behavioural indicators are no longer available in mechanically ventilated or unconscious patients. Crown Copyright (C) 2009 Published by Elsevier Ltd. All rights reserved.