中文版重症照護疼痛觀察工具之效度檢定

Validation of the Chinese Version of the Critical-Care Pain Observation Tool

陳惠君(Huei-Jiun Chen) ； 曾月霞(Yueh-Hsia Tseng) ； 陳玉敏(Yuh-Min Chen)

《護理暨健康照護研究》 7卷2期 (2011/06) Pp. 108-116

https://doi.org/10.6225/JNHR.7.2.108

摘要

背景　疼痛是大多數重症病患普遍及痛苦的經驗，然而，病患卻因為無法溝通、存在氣管內管／氣管造廔口及鎮靜劑使用，導致醫護人員在疼痛評估上的困難。過去的研究已顯示重症照護疼痛觀察工具(Critical-Care Pain Observation Tool, CPOT)在重症照護上，是一個有效的評估工具。CPOT包含四個指標，分別為病患的臉部表情、身體動作、順從呼吸器及肌肉緊張。
目的　驗證中文版重症照護疼痛觀察工具之效度。
方法　本研究採交叉設計並利用觀察法蒐集資料，共有120名意識清楚及不清楚重症病患參與研究。在病患接受⑴會引起疼痛護理常規－抽痰，及⑵不會引起疼痛的護理常規－量血壓之前、中、後20分鐘，分別進行評估。而在此過程中，會請意識清楚並使用呼吸器病患提供其自覺疼痛分數。
結果　在區辨效度方面，可由以下結果得到支持：⑴病患接受抽痰時其CPOT得分會增加，但在測量血壓時的CPOT得分卻相對平穩。⑵抽痰中的CPOT得分顯著高於休息時。在效標關聯效度方面，病患在接受抽痰時的CPOT得分，與其自評疼痛分數呈正相關。中文版CPOT的最佳篩檢分數為2分，其敏感度為及特異度分別為60%、100%。
結論　中文版CPOT在重症病患疼痛評估上，是一個有效的工具。

關鍵字

疼痛評估 ； 重症照護 ； 重症照護疼痛觀察工具CPOT ； 效度

並列摘要

Background: While pain is a common and distressing experience for ICU patients it is difficult to assess due to verbal communication difficulties caused by endotracheal/tracheostomy tubes and sedative agents. Previous studies have shown the Critical-Care Pain Observation Tool (CPOT) as a valid evaluation tool in critical care. The tool includes the 4 behavioral categories of (1) facial expression, (2) body movements, (3) patient compliance with ventilator protocols and (4) muscle tension.
Purpose: The purpose of this study was to validate the Chinese version of the Critical-Care Pain Observation Tool.
Methods: A total of 120 conscious and unconscious ICU patients in a medical center participated in this study. Patients were assessed before, during, and 20 minutes after the two following procedures: (1) nociceptive procedure: performing suction, and (2) non-nociceptive procedure: taking noninvasive blood pressure (NIBP). Ventilated patients were also asked to provide a self-report level of pain while conscious.
Results: Discriminant validity was supported with increases of the CPOT during suction and no increase or decrease during NIBP. Discriminant validity was also supported by higher scores during suction versus at rest. In terms of criterion validity, the CPOT scores correlated to patients' self-reports of pain. Using a CPOT cutoff score of 2 yielded a sensitivity of 60% and specificity of 100%.
Conclusion: Results support the Chinese version of CPOT as a valid tool to assess pain in critically ill patients.

並列關鍵字

pain assessment ； critical care ； Critical-Care Pain Observation Tool CPOT ； validity