中文版呼吸窘迫觀察量表於心肺重症患者之信效度研究

背景：呼吸困難是大多數罹患心肺疾病重症患者普遍及痛苦的感受。有效的呼吸困難控制必須透過準確的呼吸困難評估，然而，國內目前尚無針對無法自我報告呼吸困難者之評量工具。目的：透過雙向翻譯，發展中文版呼吸窘迫評估量表(Respiratory Distress Observation Scale, RDOS)並檢測其信效度。方法：本研究分兩階段，第一階段為雙向翻譯，建立中文版RDOS，並檢測其與原始版本之對等性。第二階段採方便取樣，樣本來自中部某醫學中心呼吸加護病房，收集108位心肺重症患者進行中文版RDOS心理計量檢定，包括：(1)所有個案呼吸困難資料之內在一致性信度分析；(2)個案分別於間隔1小時、1個班別後再測，進行再測信度分析；(3)針對意識清楚個案收集中文版情境焦慮量表分數、垂直視覺類比呼吸困難量表分數及對意識不清個案收集吸入氧氣濃度、血氧飽和濃度值，以測試同時及收斂效度；(4)比較個案於不同疾病嚴重度時期之呼吸困難差異，以建立建構效度。結果：中文版RDOS具文化對等性，其內在一致性Cronbach’s α為0.73；間隔1小時、間隔1班別之再測信度分別為0.98、0.71；施測者間信度為0.97 (p<0.001)。在效度部分，中文版RDOS之CVI (Content validity index)值達0.97以上，且於意識清楚的重症患者身上，與中文版情境焦慮分數(r=0.69, p<0.001)、呼吸困難垂直視覺類比量表分數(r=0.76, p<0.001)呈顯著相關，具同時及收斂效度；於意識不清楚的重症患者身上，與吸入氧氣濃度(r=0.26, p<0.05)呈顯著正相關、末梢血氧飽和濃度值(r= -.42, p=0.001)呈顯著負相關，具同時及收斂效度，此外，中文版RDOS亦可有效鑑別入住加護病房至少1天與轉出前1天之呼吸困難差異(t=8.81, p<0.001)，具建構效度。結論：中文版RDOS具良好的信效度，不論評估者是否有胸腔/呼吸照護背景，均可快速上手，在短時間內完成評估，除可使加護病房醫護人員方便管理及追蹤重症患者呼吸困難變化情形外，亦可使其系統性地了解心肺疾病重症患者治療前後之呼吸困難差異。

關鍵字

重症患者；呼吸困難；信度；效度

並列摘要

Background: Dyspnea is a common and painful feeling in most critically ill patients suffering from cardiovascular and pulmonary diseases. Effective dyspnea control has to depend on the accurate assessment of dyspnea. However, there is no assessment tool in Chinese for those who cannot self-report dyspnea until now. Aim: To develop the Chinese version of the Respiratory Distress Observation Scale (RDOS) through two-way translation and to examine its reliability and validity. Method: The study consists of two phases. In the first phase, by two-way translation, we established the Chinese version of the RDOS and examined its equivalence with the original version of the RDOS. In the second phase, a convenient sample was chosen from respiratory intensive care unit in a medical center in central Taiwan. One hundred and eight critically ill patients were enrolled for the psychometric analysis of the RDOS. The study involved: (1) the internal consistency analysis of dyspnea data of all participants, (2) the test-retest analysis of participants who were re-measured after one hour、one shift, (3) the concurrent and convergent validity analysis by the Chinese version of the State Anxiety Inventory score, the Vertical Analog Dyspnea Scale score of the conscious participants and Fraction of inspiration O2(FiO2), the oxygen saturation of unconscious participants, respectively, and (4) the construct validity analysis by comparing the difference of dyspnea level between two groups with different disease severity. Results: The Chinese version of RDOS had good reliability and validity. Its internal consistency Cronbach’s α was 0.73, the test-retest analysis of all participants after one hour ,0.98(p<0.001)；one shift, 0.71 (p<0.001) .The inter-rater reliability was high (r =0.97, p<0.001), and validity analysis about Content validity index(CVI) was 0.97. The concurrent and convergent validity analysis by the Chinese version of the state anxiety scale score of conscious participants (r=0.69, p<0.001), the dyspnea vertical visual analogue scale score of conscious participants (r=0.76,p<0.001) and Fraction of inspiration O2 of unconscious participants (r=0.26, p<0.05), oxygen saturation of unconscious participants (r= -.42, p=0.001) were significant. Besides , the construct validity analysis by comparing the difference of dyspnea level between two groups with different disease severity (t=8.81, p<0.001) was significant, too. Conclusion: The Chinese version of the RDOS has good reliability and validity, and can provide clinical staff a systematic dyspnea assessment tool for critically ill patients with cardiopulmonary disease.