運用疼痛行為量表於恢復室病人之比較性研究

Comparative Analysis of Pain Assessment With the Behavioural Pain Rating Scale and Numerical Rating Scale for Patients in Post Anesthesia Care Unit

張庭瑄(Ting-Hsuan Chang)

指導教授 ： 陳大樑

共同指導教授 ： 蔡仁貞

臺北醫學大學/護理學院/護理學研究所/碩士(2011年)

https://doi.org/10.6831/TMU.2011.00099

摘要

急性疼痛一直是手術後病人重要的健康問題，也是麻醉術後恢復室病人遇到的第一個難題。而恢復室是手術病患麻醉後的第一個留置單位，良好的疼痛處理有賴於正確、完整、有系統的疼痛評估。然而，對於因全身麻醉手術後的患者停留在麻醉後恢復室的階段，病患可能由於殘留的麻醉藥物和術後模糊不清的視覺,短暫的認知知覺障礙，尚無法清楚溝通其疼痛程度及止痛劑之需求，因此，適當的疼痛客觀評估仍是重要的指標。
本研究目的為探討疼痛行為量表與數字等級量表評估病患疼痛相關性，以疼痛行為量表預測病患自我疼痛報告程度，運用於恢復室初始急性疼痛評估。
方法: 採用前瞻性研究(Prospective study) ，以需接受全身麻醉氣管插管之婦科病患作為本研究之對象。研究於民國99年10月至民國100年4月共選取60位符合條件之病患，在某醫學中心之麻醉後恢復室進行術後疼痛評估。病患麻醉術後至恢復室觀察停留一小時期間，以疼痛行為量及數字等級量表同時評估病患疼痛程度間之相關性及預測性。
結果顯示在疼痛行為量表及數字等級量表同時評估病患疼痛程度具高相關性(r= .79- .90；P< .001)；疼痛行為表現之臉部表情、焦躁不安、肌肉張力、發聲與能被安撫狀況與自述疼痛程度均呈高相關性 (r= .65 - .75；P< .001)；疼痛行為量表對數字等級量表有預測力，其總解釋變異量可達89%；發聲、肌肉張力、能被安撫狀況對病患止痛劑需求時有預測力，其解釋變異量達81%。止痛劑使用後在數字等級量表及疼痛行為量表上各具有顯著差異(P< .001)。人口學部分，年齡、教育程度、過去手術經驗、手術方式、麻醉手術時間、手術結束前半小時給予鴉片類止痛劑在統計學上無顯著差異，並不影響在麻醉後恢復室疼痛行為量表及數字等級量表所測得疼痛程度。
結論與建議:藉由此研究協助醫護人員面對於恢復室尚無法清楚表達其疼痛程度的病患時，進一步達成良好之疼痛溝通及處理。

關鍵字

恢復室 ； 疼痛 ； 疼痛評估量表

並列摘要

Acute postoperative pain is not only a major health issue for patients undertaking surgery, but is also the primary problem in the post anesthesia care units (PACU).Adequate pain relief depends on an accurate, comprehensive and systematic pain assessment. However, patients who gradually awake from general anesthesia in the PACU may not be able to clearly describe the degrees of pain and demand for analgesics due to the residual effects of anesthetic drugs, blurred vision, and the development of short-term cognitive disorders. Therefore, an appropriate and objective assessment of the degrees of postoperative pain is valuable for effective pain management in the PACU.
Object: This research project aims to validate Behavioral Pain Rating scale (BPRS) as an objective pain assessing scale and to determine the statistical agreement between Numerical Rating scale(NRS) and Behavioral Pain Rating scale (BPRS) in predicting postoperative pain.
Method: A prospective, observational study was carried out in the gynecologic patients, who received general anesthesia, in a tertiary medical center. A total of 60 eligible patients were recruited for the assessment of postoperative pain in the PACU from October 2010 to April 2011. Pain intensity was recorded and the statistical agreement between NSR and BPRS was correlated in these patients during the first hour postoperative care at PACU.
Result: NSR and BPRS were highly correlated in assessment of pain level at PACU (r values varied from 0.79 to 0.90, P< .001 amongst different measuring time points), particularly in facial expressions, restlessness, muscle tension, voice, calmed by appease and self-pain perceived (r= .43 - .75, P< .001). The study also demonstrated that BPRS was more prophetic than NSR (the overall explanation of variance of 89%). Among these variables, the explanation of variances for voices, muscle tension, calmed by appease and predicted analgesic demands were up to 81%. Pain levels following analgesic management were also different when graded using NSR or BPRS (P< .001). Post hoc analysis further confirmed that patient demographics, age, educational level, past operation experience, surgical procedure, anesthetic time, and administration of opioids half-an-hour before the conclusion of surgery did not significantly affect the degree of pain rated by NSR or BPRS.
Conclusion: BPRS is a valid and useful assessment tool to objectively evaluate the postoperative pain levels in PACU, particularly when subjective description of pain is not feasible.

並列關鍵字

PACU ； Pain ； pain assessment scale

參考文獻

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