重症患者疼痛观察工具在开颅术后患者静息状态下疼痛评估中的应用效果

摘要

目的 观察重症患者疼痛观察工具(CPOT)评价神经外科开颅术后患者静息状态下疼痛的信度和效度.方法 采用前瞻性观察性研究方法,选择2017年5月—2018年5月北京天坛医院神经外科开颅术后患者200例,用中文版CPOT对患者进行静息状态下的疼痛评价,记录其评分值,同时使用长海痛尺让患者进行自我疼痛的评估,作为金标准.绘制受试者工作特征曲线(ROC),计算曲线下面积并确定CPOT评分判断疼痛的敏感度和特异度,采用组内相关系数(ICC)评价CPOT评定者间的信度.结果 共纳入开颅术后回ICU患者200例,其中无气管插管患者和有气管插管患者各100例.中文版CPOT在两组患者中均具有良好的信度,在无气管插管患者中ICC为0.857(95％CI:0.787～0.904),在有气管插管患者中ICC为0.851(95％CI:0.778～0.899).在无气管插管患者,使用COPT≥2分评价患者静息条件下存在疼痛具有最大的约登指数,其敏感度和特异度分别为58％和86％;在有气管插管患者,COPT≥3分时对患者具有最大的约登指数,其敏感度和特异度分别为74％和91％;使用CPOT评价有气管插管患者与无气管插管患者疼痛的曲线下面积差异无统计学意义(0.866 vs.0.777,P>0.05).结论 应用CPOT评价神经外科开颅术后患者静息状态下的疼痛具有较好的信度和效度.%Objective To explore the reliability and validity of critical-care pain observation tool (CPOT)in pain assessment in resting state among neurosurgery patients undergoing craniotomy. Methods From May 2017 to May 2018,we selected 200 neurosurgery patients undergoing craniotomy at Beijing Tiantan Hospital with the method of prospective and observational study. The Chinese version of CPOT was used to pain assessment in resting state of patients and its scores were recorded. At the same time,the Changhai Pain Rating Scale was used to pain assessment by themselves as a gold standard. We drew the receiver operating characteristic(ROC),calculated the area under curve and confirmed the score of CPOT to determine the sensitivity and specificity of pain. The intraclass correlation coefficient(ICC)was used to evaluate the reliability among CPOT reviewers. Results A total of 200 patients undergoing craniotomy back to intensive care unit (ICU)were included including 100 patients without and 100 patients with trachea cannula. The Chinese version of CPOT had good reliability in patients between two groups with 0.857(95％CI:0.787-0.904)for the ICC of patients without trachea cannula and with 0.851(95％CI:0.778-0.899)for the ICC of patients with trachea cannula. Among patients without trachea cannula,when the cut-off value of CPOT was equal or greater than 2,CPOT showed the highest Youden index in assessing pain with 58％ for the sensitivity and 86％ for thespecificity. Among patients with trachea cannula,the cut-off value of CPOT being equal or greater than 3 showed the highest Youden index in assessing pain with 74％ for the sensitivity and 91％ for the specificity. There was no statistical difference in the area under curve of pain assessed by CPOT between patients with and without trachea cannula(0.866 vs. 0.777,P>0.05). Conclusions CPOT has the good reliability and validity in pain assessment in resting state among neurosurgery patients undergoing craniotomy.