中文版重症照護疼痛觀察工具之效度檢定

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Title:	中文版重症照護疼痛觀察工具之效度檢定 Validation of Chinese Version of the Critical-Care Pain Observation Tool
Authors:	陳惠君;Huei-Jiun Chen
Contributors:	健康照護學院護理學系碩士班
Keywords:	疼痛;重症照護;疼痛評估量表;效度;pain;critical care;pain assessmemt scale;validity
Date:	2010
Issue Date:	2010-09-29 12:11:20 (UTC+8)
Abstract:	疼痛感受是大多數重症病患普遍及痛苦的經驗。有效的疼痛控制必須透過準確的疼痛評估，然而，重症病患卻因為無法溝通、存在氣管內管/氣管造廔口及鎮定劑使用，導致臨床醫護人員在疼痛評估上的困難。本研究目的為驗證中文版重症照護疼痛觀察工具(Critical-Care Pain Observation Tool, CPOT)於無法溝通的病患，並測試其效度。本研究採立意取樣，於中部某醫學中心的內、外科加護中心進行收案，共有120名意識清楚及不清楚病患參與研究。研究設計採重覆測量，在病患接受(1)會引起疼痛護理常規-抽痰，及(2)不會引起疼痛的護理常規執行-量血壓前、中、後20分鐘進行評估。而在此過程中，一併要求意識清楚並使用呼吸器病患提供其自覺疼痛分數。在區辨效度方面，可由以下結果得到驗證：(1)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。(2)抽痰中的CPOT得分顯著高於病患休息時。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%。本研究結果顯示CPOT在重症病患疼痛評估上，是一個有效的工具。建議未來還需進一步研究以確定CPOT能應用於其他重症病患，並進一步評估疼痛嚴重程度的變化。 Pain is a common and distressing symptom in ICU patients. Effective management can only be achieved with accurate pain assessment. However, this is difficult in the critically ill as patients are often unable to communicate verbally due to the presence of endotracheal/tracheostomy tubes and sedation. The aim of this study was to validate the Chinese version of the Critical-Care Pain Observation Tool (CPOT) in non-verbally communicating patients. Purposive sampling was used. A total of 120 conscious and unconscious patients in the intensive care units of a medical center participated in the study. Patients were assessed before, during, and 20 minutes after the 2 following procedures: (1) nociceptive procedure: performing suction, and (2) non-nociceptive procedure: taking noninvasive blood pressure (NIBP). Consciously ventilated patients were also asked to provide a self-report level of pain. Discriminant validity was supported with increases of the CPOT during suction, but remaining stable during NIBP. Discriminant validity was also supported by higher scores during suction versus at rest. For criterion validity, the CPOT scores were correlated to the patients’ self-reports of pain. Using a CPOT cutoff score of 2 yielded a sensitivity of 60% and a specificity of 100%. These results support that CPOT is a valid tool to assess pain in critically ill patients. Further studies are needed to determine if CPOT can be used in other critical ill patients for assessing changes in severity of pain over time.
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