中文版重症监护疼痛观察工具在有创机械通气患者中的应用研究

Application of the Chinese version of Critical-Care Pain Observation Tool in patients undergoing invasive mechanical ventilation

摘要:

目的：使用中文版重症监护疼痛观察工具（Critical-Care Pain Observation Tool，CPOT）比较有创机械通气患者在翻身前、翻身中及翻身后对疼痛的行为反应及生理反应。方法：选取2015年1月至2017年1月在某大学三级综合医院呼吸内科重症监护病房（intensive care unit，ICU）进行有创机械通气治疗的120例患者作为研究对象，使用中文版CPOT在患者实施翻身操作的3个阶段（翻身前1 min、翻身中及翻身后10 min）对患者的疼痛反应进行观察，记录患者在各个阶段的CPOT得分、各测量条目得分、各项生理学指标（平均动脉压、心率、呼吸频率、血氧饱和度）及各测量条目得分为1～2分的观察百分比。比较不同阶段CPOT得分、各测量条目得分及各项生理学指标的差异性。结果：实施翻身操作前1 min的CPOT得分为0.35±0.99，翻身操作中CPOT得分为1.96±1.77，翻身操作后10 min的CPOT得分为0.12±0.58；面部表情与基线测量相比增加幅度最大（最大占比72%），其次分别是身体活动（最大占比47%）、机械通气顺应性（最大占比36%），最后是肌肉紧张度（最大占比36%）。有创机械通气患者在实施翻身操作的不同阶段CPOT得分及各项生理学指标变化均有统计学差异（P<0.05）。结论：通过观察有创机械通气患者在翻身操作过程中的行为及生理变化，医务人员可以对语言沟通障碍危重患者的疼痛进行客观化评估。中文版CPOT量表可以有效测量患者的疼痛过程，值得在有创机械通气患者中推广应用。

Abstract:

Objective：To investigate the behavioral response and physiological reaction to pain before，during，and after the turning procedure in patients undergoing invasive mechanical ventilation，with the application of the Chinese version of Critical-Care Pain Observation Tool（CPOT）. Methods：A total of 120 patients who underwent invasive mechanical ventilation in the intensive care unit （ICU） in Department of Respiratory Medicine in a tertiary general hospital from January 2015 to January 2017 were enrolled. The Chinese version of CPOT was used to observe pain response at three stages of the turning procedure（at 1 minute before the turning procedure，during the turning procedure，and at 10 minutes after the turning procedure）. The scores of CPOT and each item，related physiological indices（mean arterial pressure，heart rate，respiratory rate，and blood oxygen saturation），and percentage of observations with a score of 1 to 2 points on each item of the CPOT scale were recorded at the three stages of the turning procedure. The scores of CPOT and each item and related physiological indices were compared between stages. Results：The score of CPOT was 0.35±0.99 at 1 minute before the turning procedure，1.96±1.77 during the procedure，and 0.12±0.58 at 10 minutes after the procedure. Compared with baseline levels，facial expression had the greatest increase as high as 72%，followed by body movements as high as 47%，compli－ance with mechanical ventilation as high as 36%，and muscle tension as high as 36%. There were significant changes in CPOT score and physiological indices in different stages of the turning procedure（P<0.05）. Conclusion：Observation of behavioral and physiological changes during the turning procedure helps medi－cal staff to perform an objective evaluation of pain in critically ill patients with impaired verbal communication. The Chinese version of CPOT scale can effectively measure the pain process in pa－tients and thus holds promise for clinical application in patients undergoing invasive mechanical ventilation.