Devlin J W, Boleski G, Mlynarek M, Nerenz D R, Peterson E, Jankowski M, Horst H M, Zarowitz B J
Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA.
Crit Care Med. 1999 Jul;27(7):1271-5. doi: 10.1097/00003246-199907000-00008.
To establish the validity and reliability of a new sedation scale, the Motor Activity Assessment Scale (MAAS).
Prospective, psychometric evaluation.
Sixteen-bed surgical intensive care unit (SICU) of a 937-bed tertiary care, university-affiliated teaching hospital.
Twenty-five randomly selected, adult, mechanically ventilated, nonneurosurgical patients who were admitted to the SICU > or = 12 hrs after surgery and were not receiving neuromuscular blockers.
Four hundred assessments (eight per patient) were completed consecutively but independently, in pairs, at standardized times (both day and night) by two nurses who were preselected for each assessment from a pool of 32 pretrained SICU nurses.
To estimate validity, paired assessments (four/patient) compared the MAAS result with the subjective assessment using a 10-cm visual analog sedation scale, the percent change in blood pressure and heart rate from the previous 4-hr baselines, and the number of recent agitation-related sequelae. To estimate reliability, paired assessments (four/patient) measured correlation between assessments of the same type (e.g., MAAS-MAAS). Generalized estimating equations, which accounted for the four repeated measures in each patient, supported MAAS validity by finding a linear trend between MAAS and the visual analog scale (p < .001), blood pressure (p < .001), heart rate (p < .001), and agitation-related sequelae (p < .001) end points. The MAAS (kappa = 0.83 [95% confidence interval, 0.72 to 0.94]) was found to be more reliable than subjective assessment using the visual analog scale (intraclass correlation coefficient = 0.32 [95% confidence interval, 0.05 to 0.55]).
The MAAS is a valid and reliable sedation scale for use with mechanically ventilated patients in the SICU. Further studies are warranted regarding the effect of MAAS implementation in our SICU on patient outcomes, such as quality of sedation and length of mechanical ventilation, as well as the use of the MAAS in other patient populations (e.g., medical).
建立一种新的镇静评分量表——运动活动评估量表（MAAS）的有效性和可靠性。
前瞻性心理测量评估。
一所拥有937张床位的三级医疗大学附属医院的16张床位的外科重症监护病房（SICU）。
25名随机选择的成年机械通气非神经外科患者，他们在术后≥12小时入住SICU，且未接受神经肌肉阻滞剂治疗。
由32名经过预培训的SICU护士中预先挑选出的两名护士，在标准化时间（白天和晚上）连续但独立地成对完成400次评估（每位患者8次）。
为评估有效性，成对评估（每位患者4次）将MAAS结果与使用10厘米视觉模拟镇静量表的主观评估、与前4小时基线相比血压和心率的变化百分比以及近期与躁动相关的后遗症数量进行比较。为评估可靠性，成对评估（每位患者4次）测量同一类型评估之间的相关性（例如，MAAS - MAAS）。考虑到每位患者的四项重复测量的广义估计方程，通过发现MAAS与视觉模拟量表（p <.001）、血压（p <.001）、心率（p <.001）以及与躁动相关的后遗症（p <.001）终点之间的线性趋势，支持了MAAS的有效性。发现MAAS（kappa = 0.83 [95%置信区间，0.72至0.94]）比使用视觉模拟量表的主观评估更可靠（组内相关系数 = 0.32 [95%置信区间，0.05至0.55]）。
MAAS是一种用于SICU机械通气患者有效的、可靠的镇静量表。有必要进一步研究在我们的SICU实施MAAS对患者预后的影响，如镇静质量和机械通气时间，以及MAAS在其他患者群体（如内科患者）中的应用。
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