Young Jeanne, Siffleet Jo, Nikoletti Sue, Shaw Thérèse
Sir Charles Gairdner Hospital, Centre for Nursing Research, Nedlands, Australia.
Intensive Crit Care Nurs. 2006 Feb;22(1):32-9. doi: 10.1016/j.iccn.2005.04.004. Epub 2005 Sep 29.
Current empirical evidence supports claims that pain in sedated, unconscious Intensive Care Unit (ICU) patients is underrated and under-treated. Given the severity of ICU patients' illness pain management, whilst important, may not be considered a priority and therefore can be easily overlooked. The aim of this study was to validate the Behavioural Pain Scale (BPS) for the assessment of pain in critically ill patients by evaluating facial expressions, upper limb movements and compliance with mechanical ventilation.
A prospective, descriptive repeated measures study design was used to assess the validity and reliability of the BPS for assessing pain in critically ill patients undergoing routine painful (repositioning) and non-painful (eye care) procedures.
An average of 73% of BPS scores increased (indicating pain) after patients were repositioned, as opposed to 14% after eye care. This increase was statistically significant for repositioning (p < 0.003) but not for eye care (p > 0.3). The odds of an increase in BPS between pre- and post-procedure assessments was more than 25 times higher for repositioning compared with eye care (p < 0.0001), after controlling for analgesics and sedatives.
The BPS was found to be a valid and reliable tool in the assessment of pain in the unconscious sedated patient. Results also highlighted that traditional pain indicators, such as fluctuations in haemodynamic parameters, are not always an accurate measure for the assessment of pain in unconscious patients and as such more objective pain assessment measures are essential. Finally, further validation of the BPS and identification of other painful routine procedures is needed to enhance pain management delivery for unconscious patients.
目前的实证证据支持以下观点，即重症监护病房（ICU）中接受镇静、失去意识的患者的疼痛被低估且治疗不足。鉴于ICU患者病情的严重性，疼痛管理虽然重要，但可能不被视为优先事项，因此很容易被忽视。本研究的目的是通过评估面部表情、上肢运动和对机械通气的顺应性，验证行为疼痛量表（BPS）在评估危重症患者疼痛方面的有效性。
采用前瞻性、描述性重复测量研究设计，评估BPS在评估接受常规疼痛（翻身）和非疼痛（眼部护理）操作的危重症患者疼痛方面的有效性和可靠性。
患者翻身后面部表情评分平均有73%升高（表明疼痛），而眼部护理后这一比例为14%。翻身导致的评分升高具有统计学意义（p < 0.003），而眼部护理则无统计学意义（p > 0.3）。在控制了镇痛药和镇静剂后，与眼部护理相比，翻身前后BPS评分升高的几率高出25倍以上（p < 0.0001）。
发现BPS是评估无意识、接受镇静患者疼痛的有效且可靠的工具。结果还突出表明，传统的疼痛指标，如血流动力学参数的波动，并不总是评估无意识患者疼痛的准确指标，因此更客观的疼痛评估措施至关重要。最后，需要对BPS进行进一步验证，并确定其他疼痛性常规操作，以加强对无意识患者的疼痛管理。
