School of Nursing, McGill University, Montreal, Quebec, Canada.
Intensive Crit Care Nurs. 2010 Apr;26(2):83-90. doi: 10.1016/j.iccn.2009.11.003. Epub 2009 Dec 30.
The aim of this study was to examine the discriminant and criterion validity of vital signs (mean arterial pressure [MAP], heart rate [HR], respiratory rate [HR], transcutaneous oxygen saturation [SpO(2)], and end-tidal CO(2)) for pain assessment in postoperative cardiac surgery ICU adults. A repeated-measure within-subject design was used. A convenience sample of 105 patients from a cardiology health center in Canada participated. Patients were observed during three testing periods: (1) unconscious and mechanically ventilated, (2) conscious and mechanically ventilated and (3) after extubation. For each of these testing periods, vital signs were assessed using the ICU monitoring at rest, during a nociceptice procedure and 20 min post-procedure. Conscious patients' self-reports of pain were obtained. Discriminant validity was supported with significant changes in most vital signs during the nociceptive procedure. Some of the vital signs (HR, RR, and SpO(2)) were associated with the patients' self-reports of pain but were dependent on the patients' status (mechanically ventilated or not). Findings regarding the use of vital signs for pain assessment are not consistent and should be considered with caution. As recommended by experts, vital signs should only be used as a cue when behavioural indicators are no longer available in mechanically ventilated or unconscious patients.
本研究旨在检验生命体征（平均动脉压[MAP]、心率[HR]、呼吸频率[RR]、经皮血氧饱和度[SpO2]和呼气末二氧化碳[EtCO2]）在评估术后心脏手术 ICU 成人疼痛方面的判别和效标效度。采用重复测量的被试内设计。在加拿大一家心脏病中心的便利样本中，有 105 名患者参与了研究。在三个测试期内观察患者：（1）无意识和机械通气，（2）意识和机械通气，（3）拔管后。对于每个测试期，使用 ICU 监测在休息时、在伤害性过程中和过程后 20 分钟评估生命体征。意识患者自我报告疼痛。在伤害性过程中，大多数生命体征发生了显著变化，这支持了判别效度。一些生命体征（HR、RR 和 SpO2）与患者的自我报告疼痛有关，但取决于患者的状态（是否机械通气）。关于生命体征用于疼痛评估的发现并不一致，应谨慎考虑。正如专家所建议的，只有在机械通气或无意识患者无法使用行为指标时，生命体征才应作为提示使用。
