Institute of Higher Education and Nursing Research, Lausanne University - CHUV, Avenue César-Roux 19 - 2(e) étage, 1005 Lausanne, Switzerland.
Aust Crit Care. 2012 May;25(2):110-8. doi: 10.1016/j.aucc.2011.10.002. Epub 2011 Nov 21.
Health professionals are confronted with the difficulty of adequately evaluating pain in critically ill, brain-injured patients, as these patients are often unable to self-report. In addition, their confused and stereotyped behaviours may change their responses to pain; the indicators and descriptors generally used to evaluate pain in the critically ill may therefore not be appropriate for brain-injured patients.
The aim of this integrative review was to identify clinically measurable and observable pain indicators and descriptors for brain-injured, critically ill adults.
A search of electronic databases (Medline, CINAHL, Embase) combined with cross-referencing was performed. Articles were included if they described pain indicators in critically ill adults and included brain-injured patients in their population.
Seven articles met the inclusion criteria. They were critically appraised for their quality and their relevance for the population of brain-injured patients. Behavioural pain indicators such as facial expressions, body movements and muscle tension were found in all of the articles. However, the descriptions of the indicators differ from one article to another. The intensity and nature of behavioural pain responses vary according to the level of consciousness. Changes in physiological parameters have also been reported, but these results are inconclusive.
Additional research is needed to identify and better describe pain indicators that are specific to brain-injured patients in the ICU. Studies with large samples, different brain injury diagnoses and various levels of consciousness are warranted.
由于重症、脑损伤患者通常无法自行报告，医疗专业人员在充分评估其疼痛方面存在困难。此外，他们混乱和刻板的行为可能会改变他们对疼痛的反应；因此，用于评估重症患者疼痛的指标和描述符可能不适合脑损伤患者。
本次综合回顾旨在确定可临床测量和观察的脑损伤、重症成人疼痛指标和描述符。
通过对电子数据库（Medline、CINAHL、Embase）进行搜索并结合交叉引用进行检索。如果文章描述了重症成人的疼痛指标，并将脑损伤患者纳入其研究人群，则将其纳入。
有 7 篇文章符合纳入标准。对其质量和对脑损伤患者人群的相关性进行了批判性评估。在所有文章中都发现了行为疼痛指标，如面部表情、身体运动和肌肉紧张。然而，对这些指标的描述因文章而异。行为疼痛反应的强度和性质根据意识水平而有所不同。还报告了生理参数的变化，但这些结果尚无定论。
需要进一步研究以确定和更好地描述 ICU 中特定于脑损伤患者的疼痛指标。需要进行具有大样本量、不同脑损伤诊断和不同意识水平的研究。
