Chatelle Camille, De Val Marie-Daniele, Catano Antonio, Chaskis Cristo, Seeldrayers Pierrette, Laureys Steven, Biston Patrick, Schnakers Caroline
*Coma Science Group, Cyclotron Research Centre, University of Liège, Liège ∥Acute Pain Service Departments of §Intensive Care ¶Rehabilitation #Neurosurgery **Neurology, University Hospital of Charleroi, Charleroi, Belgium †Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School ‡Department of Neurology, Massachusetts General Hospital, Boston, MA ††Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA.
Clin J Pain. 2016 Apr;32(4):321-6. doi: 10.1097/AJP.0000000000000259.
Our objective was to assess the clinical usefulness of the Nociception Coma Scale-revised (NCS-R) in pain management of patients with disorders of consciousness.
Thirty-nine patients with potential painful conditions (eg, due to fractures, decubitus ulcers, or spasticity) were assessed during nursing cares before and after the administration of an analgesic treatment tailored to each patient's clinical status. In addition to the NCS-R, the Glasgow Coma Scale (GCS) was used before and during treatment to observe fluctuations in consciousness. Twenty-three of them had no analgesic treatment before the assessment, whereas the analgesic treatment has been adapted in the other 16 patients. We performed nonparametric Wilcoxon tests to investigate the difference in the NCS-R and GCS total scores but also in the NCS-R subscores before versus during treatment. The effect of the level of consciousness and the etiology were assessed using a Mann-Whitney U test.
NCS-R total scores were statistically lower during treatment when compared with the scores obtained before treatment. We also found that the motor, verbal, and facial expression subscores were lower during treatment than before treatment. In contrast, we found no difference between the GCS total scores obtained before versus during treatment.
Our results suggest that the NCS-R is an interesting clinical tool for pain management. Besides, this tool seems useful when a balance is needed between reduced pain and preserved level of consciousness in patients with disorders of consciousness.
我们的目的是评估修订后的伤害性昏迷量表（NCS-R）在意识障碍患者疼痛管理中的临床实用性。
在根据每位患者的临床状况进行镇痛治疗前后的护理过程中，对39例有潜在疼痛状况（如因骨折、褥疮或痉挛）的患者进行了评估。除了NCS-R外，在治疗前和治疗期间使用格拉斯哥昏迷量表（GCS）来观察意识波动。其中23例在评估前未接受镇痛治疗，而另外16例患者的镇痛治疗已进行调整。我们进行了非参数Wilcoxon检验，以研究治疗前与治疗期间NCS-R和GCS总分以及NCS-R子分数的差异。使用Mann-Whitney U检验评估意识水平和病因的影响。
与治疗前获得的分数相比，治疗期间NCS-R总分在统计学上较低。我们还发现，治疗期间运动、言语和面部表情子分数低于治疗前。相比之下，我们发现治疗前与治疗期间获得的GCS总分没有差异。
我们的结果表明，NCS-R是一种用于疼痛管理的有趣临床工具。此外，当需要在意识障碍患者减轻疼痛和保持意识水平之间取得平衡时，该工具似乎很有用。
