拉姆齐镇静评分量表与里士满躁动镇静评分量表：一项横断面研究。
Ramsay Sedation Scale and Richmond Agitation Sedation Scale: A Cross-sectional Study.
作者信息
Rasheed Akram M, Amirah Mohammad F, Abdallah Mohammad, P J Parameaswari, Issa Marwan, Alharthy Abdulrhman
机构信息
Akram M. Rasheed, MSN, RN, is part of the Nursing Education & Development Committee at the Critical Care Department in King Saud Medical City, Riyadh, Saudi Arabia. Mohammad F. Amirah, MSN, RN, is part of the Nursing Education & Development Committee at the Critical Care Department in King Saud Medical City, Riyadh, Saudi Arabia. Mohammad Abdallah, PharmD, is currently employed at the Pharmaceutical Care Services in King Saud Medical City, Riyadh, Saudi Arabia. Parameaswari P.J., PhD, is a biostatistician at the research center in King Saud Medical City, Riyadh, Saudi Arabia. Marwan Issa, MSN, RN, is part of the Nursing Education & Development Committee at the Critical Care Department in King Saud Medical City, Riyadh, Saudi Arabia. Abdulrhman Alharthy, MD, PhD, is an intensives MD consultant at the Critical Care Department in King Saud Medical City, Riyadh, Saudi Arabia.
出版信息
Dimens Crit Care Nurs. 2019 Mar/Apr;38(2):90-95. doi: 10.1097/DCC.0000000000000346.
BACKGROUND
Many sedation scales and tools have been developed and compared for validity in critically ill patients. However, selection and use of sedation scales vary among intensive care units.
OBJECTIVE
The aim of this study is to compare the reliability of 2 sedation scales-Ramsay Sedation Scale and Richmond Agitation-Sedation Scale (RASS)-in the adult intensive care unit.
METHOD
Four hundred twenty-five patients were recruited in the study. Informed consent had been obtained from each patient guardian/relative. However, only 290 patients (68.24%) completed the study and were independently assessed for sedation effect by investigator and bedside nurses simultaneously using Ramsay scale and RASS.
RESULTS
Agreement between the nurse and investigator scores on Ramsay scale (weighted κ = 0.449, P < .001) indicated weak level of agreement. Agreement between the nurse and investigator on RASS (weighted κ = 0.879, P < .001) indicated a strong level of agreement. Cronbach α analysis showed that 10 items of RASS had an excellent level of internal consistency (α = .989) compared with good level of internal consistency of Ramsay scale (α = .828).
DISCUSSION
Richmond Agitation-Sedation Scale showed excellent interrater agreement compared with weak interrater agreement of Ramsay scale. The results also support that RASS has consistent agreement with clinical observation and practice among different observers. The results suggest that use of RASS is linked to a more reliable assessment of sedation levels in the intensive care unit.
背景
许多镇静评分量表和工具已被开发出来，并针对重症患者的有效性进行了比较。然而，不同重症监护病房在镇静评分量表的选择和使用上存在差异。
目的
本研究旨在比较成人重症监护病房中两种镇静评分量表——拉姆齐镇静评分量表（Ramsay Sedation Scale）和里士满躁动-镇静评分量表（Richmond Agitation-Sedation Scale，RASS）的可靠性。
方法
本研究招募了425名患者。已获得每位患者监护人/亲属的知情同意。然而，只有290名患者（68.24%）完成了研究，并由研究者和床边护士同时使用拉姆齐量表和RASS对镇静效果进行独立评估。
结果
护士和研究者在拉姆齐量表上的评分一致性（加权κ=0.449，P<.001）表明一致性水平较弱。护士和研究者在RASS上的一致性（加权κ=0.879，P<.001）表明一致性水平较高。克朗巴赫α分析表明，与拉姆齐量表良好的内部一致性水平（α=.828）相比，RASS的10个项目具有优秀的内部一致性水平（α=.989）。
讨论
与拉姆齐量表较弱的评分者间一致性相比，里士满躁动-镇静评分量表显示出优秀的评分者间一致性。结果还支持RASS在不同观察者之间与临床观察和实践具有一致的一致性。结果表明，使用RASS与重症监护病房中更可靠的镇静水平评估相关。
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