Terai T, Yukioka H, Asada A
Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School, Osaka, Japan.
Reg Anesth Pain Med. 1998 Mar-Apr;23(2):147-51. doi: 10.1097/00115550-199823020-00006.
The visual analog scale (VAS) is a simple and sensitive mean of pain assessment. The faces scale is also a simple, self-reporting method for children. Facial signs of pain have not been used to assess pain in postoperative adult patients in the intensive care unit (ICU).
Fifty patients undergoing esophageal cancer surgery by a thoracoabdominal procedure were studied. Epidural opioids, such as morphine or buprenorphine, combined with bupivacaine were administered during and after surgery. Pain measurement was performed by a physician in the ICU using the self-reported VAS 0.5, 1, 2, 4, and 6 hours after tracheal extubation and thereafter every 4 hours during the stay in the ICU. A nurse who was unaware of the patients' VAS scores assessed facial expression as a measure of pain intensity using a five-grade faces scale immediately before pain evaluation by VAS. The VAS was rescaled into five discrete units that would match the five faces scale scores. Weighted kappa statistics were used to establish a relative level of agreement between the five-grade VAS and faces scale.
Good agreement was found between the five-grade VAS and the faces scale 30 minutes and 1 hour after tracheal extubation (weighted kappa values .67 and .62, respectively). The VAS and faces scales were measured 7-13 times per patient during the stay in the ICU, and 518 observations were collected. Although moderate agreement was found between the five-graded VAS and faces scale for all pairs of observation (weighted kappa values .54), less agreement was found between them in patients with moderate pain. In addition, the calculated mean differences between the five-graded VAS and faces scale differed significantly between patients.
The faces scale may be useful for pain evaluation in the ICU.
视觉模拟评分法（VAS）是一种简单且敏感的疼痛评估方法。面部表情评分法也是一种适用于儿童的简单自我报告方法。疼痛的面部体征尚未用于评估重症监护病房（ICU）成年术后患者的疼痛情况。
对50例行胸腹联合食管癌手术的患者进行研究。手术期间及术后给予硬膜外阿片类药物，如吗啡或丁丙诺啡，联合布比卡因。由ICU医生在气管拔管后0.5、1、2、4和6小时以及此后在ICU住院期间每4小时使用自我报告的VAS进行疼痛测量。一名对患者VAS评分不知情的护士在通过VAS进行疼痛评估前，立即使用五级面部表情评分法评估面部表情，作为疼痛强度的指标。将VAS重新划分为五个离散单位，使其与五级面部表情评分法的分数相匹配。采用加权kappa统计量来确定五级VAS与面部表情评分法之间的相对一致性水平。
气管拔管后30分钟和1小时，五级VAS与面部表情评分法之间有良好的一致性（加权kappa值分别为0.67和0.62）。在ICU住院期间，每位患者对VAS和面部表情评分法进行了7 - 13次测量，共收集了518次观察数据。尽管所有观察对的五级VAS与面部表情评分法之间存在中度一致性（加权kappa值为0.54），但中度疼痛患者之间的一致性较低。此外，五级VAS与面部表情评分法之间计算出的平均差异在患者之间有显著差异。
面部表情评分法可能有助于ICU中的疼痛评估。
