跨学科多量表评定神经重症患者意识的信度研究  

The reliability of three scales to assess subjects with consciousness disorders in intensive care by multiple teams

作　　者：燕晓翔[1] 徐梅[2] 王古月[2] 王长青[1] 

机构地区：[1]安徽医科大学第一附属医院神经内科ICU,合肥230001 [2]安徽医科大学第一附属医院康复医学科

出　　处：《中国康复医学杂志》2018年第2期137-140,共4页Chinese Journal of Rehabilitation Medicine

摘　　要：目的:跨学科应用3种量表对重症患者进行意识评估,评价其一致性,为重症康复提供可靠的临床评定工具。方法:研究对象来自本院2017年9—12月入住神经内科重症监护室的患者30例。患者入住ICU后72h内分别用Glasgow昏迷量表、全面无反应性量表、昏迷恢复量表评定1次,每次评定由ICU医师、康复科医师、康复治疗师分别单独进行评定,3人的评定均在1天内完成,记录患者每次每个评分量表的评测结果、评定时间。结果:3位评定者应用3种量表,评定患者的得分及所用时间经过统计分析,差异无显著性(P>0.05)。对GCS、FOUR、CRS-R量表进一步进行相关分析,发现ICU医生、康复科医生、康复科治疗师在每个量表的内部评分显著相关,r>0.9,P<0.0001。在ICU医生、康复科医生、康复科治疗师评估中,GCS、FOUR、CRS-R量表间显著相关,r>0.85,P<0.0001。结论:3种量表评测意识的一致性较好,可作为重症脑血管病意识评估的工具,ICU医生、康复科医生、康复科治疗师在经过正规培训后,用GCS、FOUR、CRS-R三个量表对患者进行评估的一致性同样较好,因此三种量表用于跨学科的重症患者意识评估是可行的。Objective：To compare the reliability of three clinic scales in intensive care unit （ICU） to assess patients with consciousness disorders in order to apply these scales in the intensive care rehabilitation by multiple teams. Method：Thirty patients with consciousness disorders admitted into ICU of neurologic department were recruited between Sep 2017 and Jan 2018. Three scales, Glasgow coma scale （GCS）, Full outline of unresponsiveness（FOUR）,Coma recovery scale-revised （CRS-R）,were applied within 72h when patients were admitted into ICU. Patients were assessed by 3 team members including neurologist, physiatrist, physiotherapist in one day, respectively. Sores of the scales and the time-spend for each scale were also recorded. Result：No statistical significant differences were found in the scores and time-spend among three scales and three raters（P〉0.05）.Further analysis indicated that inter-scores of 3 raters （neurologist, physiatrist, physiotherapist） among 3 scales （GCS、FOUR、CRS-R） were highly related with r〉0.9 and P〈0.0001 respectively. High relationship among 3 scales within each rater was also significantly correlated with r〉0.85 and P〈0.0001 respectively. Conclusion：GCS,FOUR and CRS-R were highly reliable when they were applied to assess patients with the consciousness disorders in ICU. These three scales were also reliable and feasible used by multiple teams after short training to the raters.

关 键 词：重症康复 意识障碍 意识量表 Glasgow昏迷量表 全面兀反应性量表 昏迷恢复量表 

分 类 号：R473[医药卫生—护理学] R493[医药卫生—临床医学]