两种疼痛评分量表在学龄前患儿中的应用比较  

Comparison of two pain assessment scales in preschool children

作　　者：赵线 刘韦辰 张潇昂 廖雨萍 万露 魏建梅[2] Zhao Xian;Liu Weichen;Zhang Xiaoang;Liao Yuping;Wan Lu;Wei Jianmei(Department of Pediatrics,The First Affiliated Hospital of Nanchang University,Nanchang City,Jiangxi Province 330006,China;Department of Painology,The First Affiliated Hospital of Nanchang University,Nanchang City,Jiangxi Province 330006,China)

机构地区：[1]南昌大学第一附属医院儿科,南昌市330006 [2]南昌大学第一附属医院疼痛科,南昌市330006

出　　处：《中华疼痛学杂志》2024年第6期874-880,共7页Chinese Journal Of Painology

基　　金：江西省教育厅科学技术研究项目(200134)。

摘　　要：目的比较两种疼痛评分量表在学龄前患儿中的信效度及应用效果。方法选取2023年3月2日至2024年3月1日,在南昌大学第一附属医院儿科住院的202例患儿,3~6岁,性别不限。录制患儿接受疼痛性和非疼痛性操作的视频,分别使用Wong-Baker面部表情量表和儿童疼痛行为(FLACC)量表进行疼痛评估,以验证信效度和评估一致性;向28名中位工作年限6年、以护师职称为主的儿科病房护士发放问卷来评估量表的可行性和临床适用性。使用组内相关系数(ICC)、Pearson相关系数、Mann-Whitney U检验、配对样本t检验、条目水平内容效度(I-CVI)分析来评估信效度和组间差异,用Bland-Altman图进行一致性检验。使用受试者工作特征(ROC)曲线评估预测价值。结果Wong-Baker面部表情量表和FLACC量表的ICC分别为0.922、0.908(P均<0.001),重测信度系数分别为0.947、0.903(P均<0.001);两种量表在疼痛性和非疼痛性操作的评分差异均具有统计学意义(Z=16.77、16.66,P均<0.001),I-CVI分别为0.958、0.925。Bland-Altman图显示一致性界限为(-2.7,2.4),95%以上的散点落在该界限内。ROC曲线显示量表曲线下面积(AUC)分别为0.911、0.888。两个量表的可行性和临床适用性评分分别为(42.43±1.07)、(39.50±1.00),差异具有统计学意义(t=11.64,P<0.001)。结论两种量表均具有良好的信效度、评估一致性,能准确识别不同疼痛程度。两种量表可结合使用以提高评估准确性,但在使用Wong-Baker面部表情量表时需重点区分情绪与疼痛强度。ObjectiveTo compare the reliability,validity,and the application effects of two pain assessment scales in preschool children.MethodsFrom March 2,2023,to March 1,2024,202 pediatric inpatients aged 3 to 6 years,regardless of gender,were enrolled from the Department of Pediatrics in the First Affiliated Hospital of Nanchang University.The children undergoing painful and non-painful procedures were videoed.Pain was assessed by the Wong-Baker faces pain rating scale and the face,legs,activity,cry,consolability(FLACC)scale to verify their reliability,validity,and consistency.Questionnaires were distributed to 28 pediatric ward nurses with a median of 6 years of experience and primarily at the senior nurse level to assess the feasibility and clinical applicability of the scales.Reliability,validity and inter-group differences were analyzed by the intraclass correlation coefficient(ICC),Pearson correlation coefficient,Mann-Whitney U test,paired-sample t-test,and item-level content validity index(I-CVI).Consistency was evaluated by Bland-Altman plots,and predictive value was assessed by receiver operating characteristic(ROC)curves.ResultsThe ICC for the Wong-Baker faces pain rating scale and FLACC scale were 0.922 and 0.908,respectively(all P<0.001),and the test-retest reliability coefficients were 0.947 and 0.903(all P<0.001).The differences for both scales in painful and non-painful operations were statistically significant(Z=16.77,16.66,all P<0.001),with I-CVI of 0.958 and 0.925,respectively.The Bland-Altman plot indicated a consistency limit of(-2.7,2.4),with over 95%of data points falling within this range.ROC curves indicated that area under the curve(AUC)were 0.911 and 0.888,respectively.The feasibility and clinical practicality score was(42.43±1.07)and(39.50±1.00)of the Wong‐Baker faces pain rating scale and FLACC scale,respectively,with a statistically significant difference(t=11.64,P<0.001).ConclusionThe two scales have strong reliability,validity and consistency in the assessment,and can accurately identify

关 键 词：儿童 学龄前 疼痛 个性量表 Wong-Baker面部表情量表 儿童疼痛行为量表 

分 类 号：R47[医药卫生—护理学]