摘要
目的评价重症监护疼痛观察工具(CPOT)用于重症脑损伤患者疼痛评价的效度。方法在Pub Med、Embase、Cochrane Library databases、万方数据库中,检索有关CPOT应用于重症脑损伤患者疼痛评价的文献,文献检索时限为2006年1月至2018年9月。由两名研究者按预先设定好的纳入及排除标准,独立完成文献的筛选、质量评价与数据提取,最终确定纳入荟萃分析的研究。应用Revman 5.3及meta-Di Sc对所纳入的研究进行统计学处理,包括对均数差(MD)和诊断性试验的荟萃分析。结果共纳入9项研究,944例重症脑损伤患者。对于CPOT的判别效度,当患者接受非致痛性与致痛性操作时(6项研究),CPOT评分的差异具有统计学意义,MD为-2.25[95%可信区间(CI):-2.61^-1.89,P <0.001];致痛性操作前和致痛性操作时(8项研究),CPOT评分的差异具有统计学意义,MD为-2.06(95%CI:-2.59^-1.53,P <0.001)。对于CPOT的效标效度(4项研究),以患者主诉疼痛为参照标准,在对患者进行操作时,合并后的敏感度和特异度分别为0.739(95%CI:0.689~0.785,I^2=34.7%)和0.789(95%CI:0.737~0.835,I^2=0),曲线下面积(AUC)为0.831。校标效度的异质性分析显示存在阈值效应。结论对于重症脑损伤患者的操作性疼痛,CPOT具有较好的判别效度。对于CPOT的校标效度,需进一步研究提示疼痛的界值。
Objective To evaluate the validity of pain assessment with Critical-care pain observation tool(CPOT) in severe brain injury patients. Methods Literatures regarding pain assessment with CPOT in severe brain injury patients were systematically searched through the PubMed and other databases. Studies that met the inclusion and exclusion criteria were identified, quality was assessed and data were extracted by two independent investigators. Statistical analysisincluding meta-analysis of mean difference(MD) and diagnostic studieswere performed withRevMan 5.3 and meta-DiSc software. Results A total of 9 published and eligible studies involving 944 cases were included in this meta-analysis. In total of 6 studies, CPOT score had statistical significancein the discriminant validity during non-nociceptive and nociceptive procedure(MD=-2.25, P < 0.001). Meanwhile, CPOT had statistical significance before and during nociceptive procedure in total of 8 studies(MD=-2.06, P < 0.001). To assess the criterionvalidity of CPOT, with the referencestandard of ″patients′ complaint of pain″ during medical procedures in 4 studies, pooled sensitivity and specificity were 0.739(95% CI: 0.689-0.785, I^2=34.7%) and 0.789(95% CI: 0.737-0.835, I^2=0). The area under AUC curve was 0.831. The heterogeneity analysis of calibration validity showed the existence of threshold effect. Conclusion CPOT has a good discriminant validity and criterion validityforpain assessment during nociceptive procedureamong severe brain injury patients. For the criterion validity of CPOT the cut-off value of pain needs further investigation.
作者
陈静然
单凯
陈光强
徐明
李宏亮
周建新
Chen Jingran;Shan Kai;Chen Guangqiang;Xu Ming;Li hongliang;Zhou Jianxin(Department of Critical Care Medicine,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)
出处
《中华重症医学电子杂志》
2019年第4期338-345,共8页
Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)
基金
首都卫生发展科研专项基金(首发2014-2-2041)
关键词
疼痛
评价
脑损伤
重症
重症疼痛观察工具
荟萃分析
Pain
Assessment
Severe brain injury
Critical care
Critical-care pain observation tool
Meta-analysis
