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系統識別號 U0007-2307201112350300
論文名稱(中文) 運用疼痛行為量表於恢復室病人之比較性研究
論文名稱(英文) Comparative Analysis of Pain Assessment With the Behavioural Pain Rating Scale and Numerical Rating Scale for Patients in Post Anesthesia Care Unit
校院名稱 臺北醫學大學
系所名稱(中) 護理學研究所
系所名稱(英) Graduate Institute of Nursing
學年度 99
學期 2
出版年 100
研究生(中文) 張庭瑄
研究生(英文) Ting-Hsuan Chang
學號 M406096022
學位類別 碩士
語文別 中文
口試日期 2011-06-22
論文頁數 82頁
口試委員 指導教授-陳大樑
共同指導教授-蔡仁貞
委員-孫維仁
委員-張怡
委員-林子鏞
中文關鍵字 恢復室  疼痛  疼痛評估量表 
英文關鍵字 PACU  Pain  pain assessment scale 
學科別分類
中文摘要 急性疼痛一直是手術後病人重要的健康問題,也是麻醉術後恢復室病人遇到的第一個難題。而恢復室是手術病患麻醉後的第一個留置單位,良好的疼痛處理有賴於正確、完整、有系統的疼痛評估。然而,對於因全身麻醉手術後的患者停留在麻醉後恢復室的階段,病患可能由於殘留的麻醉藥物和術後模糊不清的視覺,短暫的認知知覺障礙,尚無法清楚溝通其疼痛程度及止痛劑之需求,因此,適當的疼痛客觀評估仍是重要的指標。
本研究目的為探討疼痛行為量表與數字等級量表評估病患疼痛相關性,以疼痛行為量表預測病患自我疼痛報告程度,運用於恢復室初始急性疼痛評估。
方法: 採用前瞻性研究(Prospective study) ,以需接受全身麻醉氣管插管之婦科病患作為本研究之對象。研究於民國99年10月至民國100年4月共選取60位符合條件之病患,在某醫學中心之麻醉後恢復室進行術後疼痛評估。病患麻醉術後至恢復室觀察停留一小時期間,以疼痛行為量及數字等級量表同時評估病患疼痛程度間之相關性及預測性。
結果顯示在疼痛行為量表及數字等級量表同時評估病患疼痛程度具高相關性(r= .79- .90;P< .001);疼痛行為表現之臉部表情、焦躁不安、肌肉張力、發聲與能被安撫狀況與自述疼痛程度均呈高相關性 (r= .65 - .75;P< .001);疼痛行為量表對數字等級量表有預測力,其總解釋變異量可達89%;發聲、肌肉張力、能被安撫狀況對病患止痛劑需求時有預測力,其解釋變異量達81%。止痛劑使用後在數字等級量表及疼痛行為量表上各具有顯著差異(P< .001)。人口學部分,年齡、教育程度、過去手術經驗、手術方式、麻醉手術時間、手術結束前半小時給予鴉片類止痛劑在統計學上無顯著差異,並不影響在麻醉後恢復室疼痛行為量表及數字等級量表所測得疼痛程度。
結論與建議:藉由此研究協助醫護人員面對於恢復室尚無法清楚表達其疼痛程度的病患時,進一步達成良好之疼痛溝通及處理。
英文摘要 Acute postoperative pain is not only a major health issue for patients undertaking surgery, but is also the primary problem in the post anesthesia care units (PACU).Adequate pain relief depends on an accurate, comprehensive and systematic pain assessment. However, patients who gradually awake from general anesthesia in the PACU may not be able to clearly describe the degrees of pain and demand for analgesics due to the residual effects of anesthetic drugs, blurred vision, and the development of short-term cognitive disorders. Therefore, an appropriate and objective assessment of the degrees of postoperative pain is valuable for effective pain management in the PACU.
Object: This research project aims to validate Behavioral Pain Rating scale (BPRS) as an objective pain assessing scale and to determine the statistical agreement between Numerical Rating scale(NRS) and Behavioral Pain Rating scale (BPRS) in predicting postoperative pain.
Method: A prospective, observational study was carried out in the gynecologic patients, who received general anesthesia, in a tertiary medical center. A total of 60 eligible patients were recruited for the assessment of postoperative pain in the PACU from October 2010 to April 2011. Pain intensity was recorded and the statistical agreement between NSR and BPRS was correlated in these patients during the first hour postoperative care at PACU.
Result: NSR and BPRS were highly correlated in assessment of pain level at PACU (r values varied from 0.79 to 0.90, P< .001 amongst different measuring time points), particularly in facial expressions, restlessness, muscle tension, voice, calmed by appease and self-pain perceived (r= .43 - .75, P< .001). The study also demonstrated that BPRS was more prophetic than NSR (the overall explanation of variance of 89%). Among these variables, the explanation of variances for voices, muscle tension, calmed by appease and predicted analgesic demands were up to 81%. Pain levels following analgesic management were also different when graded using NSR or BPRS (P< .001). Post hoc analysis further confirmed that patient demographics, age, educational level, past operation experience, surgical procedure, anesthetic time, and administration of opioids half-an-hour before the conclusion of surgery did not significantly affect the degree of pain rated by NSR or BPRS.
Conclusion: BPRS is a valid and useful assessment tool to objectively evaluate the postoperative pain levels in PACU, particularly when subjective description of pain is not feasible.
論文目次 目錄
致 謝…………………………………………………………………Ⅰ
中文摘要 ………………………………………………………………Ⅱ
英文摘要 ………………………………………………………………Ⅳ
目錄 ……………………………………………………………………Ⅵ
表目錄 …………………………………………………………………Ⅸ
圖目錄 …………………………………………………………………Ⅹ第一章 緒論 ……………………………………………………………1
第一節 研究背景及動機 …………………………………………1
第二節 研究目的 …………………………………………………4
第二章 文獻查證 ………………………………………………………5
第一節 疼痛的概念 ………………………………………………5
第二節 急性術後疼痛機轉與影響 ………………………………5
第三節 手術後疼痛評估 …………………………………………8
第四節 恢復室疼痛行為評估相關研究 ………………………14
第三章 研究方法………………………………………………………20
第一節 研究架構…………………………………………………20
第二節 研究假說…………………………………………………21
第三節 研究材料與方法…………………………………………22
第四節 統計分析…………………………………………………27
第四章 分析與結果……………………………………………………30
第一節 研究對象基本資料 ……………………………………31
第二節 病患特性與疼痛程度間之差異 ………………………34
第三節 疼痛行為量表與數字等級量表之疼痛程度相關性……36
第四節 疼痛行為表現與數字等級量表之疼痛程度相關性……38
第五節 疼痛行為量表所能預測數字等級量表之疼痛程度……40
第六節 止痛劑需求時疼痛行為量表預測數字等級量表之疼痛程度…………………………………………………………42
第七節 止痛劑需求時之疼痛行為預測因子……………………44
第八節 止痛劑需求時與需求後疼痛量表疼痛程度之差異……46
第九節止痛劑需求時與需求後數字等級量表疼痛程度之差異…………………………………………………………48
第五章 討論……………………………………………………………50
第一節 病患特性與疼痛行為量表級數字等級量表疼痛程度間差
異性分析…………………………………………………52
第二節 疼痛行為量表與數字等級量表相關性研究分析………55
第三節 疼痛行為量表預測數字等級量表分析 ……………… 58
第四節 止痛劑需求時與需求後疼痛程度分析…………………60
第六章 結論與建議 …………………………………………………62
第一節 結論………………………………………………………62
第二節 建議………………………………………………………63
第三節 研究限制…………………………………………………64
參考文獻 ………………………………………………………………65
中文部份 ………………………………………………………………65
英文部分 ………………………………………………………………66
附錄 ……………………………………………………………………74
附錄一 口語等級量表……………………………………………74
附錄二 視覺類比量表……………………………………………74
附錄三 數字等級量表……………………………………………75
附錄四 臉譜量表…………………………………………………75
附錄五 Behavioural pain assessment scale ………………76
附錄六 研究生與研究護士之測試者間之一致性………………77
附錄七 疼痛行為量表……………………………………………79
附錄八 人體試驗委員會審查證明書……………………………80
附錄九 臨床試驗受試者說明及同意書…………………………81

表目錄
表一 研究資料之統計方式……………………………………………28
表二 病患基本屬性分析………………………………………………32
表三 基本資料與疼痛行為量表及數字等級量表之差異性…………35
表四 疼痛行為量表與數字等級量表各階段疼痛程度相關性………37
表五 疼痛行為表現與數字等級量表各階段之相關性………………39
表六 疼痛行為量表所能預測數字等級量表之疼痛程度……………41
表七 止痛劑需求時疼痛行為量表預測數字等級量表之疼痛程度…43
表八 自述止痛劑需求時之疼痛行為預測因子………………………45
表九 止痛劑需求時與需求後之疼痛行為量表得分…………………47
表十 止痛劑需求時與需求後之數字等級量表得分…………………49

圖目錄
圖一 研究架構圖 ……………………………………………………20
圖二 現行恢復室疼痛管理流程圖 …………………………………24
參考文獻 中文部分
吳麗玲、高淑芬、史麗珠(1998)•腹部手術後急性疼痛定義性特徵
之臨床度•護理研究,6 (5),383 - 392。
林佳靜、陳淑如、謝麗鳳(1997)•疼痛護理•護理雜誌,44(1),37
-47。
林碧珠、張菁鏸、許秀珠、林梅絹、羅悅禎、蘇淑娟(2009)•在職教
育提升外科護理人員術後疼痛評估能力之成效•榮總護
理,26(2),136 -144。
李秀枝、吳聖良(2010) •病人主訴術後疼痛強度與護理人員評估結
果差異之比較•護理雜誌,57 (3),60-67。
陳淑如、林佳靜、鄭綺、何善台(1998).探討手術後病人對疼痛護理
及疼痛控制的滿意度及其影響因素•護理研究,6(6),475-488
賴裕和(2003)•以實證為基礎的疼痛處置•護理雜誌,50 (1),29
-33。
國家衛生研究院(2007) •手術後疼痛臨床照護指引•台灣護理學
會,1-55。

英文部分
Acello B. (2000). Meeting JACHO standards for pain control.
Nursing, 30(3):52.
A.M.Machata., B. Kabon. (2009). A new instrument for pain
Relationships Among the assessment in the immediate
postoperative period . Anaesthesia, 64, 392 - 398.
American Geriatrics Society. (2002). The management of
persistent pain in older persons. Journal of the
American Geriatrics Society, 50(suppl. 6),S205 - S224.
Apfelbaum, J. L., Chen, C., Mehta, S. S., & Gan, T. J.
(2003). Postoperative pain experience: Results from a
national survey suggest postoperative pain continues to
be undermanaged. Anesthesia & Analgesia, 97, 534-540. Aubrun, F., Valade, N., Coriat, P., & Riou, B. (2008).
Predictive factors of severe postoperative pain in the
postanesthesia care unit. Anesthesia and Analgesia,
106(5), 1535-1541.
Bardiau, F. M., Taviaux, N. F., Albert, A., Boogaerts, J.
G., & Stadler, M. (2003).An intervention study to
enhance postoperative pain management.
Anesthesia and Analgesia, 96(1), 179-185.
Bieri, D., Reeve, R.A ., Champion, G.D ., Addicoat , L., &
Zieglar, J.B. (1990).
The faces pain scale for the self-assessment of severity
of pain experienced by children: development, initial
validation, and preliminary investigation for ratio
scale properties. Pain, 41(2), 139- 150.
Breivik H.(1998) . Postoperative pain management. Why is it
difficult to show that it impoves outcome. European
Journal of anesthesiology,15(6),748 -751.
Breivik ,H., Borchgrevink ,P. C. (2008). Assessment of
pain. British Journal of Anaesthesia , May 16, 1 -8.
Carr, E.C.J.(1990). Postoperative pain:patients
expectations and experiences.Journal of Advanced
Nursing, 5(1),89-100.
Carroll, K. C., Atkins, P. J., Herold, G. R., Mlcek, C. A.,
Shively, M., Clopton, P., et al. (1999). Pain assessment
and management in critically ill postoperative and
trauma patients: A multisite study. American Journal of
Critical Care, 8(2), 105-117.
Chamber, W., & Price, G. ( 1967). Influence of Nurse upon
Effects of Analgesics Admimistered. Nurse Research, 16
(3): 228 - 233.
Chris Pasero. (2002). The Challenge of Pain Assessment in
PACU.
Journal of Peri Anesthesia Nursing, 17(5), 348 - 350.
DeLoach, L. J., Higgins, M. S., Caplan, A. B., & Stiff, J.
L. (1998). The visual analog scale in the immediate
postoperative period: intrasubject variability and
correlation with a numeric scale. Anesthesia and
Analgesia, 86(1),102-106.
Denise Li., Kathleen Puntillo. (2008). A Review of
Objective Pain Measures for Use With Critical Care Adult
Patients Unable to Self-Report. The Journal of Pain, 9(
1), 2-10.
Donovan B. D. (1983). Patient attitudes to postoperative
pain relief. Anesth Intens Care, 11,125-129.
Drayer RA , Henderson J , Reidenberg M. (1999). Barriers to
better pan control in hospital ized patients. Journal of
Pain and Symptom Management,17(6),434 - 440.
Ferrell BR, Wisdom C, Wenzl C. (1989). Quality of Life as
an outcome variable in the management of cancer pain.
Cancer,63, 2321 - 2327.
Filos, K. S., & Lehmann, K. A. (1999). Current concepts and
practice in postoperative pain management: Need for a
change? European Surgical Research, 31, 97-107.
Gordon, D.B., Daul, J. L., Miaskowski, C., McCarberg,
B.,Todd, K. H., Paice, J. A. et al. (2005). American
Pain Society recommendations for improving the quality
of acuteand cancer pain managemrnt. Archives of Internal
Medicine, 165, 1574 - 1580.
Heid, F. & Jage, J. (2002). The treatment of pain in
urology. British Journal of Urology, 90(5), 481- 488.
Jarred Younger, PhD. (2009). Pain outcomes: A brief review
of instruments and techniques. Anesthetic Techniques in
Pain Management, 39-43.
Jensen, M. P., & Karoly, P. (2001). Self-report scales and
procedures for assessing pain in adults. In D. C. Turk &
R. Melzack (Eds.),
Handbook of pain assessment (Rev. ed.,pp. 15 - 34). New
York: Guilford.
Persson, K ., & Ostman, M. (2004). The Swedish version of
the PACU-behavioural pain rating scale: a reliable
method of assessing postoperative pain? Scand J Caring
Sci, 18, 304 - 309.
Katja Heikkinen., Sanna Salantera. , Marjaana Kettu., &
Markku Taittonen. (2005). Prostatectomy patients’
postoperative pain assessment in the recovery room.
Journal of Advanced Nursing, 52(6), 592 - 600.
Keef, F., & Dolan, E . (1986). Pain behavior and coping
strategies in low back pain and myofascial pain. Pain,
24(1), 49 - 56.
Lentschener, C., Tostivint, P., White, P. F., Gentili, M.
E., & Ozier,Y. (2007). Opioid-induced sedation in the
postanesthesia care unit does not insure adequate pain
relief: a case-control study. Anesthesia and Analgesia,
105(4), 1143 - 1147.
Labus,J.S., Keefe,.F.J., & Jensen,M.P. (2003). Self-report
of pain intensity and direct observations of pain
behavior: when are they correlated. Pain ,102(1-2),109
-124.
Lauren J. DeLoach. , Michael S. Higgins. (1997). The Visual
Analog Scale in the immediate postoperative period:
lntrasubject variability and correlation with a numeric
scale. Anesth Analg. 86,102-106.
Li, L., Liu, X., & Herr, K. (2007). Postoperative pain
assessment: A Comparison of four scales in Chinese
adults. Pain Medicine, 8(3),223 –234.
Lynch, E. P., Lazor, M. A., Gellis, J. E., Orav, J.,
Goldman, L., & Marcantonio, E. R. (1998). The impact of
postoperative pain on the development of postoperative
delirium. Anesthesia and Analgesia,86(4),781-785.
Lyach,M. (2001). Pain as the fifth vital sign. Journal of
Intravenous Nursing, 24(2), 85 - 94.
Mateo O, Krenzischek D. (1992). A pilot study to assess the
relationship between behavioral manifestations and
self-report of pain in post anesthesia care unit
patients. J Post Anesth Nurs, 7(1),15 - 21.
McCaffery,M. (1968). Nursing practice theories related to
cognition, bodily pain, and man-environment nteractions.
LosAngeles: UCLA Students Store.
McCaffery, M. (1994). How reliable is your patient's pain
assessment? Nursing, 24 (1), 19.
MafcCfery, M., Ferrell, B. R., & Pasero, C. (2000).
Nurses’ personal Opinions about patients’ pain and
their effect on recorded assessments and titration of
opioid doses. Pain Management Nursing, 1(3), 79 - 87.
McCaffery , M., Pasero C.(1999) Assessment Underlying
complexities,misconceptions, and practical tools, in
pain: Clinical Manual(ed2).St Louis, MO, Mosby, 35-102.
Mularski, R. A., White-Chu, F., Overbay, D., Miller, L.,
Asch, S. M., & Ganzini, L. (2006). Measuring pain as the
5th vital sign does not improve quality of pain
management. Journal of General Internal Medicine, 21(6),
607-612.
Myles, P. S., & Urquhart, N. (2005). The linearity of the
visual analogue scale in patients with severe acute
pain. Anaesthesia and Intensive Care, 33(1), 54-58.
Nursing Practice Committee. (2007) . Acute pain measurement
Procedure .Wimmera Health Care Group , 1- 5. Retrieved
December 8, 2009, from http://www.health.vic.gov.au
/qualitycouncil
Paice, J.A.,Mohon, S.M., & Faut-Callahan, M. (1991).
Factors associated with adequate pain control in
hospitalized post-surgical patients diagnosed with
cancer.Cancer Nursing, 14(6),298-305.
Payen, J., Bru, O., Bosson, J., Lagrasta, A., Novel, E.,
Deschaux, et al.(2001). Assessing pain in critically ill
sedated patients by using a behavioral pain scale.
Critical Care Medicine, 29(12), 2258-2263.
Persson,K., & Ostman, M. (2004). The Swedish version of the
PACU-Behavioural Pain Rating Scale: a reliable method of
assessing postoperative pain? Scandinavian Journal of
Caring Sciences, 18(3),304-309
Price , D., Mayer D.J., Mao J., & Caruso F.S.(2000).
NMDA-receptor antagonists and opoid receptor
interactions as related to analgesia and tolerance. J
Pain Symptom Manage, 19:S7-11.
Puntillo, K., & Weiss, S. (1994). Pain: Its mediators and
associated morbidity in Critically ill cardio vascular
surgical patients. Nursing Research,43(1),31-35.
Puntillo, K., Neighbor, M.& O’Neil, N., & Nixon, R.
(2003). Accuracy of emergency nurses in assessment of
patients’ pain. Pain Management Nursing, 4(4), 171-175.
Randallcc, Ihab I, Ahmad E, Sarosh S,Frank Z,Lori A.
(2004). A comparison of the verbal rating scale and the
visual analog scale for pain assessment. The Internet
Journal of Anesthesiology,8(1), 438-441.
Rond, M. E. J., Wit, R. W., Dam, F. S. A., & Muller, M. J.
(2000). A pain monitoring program for nurses: Effects on
communication, assessment and documentation of patients'
pain. Journal of Pain & Symptom Management, 20 (6),
424-439.
Scott I. E. (1994). Effectiveness of documented assessment
of postoperative pain. British Journal of Nursing
,3(10), 491-501.
Sloman, R., Rosen, G., Rom, M., & Shir, Y. (2005). Nurses'
assessment of pain in surgical patients. Journal of
Advanced Nursing, 52 (2), 125-132.
Simmonds, M. J. (2006). Measuring and managing pain and
performance. Manual therapy, 11(3), 175-179.
Summers, S. (2001). Evidence-based practice part 2:
reliability and validity of selected acute pain
instruments. Journal of Perianesthesia Nursing, 16(1),
35-40.
Sommer, M., de Rijke, J. M., & van Kleef, M. (2008). The
prevalence of postoperative pain in a sample of 1490
surgical inpatients. European Journal of
Anaesthesiology, 25(4), 267-274.
Sullivan,M.J.,Thibault,P.,Savard,A.,Catchlove,R,Kozey,.,tani
sh,W.D.(2006).The dimensions of pain behavior. Pain,
125(3), 270-277.
Tsui SL,Law S, Fok M, Lo JR, Ho E, Yang J, Wong J.(1997).
Postoperative analgesia reduces mortality and morbidity
after esophagectomy. Am J Surg, 173, 472-8.
Terri Voepel-Lewis., Sandy Merkel., Agnieszka Trzcinka., &
Shobha Malviya.(2002). The reliability and validity of
the face, legs, activity, cry, consolability
observational tool as a easure of pain in children with
cognitive impairment. Anesth Analg, 95,1224- 9.
Terri Voepel-Lewis., Jennifer Zanotti., Jennifer and Sandra
Merkel, R.(2010).
Realiability and validity of the face, legs, activity,
cry, consolability behavioral tool in assessment acute
pain in critically ill patients. American Journal of
Critical Care, 19(1), 55-61.
Tung, H.P., Chen, M. J., Huang, M. L., Chiang, H.S., & Wu,
C.P. (2006).Assessment of pain intensity by nurses in
the emergency department. Journal of Emergency Medicine,
Taiwan , 8(3), 77-82.
Warfiled, P.h.H., Brockopp, D.Y., & Brockopp,G.W.(1992).The
role of prior pain experience and expectation on
postoperative pain. Journal of Pain and Symptom
Management, 7(1), 34-37.
Webb MR. (1994). Behavioral responses and self-reported
pain in postoperative patients. J Post Anesth Nurs,9
(2), 91-5.
Wright,S.M.(1993).The use of therapeutic touch in the
management of pain. Nursing Clinical Of North America,
22(3), 705-713.
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    臺北醫學大學 圖書館 簡莉婷
    E-mail:etds@tmu.edu.tw
    Tel:(02) 2736-1661 ext.2519
    Fax:(02) 2737-5446