Page 105 - 2022-35-中国全科医学

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【Abstract】 Background Timely and accurate pain assessment is essential for safe and effective management of
pain in neonates. Scholars at home and abroad have developed more than 40 pain assessment scales for different neonatal groups
and types of pain. However，the reliability and stability of the outcomes vary significantly. In addition，existing single studies
or systematic reviews（SRs） can only provide unsystematic evidence of a particular scale or specific psychometric properties，
which is not conducive to clinical decision-making. Objective To overview the SRs of psychometric properties of neonatal pain
assessment scales，providing clinical practitioners and researchers with evidence for the best pain assessment scale. Methods
Databases including CNKI，SinoMed，Wanfang DATA，VIP，PubMed，Embase，Cochrane Library，Web of Science and
CINAHL were searched for SRs about psychometric properties of neonatal pain assessment scales. By screening the references of
the included SRs，their associated studies were found. Two researchers independently performed literature screening，and data
extraction，then assessed the methodological quality using the JBI systematic review critical appraisal tool，risk of bias using the
ROBIS，the reporting quality using the PRISMA statement，and the evidence quality using CERQual. Results A total of seven
SRs were included. According to the JBI and ROBIS tools，four SRs were of high quality and had a low risk of bias，while three
were of relatively low quality and had an increased risk of bias. With the PRISMA checklist，5 SRs were fairly complete with over
60% of report completion rate（RCR），1 SR had certain reporting deficiencies with 45.95% of RCR，and 1 SR had serious
information missing with 10.81% of RCR. The results of CERQual showed that there were 22 pieces of evidence in total，including
two pieces of high quality（9.09%），eight pieces of moderate quality （36.36%），nine pieces of low quality（40.91%），
and three pieces of critically low quality（13.64%）. A synthesis of evidence showed that there were 25 scales with good internal
consistency，inter-rater reliability，construct validity，and interpretability. Those scales could be used to measure acute pain，
persistent pain，postoperative pain，or mechanically ventilated pain in preterm and/or term infants. Conclusion No single
pain assessment scale is available to assess all types of pain in neonates. It is recommended that the selection of validated scales
for periodic dynamic pain assessment in neonates should be based on clinical situations such as age and pain type. More high-
quality，well-designed studies are needed to examine the reliability and stability of the existing scales for measuring different
kinds of pain in neonates in China and to explore the feasibility of expanding their applications.
【Key words】 Infant，newborn；Pain measurement；Scales；Psychometrics；Overview of systematic review

住院新生儿因诊疗原因，不可避免地要经历各种疼痛刺 1 资料与方法
激。研究显示 82.6% 的常见临床操作可引发重度疼痛 ［1］ 。新 1.1 文献纳入和排除标准 纳入标准：（1）研究主题为新生
生儿疼痛评估与镇痛管理专家共识指出，规范适宜的疼痛管 儿疼痛评估量表的测量性能研究，包括信度（内部一致性信度、
理，可减轻或防止疼痛对身体或心理带来的各种不良影响， 评分者间信度、重测信度等）、效度（内容效度、结构效度、
加速康复进程 ［2］ 。及时、准确评估新生儿疼痛是实施疼痛管理， 校标效度等）、反应度，以及可解释性、实用性和可行性等（后
衡量镇痛措施有效性的关键。由于新生儿无法通过语言表达 三者虽非测量性能，但是量表的重要特性）；（2）量表测评
疼痛，医护人员需借助神经生理、行为反应的测量对其疼痛 对象为住院新生儿；（3）研究类型为：系统评价、Meta 分析
进行评估。包含有生理和 / 或行为指标的疼痛评估量表被认为 或 Meta 整合。排除标准：（1）研究主题为其他类型的疼痛
是最为便捷且费用最低廉的评估方法，医护人员经过简单培 评估方法，如新生儿疼痛表情自动识别系统、近红外光谱技术、
训即可掌握 ［3］ 。 心率变异性分析等；（2）无法提取测量学性能相关数据的文
基于共识选择健康测量工具的标准（Consensus-based 献；（3）发表语言为非中文或非英文；（4）系统评价计划书、
Standards for the Selection of Health Measurement Instruments， 会议摘要、重复发表的文献。
COSMIN）指出只有具备良好测量学性能的量表才能作为可靠 1.2 文献检索策略 2021-10-31 以自由词和主题词结合制
工具用于临床实践 ［4］ 。目前，针对不同的新生儿群体和不同 定检索策略，计算机检索中国知网、中国生物医学文献数据
的疼痛类型，已构建和测试了 40 多种疼痛评估量表。然而， 库、万方数据知识服务平台、维普网、PubMed、Embase、
对于具体的临床情景，应该选择哪种量表评估新生儿疼痛仍 Cochrane Library、Web of Science、CINAHL 数 据 库， 通 过 纳
没有定论。其主要原因在于现有新生儿疼痛评估量表数量众 入研究的参考文献追溯与本研究相关的文献。指南推荐意见
多，且其测量结果的可靠性和稳定性存在较大差异 ［5］ ；而已 的形成应基于当前可得的最佳证据 ［7］ ，而系统评价证据的有
发表的单项研究或系统评价仅能提供关于某个量表或量表某 效期为 3~5 年 ［8］ ，故本次文献检索时段限制为近 5 年（2016
一方面测量学性能的零散证据，不利于医护人员的临床决策。 年 11 月至 2021 年 11 月）。中国知网的检索策略为：（主题
系统评价再评价作为一种对某一特定问题相关系统评价进行 =疼痛+镇痛）AND（主题=新生儿+足月儿+早产儿+低
综合研究的一种方法，可为证据使用者提供全面系统的高质 出生体重儿 + 小于胎龄儿 + 婴儿）AND（主题 = 评估 + 评分
量证据 ［6］ 。因此，本研究拟通过系统评价再评价，对现有新 +测量+测定+量表+简表+问卷+工具）AND（主题=测
生儿疼痛评估量表的测量学性能进行全面评价，从而为临床 量学 + 信效度 + 信度+效度+反应度+ 反应性+可行性+ 实
实践者和研究者选择最佳的疼痛评估量表提供证据支持。 用性 + 适用性 + 可操作性）AND（主题 = 系统评价 + 系统综