Prince-Henry联合长海痛尺在肋骨骨折疼痛评分中的初步应用

Application of a self-designed motional and restrictive rating scale for pain assessment in patients with rib fractures

关键词:  肋骨骨折  疼痛评分  长海痛尺

Key words:  rib fracture  pain score  Changhai pain scale

摘要:

目的探讨Prince-Henry联合长海痛尺评分法： 动静评分法（motional and restrictive rating scale, MAR）在评估肋骨骨折疼痛中的应用。 方法回顾性分析上海市浦东新区人民医院胸外科2018年5月—2022年9月收治的肋骨骨折患者，其中手术组234例，非手术组558例，分别应用长海痛尺及本研究自行设计的动静评分法，收集两组患者伤后1~7 d的疼痛评分。 结果非手术组： 在评分方面，两种评分方法1~7 d总体均呈下降趋势，但长海痛尺评分第3天出现反弹。手术组： 长海痛尺评分第4天开始下降，MAR评分第3天开始出现下降。两组比较： 长海痛尺评分第1~3天手术组高于非手术组（P＜0.05），第4~7天，手术组低于非手术组（P＜0.05）；MAR评分第1、2、7天，手术组评分高于非手术组（P＜0.05）；第3、4、5、6天，手术组低于非手术组（P＜0.05）。疼痛评分改善方面，长海痛尺评分，第3~7天，手术组改善程度高于非手术组（P＜0.05）；MAR评分，第3~6天，手术组改善程度高于非手术组（P＜0.05）。 结论长海痛尺疼痛评分和MAR疼痛评分具有较好的一致性，MAR评分能更早识别活动性疼痛。

Abstract:

ObjectiveTo investigate the feasibility of a self-designed motional and restrictive rating scale for pain assessment in patients with rib fractures. MethodsA total of 792 patients with rib fractures admitted to the Thoracic Surgery Department of Shanghai Pudong New Area People’s Hospital from May 2018 to September 2022 were enrolled, including 234 surgically treated cases(surgical group) and 558 non-surgically treated patients(non-surgical group). A self-designed motional and restrictive rating scale(MAR) for pain assessment was developed based on the Prince-Henry scale and Changhai pain scale. Patients were evaluated with the Changhai pain scale and MAR scale during 17 days after injury. ResultsIn the non-surgical group, both scales exhibited a consistent overall decline from d 1 to d 7; however, there was a subsequent rebound in the Changhai pain scale score on d 3. In the surgical group, a decline in Changhai pain scale score was observed from the d 4 onwards, while a decrease in MAR score was noted starting from d 3. Comparison between two groups: the Changhai pain scale scores were significantly higher in the surgical group than those in the non-surgical group on d 13(P＜0.05), while the scores were significantly lower in the surgical group than those in the non-surgical group on d 47(P＜0.05). Additionally, on d 1, 2 and 7, the MAR scores were significantly higher in the surgical group compared to the non-surgical group(P＜0.05), whereas on d 3, 4, 5, and 6, the scores were significantly lower in the surgical group than those in the non-surgical group(P＜0.05). In terms of improvement in pain scores, the surgical group exhibited a significantly higher degree of improvement compared to the non-surgical group on d 37 according to the Changhai Pain Scale score(P＜0.05). Additionally, during d 3 to d 6 based on the MAR score, the surgical group demonstrated a greater level of improvement than the non-surgical group(P＜0.05). ConclusionThe Changhai Pain Scale pain score and the MAR pain score demonstrate strong consistency, while the MAR score exhibits the ability to detect active pain at an earlier stage.