摘要目的:引进并检验儿科恶心评估工具（PeNAT）、巴克斯特干呕面部表情评分（BARF）在评估中国恶性肿瘤儿童化疗相关恶心时的信效度，探索恶心需要临床干预的临界值。方法:采用前瞻性描述研究，2021年7—8月，采用便利抽样法选取中山大学肿瘤防治中心244例接受化疗的恶性肿瘤患儿，用PeNAT、BARF、视觉模拟评分（VAS）、面部表情疼痛量表修订版（FPS-R）评估化疗前、后及使用解救性止呕药/止痛药前及用药后30 ~ 60 min的恶心和疼痛水平，化疗后询问患儿恶心变化程度和是否需要止吐干预。结果:对主观感知化疗前、后恶心程度相同的患儿进行重测信度分析，PeNAT、BARF的组内相关系数均为0.940（均 P<0.05）。化疗后PeNAT、BARF评分分别为1.5（1.0，2.0）和2.0（0，2.0）分，显著高于化疗前的1.0（1.0，1.0）和0（0，0）分，差异均有统计学意义（ Z = - 9.19、- 9.09，均 P<0.01），接受止呕治疗的11例患儿化疗后PeNAT、BARF评分分别为4.0（4.0，6.0）分和3.0（2.0，4.0）分，高于无需止呕治疗的患儿的0（0，2.0）分和1.0（1.0，2.0）分，二者比较差异有统计学意义（ Z = - 4.03、- 3.86，均 P<0.05）；化疗后PeNAT、BARF评分与VAS恶心评分相关系数 r = 0.933、0.957（均 P<0.01），与FPS-R评分相关系数 r = 0.192、0.189（均 P<0.05）。应用止呕药后PeNAT、BARF评分分别为2.0（2.0，3.0）和2.5（2.0，4.0）分，较使用止呕药前的3.0（3.0，3.8）和4.0（4.0，8.0）分相比差异均有统计学意义（ Z = - 2.97、- 2.83，均 P<0.05）。依据ROC曲线和截断值判断，PeNAT≥3分、BARF≥4分时有临床意义并需要干预。 结论:PeNAT、BARF在恶性肿瘤儿童化疗相关恶心的评估中具有良好的信效度，可有效识别需要临床干预的恶心症状，用于止吐治疗的疗效评估。

abstractsObjective:To introduce and validate the Pediatric Nausea Assessment Tool (PeNAT) and the Baxter Retching Faces Scale (BARF) in the assessment of chemotherapy induced nausea in Chinese children with malignant neoplasms, and to explore the cut-off value for rescue antiemetic.Methods:A prospective descriptive study was conducted, 244 children in Sun Yat-sen University Cancer Center with malignant neoplasms who received chemotherapy were selected by convenience sampling from July to August 2021. PeNAT, BARF, Visual Analogue Scale (VAS) and the Faces Pain Scale-Revised(FPS-R) were used to assess the severity of nausea and pain before and after chemotherapy, before and 30-60 minutes after the use of rescue antiemetic or analgesic. After chemotherapy, the children also were asked the changes of nausea severity and whether antiemetic was needed.Results:A test-retest reliability was conducted on the patients with the same severity of nausea before and after chemotherapy, and the intraclass correlation coefficient of the PeNAT and BARF were 0.940 (both P<0.05). After chemotherapy, the PeNAT and BARF were 1.5(1.0, 2.0) and 2.0(0, 2.0) points, which were significantly higher than the 1.0(1.0, 1.0) and 0(0, 0) points before chemotherapy ( Z = - 9.19, - 9.09, both P<0.01). The PeNAT and BARF of 11 cases receiving antiemetic before medication were 4.0 (4.0, 6.0) and 3.0(2.0, 4.0) points, which were higher than the 0(0, 2.0) and 1.0(1.0, 2.0) points without antiemetic ( Z = - 4.03, - 3.86, both P<0.05). After chemotherapy, the correlation coefficients between PeNAT or BARF and VAS-nausea were r = 0.933, 0.957 (both P<0.01), and FPS-R were r = 0.192, 0.189 (both P<0.05). After using antiemetic, PeNAT and BARF were 2.0(2.0, 3.0) and 2.5(2.0, 4.0) points, which were significant different than the 3.0(3.0, 3.8) and 4.0(4.0, 8.0) points before using antiemetic ( Z = - 2.97, - 2.83, both P<0.05). According ROC curves and cut-off values, it was determined that PeNAT≥3 and BARF≥4 had clinical significance and require clinical intervention. Conclusions:PeNAT and BARF have excellent reliability and validity in the assessment of chemotherapy induced nausea in children with malignant neoplasms, they can effectively identify the requirement of rescue antiemetic, and evaluate the efficacy of antiemetic.