混合痔患者行吻合器切除术后慢性疼痛发生危险因素及风险模型的建立  

Risk factors of chronic pain after stapler resection in patients with mixed hemorrhoids and establishment of risk models

作　　者：江波[1] 王祥琨 贺磊 石柳亿 苏浩 JIANG Bo;WANG Xiangkun;HE Lei;SHI Liuyi;SU Hao(Anorectal Surgery,Anqing City Hospital,Anqing 246003,Anhui,China;The First Affiliated Hospital of China University of Science and Technology,Hefei 230000,Anhui,China)

机构地区：[1]安庆市立医院肛肠外科,安徽安庆246003 [2]中国科技大学第一附属医院心内科,安徽合肥230000

出　　处：《贵州医科大学学报》2022年第1期96-100,共5页Journal of Guizhou Medical University

基　　金：安徽省心血管研究所科研项目(KF2018005)。

摘　　要：目的探讨混合痔患者行吻合器切除术后慢性疼痛发生的危险因素及风险模型的建立。方法选取行吻合器切除术混合痔患者200例,根据是否发生慢性疼痛分为疼痛组(n=23)和非疼痛组(n=177),收集所有患者的临床资料[包括年龄、性别、体质量指数(BMI)、吸烟、嗜酒、饮食不良、锻炼、吻合口距离齿线距离、高血压、出血、混合痔数量、便秘、血浆白蛋白、血红蛋白、混合痔Ⅲ期或Ⅳ期等],采用多因素logistic回归筛选患者术后发生慢性疼痛的危险因素并建立个体化风险预测模型,采用rms方程包和R(R3.5.3)应用包构建列线图模型并应用校正曲线和接收者操作特征曲线(ROC)下面积(AUC)评价其预测准确性,采用Bootstrap法和caret软件包对所建列线图模型加以内部验证。结果吸烟、嗜酒、高血压、便秘及混合痔Ⅲ期或Ⅳ期是混合痔患者行吻合器切除术后发生慢性疼痛的危险因素;基于此5项危险因素建立风险预测模型,AUC为0.815(95%CI为0.791-0.837),校正曲线结果差异较小,表明该风险预测模型精准度和区分度较好。结论吸烟、嗜酒、高血压、便秘及混合痔Ⅲ期或Ⅳ期是混合痔患者行吻合器切除术后发生慢性疼痛的危险因素,建立的风险预测模型对发生慢性疼痛有较准确的预测能力和区分度。Objective To explore the risk factors of chronic pain in patients with mixed hemorrhoids after stapler resection and the establishment of risk models.Methods Two hundred patients with mixed hemorrhoids after stapling resection were selected and divided into pain group(n=23)and non-pain group(n=177)according to whether chronic pain occurred.The clinical data of all patients were collected[including age,gender,body mass index(BMI),smoking,alcoholism,poor diet,exercise,distance from anastomosis to dentition,hypertension,bleeding,number of mixed hemorrhoids,constipation,albumin,hemoglobin,and mixed hemorrhoids stageⅢorⅣ,etc.],and Multivariate logistic regression was used to screen the risk factors for chronic pain of patients after surgery and the individualized risk prediction model was established.The rms equation package and the R(R3.5.3)application package were used to construct a nomogram model and the calibration curve and the area under the ROC curve were applied(AUC)to evaluate its prediction accuracy,and Bootstrap method and caret software package were used to internally verify the built nomogram model.Result Smoking,alcoholism,high blood pressure,constipation,and stageⅢorⅣmixed hemorrhoids were risk factors for chronic pain after stapler resection in patients with mixed hemorrhoids;a risk prediction model was established based on these five risk factors,and the AUC was 0.815(95%CI was 0.791-0.837),and the difference in the results of the calibration curve was small,indicating that the risk prediction model had good accuracy and discrimination.Conclusion Smoking,alcoholism,high blood pressure,constipation,and mixed hemorrhoids stageⅢorⅣare risk factors for chronic pain after stapled resection in patients with mixed hemorrhoids.The established risk prediction model has a more accurate predictive ability and discrimination for chronic pain.

关 键 词：混合痔 吻合器切除术 慢性疼痛 危险因素 风险模型 

分 类 号：R657.18[医药卫生—外科学]