新生儿重症监护室操作性疼痛危险因素分析及列线图预测模型的构建  

Analysis of risk factors for procedural pain in Neonatal Intensive Care Unit and construction of nomogram prediction model

作　　者：赵绍漓 刘彦彦 弓少华 李丹凤 ZHAO Shao-li;LIU Yan-yan;GONG Shao-hua;LI Dan-feng(Neonatal Intensive Care Unit,Children's Hospital Affiliated to Zhengzhou University,Henan Children's Hospital,Zhengzhou Children's Hospital,Zhengzhou 450012,Henan,CHINA)

机构地区：[1]郑州大学附属儿童医院&河南省儿童医院&郑州儿童医院新生儿重症监护室,河南郑州450012

出　　处：《海南医学》2025年第4期590-594,共5页Hainan Medical Journal

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20200650)。

摘　　要：目的分析新生儿重症监护室操作性疼痛危险因素,并构建列线图预测模型。方法选取2020年5月至2022年12月于河南省儿童医院新生儿重症监护室住院治疗的716例患儿作为研究对象,根据新生儿操作性疼痛量表得分分为观察组(n=394)和对照组(n=322),比较两组患儿的一般资料,采用多因素Logistic回归分析影响操作性疼痛的危险因素,构建列线图预测模型,绘制列线图模型的受试者工作特征(ROC)曲线,以其曲线下面积(AUC)和校准曲线表示模型的区分度和校准度,使用Bootstrap自抽样法,通过交叉验证和重抽样验证进行了内部验证,其中交叉验证采用10折交叉验证;重抽样验证次数为500次,评价该模型的预测能力。结果观察组患儿操作类型复杂占比、医疗疾病诊断数目>1种占比、呼吸支持人数占比和致痛性操作总数分别为69.80%(275/394)、71.32%(281/394)、54.06%(213/394)、(4.31±1.21)次,明显多于对照组的31.68%(102/322)、45.34%(146/322)、30.43%(98/322)、(2.12±0.87)次,而胎龄、出生体质量分别为(28.23±1.24)周、(1045.31±112.57)g,明显低于对照组的(30.56±1.32)周、(1274.26±126.16)g,差异均具有统计学意义(P<0.05);多因素Logistic回归分析结果显示,胎龄小、出生体质量低、操作类型复杂、医疗疾病诊断数目>1种、需要呼吸支持、致痛性操作总数多均是新生儿重症监护室操作性疼痛的危险因素(P<0.05);根据回归分析构建的预测操作性疼痛的风险列线图模型对新生儿重症监护室操作性疼痛风险的预测值与实际值基本一致,矫正曲线与标准曲线的合度较好,该模型的AUC为0.863。结论胎龄小、出生体质量低、操作类型复杂、医疗疾病诊断数目>1种、需要呼吸支持、致痛性操作总数多均是新生儿重症监护室操作性疼痛的危险因素,基于上述危险因素构建的列线图模型具有一定的预测能力和可信度。Objective To explore the risk factors for procedural pain in Neonatal Intensive Care Unit,and to construct a nomogram prediction model.Methods A total of 716 children hospitalized in the Neonatal Intensive Care Unit of Henan Children's Hospital from May 2020 to December 2022 were selected as the study objects.According to the Neonatal Procedural Pain Scale scores,they were divided into an observation group(n=394)and a control group(n=322).The general information of children were compared between the two groups.Multivariate logistic regression was used to analyze the risk factors affecting procedural pain.The nomogram prediction model was constructed,and the receiver operating characteristic(ROC)curve of the nomogram model was drawn.The area under the curve(AUC)and the calibration curve were used to represent the discrimination and calibration of the model.Internal validation was performed using Bootstrap resampling with 10-fold cross-validation and 500 resampling iterations.Results The propor-tions of complex procedures,multiple medical diagnoses(>1 type),respiratory support,and total number of painful procedures were 69.80%(275/394),71.32%(281/394),54.06%(213/394),and 4.31±1.21 in the observation group,significantly higher than 31.68%(102/322),45.34%(146/322),30.43%(98/322),2.12±0.87 in the control group(P<0.05).Gestational age and birth weight were(28.23±1.24)weeks and(1045.31±112.57)g in the observation group,significantly lower than(30.56±1.32)weeks and(1274.26±126.16)g in the control group(P<0.05).Multivariate logistic regression analysis showed that small gestational age,low birth weight,complex procedures,multiple medical diagnoses,respiratory support,and a higher number of painful procedures were all risk factors for procedural pain in Neonatal Intensive Care Unit(P<0.05).The nomogram model demonstrated good predictive accuracy with an AUC of 0.863,and the calibration curve showed high consistency between predicted and observed values.Conclusion Younger gestational age,lower birth weight,complex pro

关 键 词：新生儿 重症监护室 操作性疼痛 危险因素 列线图 

分 类 号：R722[医药卫生—儿科]