混合痔术后患者早期疼痛灾难化预测模型构建与验证  

Construction and verification of early pain catastrophizing prediction model for patients after mixed hemorrhoids surgery

作　　者：徐美娟[1] 程莉 蒋玲芳 杨勤 XU Meijuan;CHENG Li;JIANG Lingfang;YANG Qin(Department of Nursing,Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine,Jiangxi Province,Nanchang330006,China)

机构地区：[1]江西中医药大学附属医院护理部,江西南昌330006

出　　处：《中国当代医药》2025年第10期19-24,共6页China Modern Medicine

基　　金：江西省中医药管理局科技计划项目(2023B1057)。

摘　　要：目的探讨混合痔手术患者并发术后疼痛灾难化的影响因素,构建并验证风险预测模型。方法选取2022年1月至2023年1月江西中医药大学附属医院的170例混合痔手术患者作为研究对象,根据是否发生疼痛灾难化分成疼痛灾难化组和无疼痛灾难化组,采用多因素logistic回归分析独立影响因素并建立列线图模型,并选取2023年2月至7月的70例患者作为验证组。结果本研究疼痛灾难化组45例(26.47%),无疼痛灾难化组125例(73.53%)。多因素分析结果显示,年龄(OR=1.127,95%CI:1.032~1.321,P=0.008)、视觉模拟评分法(VAS)评分(OR=2.263,95%CI:1.730~4.101,P<0.001)、医院焦虑抑郁量表-焦虑量表(HADS-A)评分(OR=1.495,95%CI:1.211~1.846,P<0.001)和医院焦虑抑郁量表-抑郁量表(HADS-D)评分(OR=1.340,95%CI:1.126~1.594,P=0.001)均为混合痔患者发生术后疼痛灾难化的独立危险因素。回归分析显示,Logit(P)=0.120×年龄+0.980×VAS+0.402×HADS-A+0.293×HADS-D-25.731。ROC曲线下面积为0.967,95%CI为0.935~0.999,灵敏度为0.933,特异度为0.952,约登指数为0.855,最佳截断值为0.365,Hosemer-Lemeshow检验显示χ^(2)=7.412,P=0.493。结论本研究构建的风险预测模型可对混合痔手术患者产生术后疼痛灾难化的影响因素进行有效识别,并提供临床护理参考。Objective To explore the influencing factors of postoperative pain catastrophizing in patients undergoing mixed hemorrhoids surgery,and establish and verify the risk prediction model.Methods A total of 170 patients with mixed hemorrhoids surgery in Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine from January 2022 to January 2023 were selected as the research objects.They were divided into pain catastrophizing group and non-pain catastrophizing group according to whether pain catastrophizing occurred.Multivariate logistic regression was used to analyze independent influencing factors and nomographic model was established.A total of 70 patients from February to July 2023 were selected as the validation group.Results There were 45 cases(26.47%)in the pain catastrophizing group and 125 cases(73.53%)in the non-pain catastrophizing group.The results of multivariate analysis showed that age(OR=1.127,95%CI:1.032-1.321,P=0.008)and visual analogue scale(VAS)score(OR=2.263,95%CI:1.730-4.101,P<0.001),hospital anxiety depression scale-anxiety scale(HDS-A)score(OR=1.495,95%CI:1.211-1.846,P<0.001)and hospital anxiety depression scale-depression scale(HDS-D)score(OR=1.340,95%CI:1.126-1.594,P=0.001)were independent risk factors for postoperative pain catastrophizing in patients with mixed hemorrhoids.Regression analysis showed that Logit(P)=0.120×age+0.980×VAS+0.402×HADS-A+0.293×HADS-D-25.731.The area under ROC curve was 0.967,the 95%CI was 0.935-0.999,the sensitivity was 0.933,the specificity was 0.952,the Yodon index was 0.855,and the best truncation value was 0.365.The Hosemer-Lemeshow test showedχ^(2)=7.412,P=0.493.Conclusion The risk prediction model established in this study can effectively identify the influencing factors of postoperative pain catastrophizing in patients with mixed hemorrhoid surgery,and provide a reference for clinical nursing.

关 键 词：混合痔 术后 疼痛灾难化 列线图 预测模型 

分 类 号：R473.6[医药卫生—护理学]