肛瘘病人术后早期疼痛灾难化及其风险模型构建

唐玲; 杨中华; 陈有喜

肛瘘病人术后早期疼痛灾难化及其风险模型构建

Early postoperative pain catastrophization in patients with anal fistula and the construction of its prediction model

摘要

摘要:
目的： 分析肛瘘病人术后早期疼痛灾难化现状，基于生物–心理–社会模型与ABC情绪理论筛选相关预测指标，构建并验证肛瘘病人术后早期疼痛灾难化的风险模型，为临床实施精准创伤导向型护理提供依据。
方法： 选取于165例肛瘘手术病人为研究对象。收集病人的一般资料情况，采用疼痛灾难化量表、家庭关怀指数问卷（APGAR）、创伤后应激量表（PCL–C）、简易心理弹性量表（CD–RSIC–10）、数字疼痛强度量表（NRS）等收集相关评分情况。运用logistic回归构建肛瘘病人术后早期的疼痛灾难化风险模型，绘制ROC曲线检验模型效能。
结果： 165例肛瘘病人中术后早期疼痛灾难化阳性95例，阳性率为57.58%。学历、病程、APGAR、PCL–C、CD–RISC–10、NRS可能是肛瘘病人疼痛灾难化的影响因素（P ＜ 0.05 ~ P ＜ 0.01）。基于6个风险变量构建列线图，模型的ROC曲线下面积为0.847（95%CI：0.788 ~ 0.906），具有良好的区分度。ROC曲线截断值为0.690时，模型的灵敏度为70.5%，特异度为88.6%，约登指数为0.591，模型测效能最佳。模型的拟合度良好（χ² = 14.59，P = 0.07）。
结论： 肛瘘病人术后早期疼痛灾难化阳性率较高，学历、病程、APGAR、PCL–C、CD–RISC–10、NRS可能是肛瘘病人术后早期疼痛灾难化的影响因素。基于影响因素构建的风险模型效能显著，构建的列线图可实现快速评估，可为识别肛瘘术后早期疼痛灾难化人群提供量化工具。

Abstract:
Objective To analyze the current situation of early postoperative pain catastrophization in patients with anal fistula, screen relevant predictive indicators based on the bio-psycho-social model and ABC emotion theory, construct and verify the risk model of early postoperative pain catastrophization in patients with anal fistula, and provide a basis for the clinical implementation of precise trauma-related nursing.
Method A total of 165 patients undergoing anal fistula surgery were selected as the research subjects. The general information of patients was collected. The relevant scoring situations were collected using the Catastrophical Pain Scale, Family Care Index Questionnaire (APGAR), Post-Traumatic Stress Scale (PCL-C), Mini-Psychological Resilience Scale (CD-RSIC-10) and Digital Pain Intensity Scale (NRS), etc. The logistic regression was used to construct a disaster risk model of pain in patients with anal fistula in the early postoperative period, and the ROC curve was drawn to test the model efficacy.
Results Among 165 patients with anal fistula, 95 cases were positive for early postoperative pain catastrophization, with a positive rate of 57.58%. The educational background, disease duration, APGAR, PCL-C, CD-RISC-10 and NRS might be the influencing factors of pain catastrophizing in patients with anal fistula (P ＜ 0.05 to P ＜ 0.01). A nomogram was constructed based on six risk variables. The area under the ROC curve of the model was 0.847 (95%CI: 0.788–0.906), indicating good discrimination. When the cutoff value of the ROC curve was 0.690, the sensitivity of the model was 70.5%, the specificity was 88.6%, and the Youden index was 0.591, indicating the best measurement efficacy of the model. The model had a good fit (χ² = 14.59, P = 0.07).
Conclusions The positive rate of early postoperative pain catastrophiation in patients with anal fistula is relatively high. The educational background, disease duration, APGAR, PCL-C, CD-RISC-10 and NRS may be the influencing factors of early postoperative pain catastrophiation in patients with anal fistula. The risk model constructed based on influencing factors has significant efficacy. The constructed nomogram can achieve rapid assessment, and provide a quantitative tool for identifying the population with disastrous early pain after anal fistula surgery.

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