单孔胸腔镜术后慢性疼痛预测模型的建立及验证
DOI:
作者:
作者单位:

南京脑科医院胸外科

作者简介:

通讯作者:

中图分类号:

基金项目:

江苏省南京市卫生科技发展专项资金项目(YKK23148)


Construction and validation of a predictive model for chronic pain after single-port video-assisted thoracic surgery
Author:
Affiliation:

Fund Project:

  • 摘要
  • |
  • 图/表
  • |
  • 访问统计
  • |
  • 参考文献
  • |
  • 相似文献
  • |
  • 引证文献
  • |
  • 资源附件
  • |
  • 文章评论
    摘要:

    目的:探讨单孔电视辅助胸腔镜手术(video-assisted thoracic surgery,VATS)后慢性疼痛的危险因素,建立预测模型并加以验证。 方法:回顾性分析2023年1月至2023年6月在南京市胸科医院行单孔胸腔镜手术的302例患者,收集患临床资料,采用数字评分量表(numeric rating scale,NRS)评定患者术后三个月疼痛程度,分为疼痛组及非疼痛组。按照7:3比例随机分为训练集(n=214)和验证集(n=88),对训练集采用单因素分析和logistic回归分析,并以此建立预测模型。采用受试者工作特征(receiver operator characteristic, ROC)曲线评估模型区分度、校准曲线评估模型的一致性、决策曲线分析(decision curve analysis, DCA)评估该模型的临床价值,并在验证集中校验模型。 结果:多因素分析显示年龄(OR=0.925,95%CI=0.872~0.981,P=0.009)、术后胸腔闭式引流时间(OR=1.273,95%CI=1.018~1.591,P=0.034)、术后第一天C反应蛋白值(CRP)(OR=1.090,95%CI=1.030~1.153,P=0.003)、术后第一天NRS评分(OR=3.060,95%CI=1.879~4.981,P<0.001)为单孔胸腔镜术后慢性疼痛的独立危险因素,基于此构建预测模型,ROC曲线下面积0.871(95% CI=0.799-0.943),最大约登指数对应0.195(0.856,0.765),Bootstrap法抽样1000次,校准曲线图预测的慢性疼痛概率与实际风险高度一致。DCA曲线表明在全预测概率下均有正收益,有较好临床价值。 结论:在单孔胸腔镜术后,患者年龄、术后胸腔闭式引流时间、术后第一天CRP值、术后第一天NRS评分值均为术后慢性疼痛的危险因素,本预测模型有助于准确预测术后慢性疼痛,有较好临床应用价值。

    Abstract:

    Objective: To explore the risk factors for chronic pain after single-port video-assisted thoracic surgery (VATS), establish the predictive model and validate it. Method: A retrospective analysis was conducted on 302 patients who underwent single-port thoracoscopy surgery at Nanjing Chest Hospital from January 2023 to June 2023, clinical data of patients were collected using a numerical rating scale(NRS) assessed the degree of pain in patients three months after surgery and divided them into a pain group and a non pain group. Randomly divided into a training set (n=214) and a validation set (n=88) according to a 7:3 ratio, and single factor analysis was performed on the training set.Logistic regression analysis is used to establish a predictive model based on the receiver's work characteristics. Operator characteristic (ROC) curve evaluation model discrimination, calibration curve evaluation model consistency, decision curve analysis (DCA) evaluate the clinical value of the model, and verifying the model in the validation set. Result: Multivariate analysis showed that age (OR=0.925, 95% CI=0.872-0.981, P=0.009), postoperative closed chest drainage time (OR=1.273, 95% CI=1.018-1.591, P=0.034), C-reactive protein value (CRP) on the first day after surgery (OR=1.090, 95% CI=1.030-1.153, P=0.003), and NRS score on the first day after surgery (OR=3.060, 95% CI=1.879-4.981, P<0.001) were independent risk factors for chronic pain after single-port thoracoscopy. Based on this, a prediction model was constructed, with an area under the ROC curve of 0.871 (95% CI=0.799-0.943) and a maximum Yoden index corresponding to 0.195. (0.856, 0.765). With a Bootstrap sample of 1000 times, the predicted risk of chronic pain by the calibration curve was highly consistent with the actual risk. The DCA curve indicates positive returns at all predicted probabilities, indicating good clinical value. Conclusion: After single-port video-assisted thoracic surgery, patient age,time of closed thoracic drainage after surgery, CRP value on the first day after surgery, and NRS score on the first day after surgery are all risk factors for chronic postoperative pain. This prediction model is helpful in accurately predicting chronic postoperative pain and has good clinical application value.

    参考文献
    相似文献
    引证文献
引用本文
分享
文章指标
  • 点击次数:
  • 下载次数:
  • HTML阅读次数:
  • 引用次数:
历史
  • 收稿日期:2024-08-23
  • 最后修改日期:2024-09-23
  • 录用日期:2024-12-16
  • 在线发布日期:
  • 出版日期:
关闭