肝动脉化疗栓塞术后患者发生急性中重度腹痛的危险因素分析

Risk factors and predictive analysis of acute severe abdominal pain after transarterial chemoembolization

目的探讨肝动脉化疗栓塞(transarterial chemoembolization,TACE)术后患者急性中重度腹痛的发生规律及危险因素,初步建立TACE术后腹痛预测模型。方法采用回顾性队列研究法,收集浙江省某三级甲等医院2018年1月-6月期间行TACE的原发性肝癌患者,根据是否发生急性中重度腹痛分为腹痛组和非腹痛组,对两组的资料进行单因素分析,将有统计学意义的因素进行Logistic回归分析,初步建立预测模型,并分析该模型的预测效果。结果共纳入患者367例,共行425次TACE,统计结果显示,预防性TACE术后均未发生急性中重度腹痛;肝内肿瘤多发(肿瘤病灶数量≥3个)、TACE术后腹痛史、手术方式和TACE次数是TACE术后发生急性中重度腹痛的独立预测因子,最终建立的预测模型受试者操作特征曲线下面积为0.794 (95%CI为0.736~0.852),Hosmer-Lemeshow检验结果显示,χ^2=2.205,P=0.974。结论本研究构建的预测模型能较好地预测TACE术后急性中重度腹痛发生的风险,可为医护人员实施预防性疼痛管理措施提供参考。

Objective To observe and investigate the occurrence regularity and risk factors of acute moderate and severe abdominal pain after transarterial chemoembolization(TACE),and to establish a prediction model of postoperative pain after TACE. Methods Retrospective cohort study was used to collect patients with primary liver cancer treated by TACE from January to June 2018 in a hospital. The patients were divided into abdominal pain group and non-pain group. The data of 2 groups was analyzed by univariate analysis. The statistically significant factors were analyzed by multivariate Logistic regression analysis,and the pain prediction model was established. The model evaluation and internal verification were carried out. Results A total of 367 patients were enrolled in this study and 425 times of TACE were performed in half a year. The statistical results showed that no moderate and severe abdominal pain occurred after preventive TACE. Multiple liver tumors(the number of tumors≥3),a history of pain after TACE,transarterial chemoembolization with drug-eluting beads and a low number of TACE were independent predictors of acute moderate and severe abdominal pain. The area under the predicted ROC curve was 0.794(95%CI0.736 ~0.852),and the test result of Hosmer-Lemeshow showed that χ^2=2.205,P =0.974. Conclusion The prediction model constructed in this study can predict acute moderate and severe abdominal pain after TACE,and can provide references for medical staff with management measures of preventive pain.