胸腔镜手术慢性术后疼痛风险预测模型的构建

Construction of prediction model for chronic postsurgical pain after video-assisted thoracoscopic surgery

目的构建胸腔镜手术慢性术后疼痛的风险预测模型,开发风险评估工具。方法本研究为单中心前瞻性研究,选取2020年11月至2021年5月在北京协和医院择期行胸腔镜肺部手术的患者,最终入组1132例,使用数字等级评分评估患者出院时的急性疼痛及术后6个月时慢性疼痛的情况,根据是否发生慢性术后疼痛将患者分为两组,通过多因素Logistic回归分析胸腔镜手术慢性术后疼痛的危险因素,构建预测模型并绘制列线图。结果术后6个月时报告慢性疼痛的患者有460例(40.6%)。慢性术后疼痛组的女性患者和有冠心病史的患者更多,出院时疼痛评分更高,出院后继续服用止疼药的患者更多,但是,术中吸入氧化亚氮和切口数量<3个的患者更少(P<0.05)。多因素Logistic回归分析发现冠心病史、术中不吸入氧化亚氮、切口数量≥3个以及出院时的疼痛评分是慢性术后疼痛的独立危险因素(P<0.05),预测模型的受试者工作特征曲线下面积为0.734。结论胸腔镜手术慢性术后疼痛的危险预测模型有助于慢性术后疼痛的临床管理。

Objective To construct a prognostic prediction model for chronic postsurgical pain after video-assisted thoracoscopic surgery and develop a risk evaluation tool.Methods As a single-center prospective study,thestudy enrolled 1132 patients received video-assisted thoracoscopic surgery between November 2020 and May 2021 at Peking Union Medical College Hospital.Numeric rating scale was used to assess theseverity of acute pain when they were discharged and chronic pain at 6 months after surgery.Patients were divided into two groups based on the presence or absence of chronic postsurgical pain.Multivariate Logistic regression was conducted to analyze the risk factors which were used to construct prediction model and draw nomogram for chronic postsurgical pain after video-assisted thoracoscopic surgery.Results 460 patients(40.6%)were reported chronic pain at 6 months after surgery.More women and more patients with coronary heart disease belonged to the group of chronic postsurgical pain.Patients reported higher scores of numeric rating scale when they were discharged and inclined to keep taking painkiller after discharge.However,there were fewer patients with incisions fewer than 3 or using nitrous oxide during surgery in the group of chronic postsurgical pain(P<0.05).The outcome of multivariate Logistic regressionshowed that the history of coronary heart disease,not using nitrous oxide insurgery,incisions more than or equal to 3,and thescore of numeric rating scale on discharge were independent risk factors for chronic postsurgical pain(P<0.05).The area under the receiver operator characteristic curve of the prediction model was 0.734.Conclusions The prediction model is conducive to clinical management for chronic postsurgical pain after video-assisted thoracoscopic surgery.