首发脑卒中患者心理痛苦预测模型的构建及验证

Construction and Validation of a Predictive Model for PsychologicalPain in First-Episode Stroke Patients

目的调查分析首发脑卒中患者心理痛苦现状及影响因素,构建心理痛苦预测模型,并进行验证。方法通过便利抽样法,选取郑州大学第二附属医院神经康复科2022年3—9月收治的242例首发脑卒中患者为对象,应用心理痛苦温度计(DT)评估患者是否存在明显心理痛苦,收集患者临床资料,通过单因素分析和多因素logistic回归分析对患者心理痛苦影响因素进行筛选,绘制列线图构建心理痛苦预测模型,并进行受试者工作特征(ROC)曲线分析以验证模型效果。结果242例首发脑卒中患者DT评分结果阳性(DT≥4分)检出126例,心理痛苦发生率为52.07%。logistic回归分析筛选最终预测变量显示,年龄、受教育程度、家庭月收入、卒中损伤程度、自我效能、应对方式、社会支持度、功能独立性均为首发脑卒中患者心理痛苦的独立性影响因素(P<0.05)。模型ROC曲线下面积为0.912(95%CI为0.705~0.943,P<0.05),灵敏度为0.871,特异度为0.825,约登指数为0.696。结论首发脑卒中患者心理痛苦发生率高,影响因素多,构建列线图预测模型有利于医护人员识别预测患者心理痛苦发生风险,为及时采取预防措施提供指导。

Objective To investigate and analyze the current situation and influencing factors of psychological pain in first-episode stroke patients,construct a predictive model for psychological pain,and validate it.Methods By convenient sampling method,242 first-episode stroke patients admitted to the Neurology of the Second Affiliated Hospital of Zhengzhou University from March to September 2022 were selected as the subjects,and the psychological pain thermometer(DT)was used to assess whether there was significant psychological pain in patients.The clinical data of patients were collected.The influencing factors of patients’psychological pain were screened through single factor analysis and multifactor logistic regression analysis,and a nomogram was drawn to build a prediction model of psychological pain,and receiver operating characteristic(ROC)curve analysis was carried out to verify the model effect.Results The results showed that 126 out of 242 first-episode stroke patients had a positive DT score(DT≥4 points),and the incidence of psychological pain was 52.07%.The final predictive variables screened by logistic regression analysis showed that age,education level,monthly family income,degree of stroke injury,self-efficacy,coping style,social support and functional independence were all independent influencing factors for psychological pain in first-episode stroke patients(P<0.05).The area under the receiver operating characteristic of the model was 0.912(95%CI was 0.705-0.943,P<0.05),the sensitivity was 0.871,the specificity was 0.825,and the Youden index was 0.696.Conclusion The incidence of psychological pain in first-episode stroke patients is high,and there are many influencing factors.Building a column chart prediction model is beneficial for medical staff to identify and predict the risk of psychological pain in patients,providing guidance for timely preventive measures.