NBASS-APS对结肠癌患者术后镇痛效果的影响因素分析及列线图模型建立<sup>★</sup>

doi:10.3969/j.issn.2095-1264.2022.06.19

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NBASS-APS对结肠癌患者术后镇痛效果的影响因素分析及列线图模型建立★
DOI:
                        10.3969/j.issn.2095-1264.2022.06.19
                    
作者:
                        
                        
                    
作者单位:德阳市人民医院 胃肠外科，四川 德阳，618000
作者简介:郭思思，女，主管护师，研究方向：胃肠护理。
通讯作者:
中图分类号:R735.3+5
基金项目:★德阳市重点科学技术研究项目（2018SZS058）。

Analysis of influencing factors of NBASS-APS in postoperative analgesia of colon cancer patients and establishment of nomogram model^★

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Gastrointestinal Surgery Department, People's Hospital of Deyang City, Deyang, 618000, Sichuan, China

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摘要:

目的探讨急性疼痛服务模式（NBASS-APS）对结肠癌患者术后镇痛效果的影响因素及列线图模型建立。方法回顾性分析2017年11月1日—2019年11月1日于我院行结肠癌根治术并于术后应用NBASS-APS镇痛的302例患者的临床资料，采用整群随机抽样法将数据分为训练集（n=193）和验证集（n=109）。分别使用单因素分析和Logistic回归多因素分析对影响训练集镇痛效果的独立危险因素进行分析，同时建立相关列线图预测模型并予以验证。结果年龄<60岁（OR=3.943， 95% CI： 1.636～9.503）、术前焦虑抑郁（OR=3.071， 95% CI： 1.307～7.216）、切口长度≥10 cm（OR=2.699， 95% CI： 1.205～6.048）、术后急性疼痛VAS评分≥7分（OR=3.434，95% CI： 1.448～8.144）、麻醉师督导条件不成熟（OR=3.138， 95% CI： 1.099～8.961）及患者依从性较差（OR=2.783， 95% CI： 1.080～7.173）是影响NBASS-APS对结肠癌患者术后镇痛效果的独立危险因素（P<0.05）。基于Logistic回归模型建立相关列线图，校准曲线验证显示训练集和验证集的预测值与实测值均基本一致，ROC曲线验证显示训练集C-index指数高达0.830（95% CI： 0.793～0.867），验证集的准确性也高达81.6%（C-index值），说明该列线图模型具有良好的精准度和区分度。结论年龄<60岁、术前焦虑抑郁、切口长度≥10 cm、术后急性疼痛VAS评分≥7分、麻醉师督导条件不成熟及患者依从性较差是影响NBASS-APS对结肠癌患者术后镇痛效果的独立危险因素，基于Logistic回归模型建立的列线图模型具有可靠的预测能力，对临床改进NBASS-APS和提高镇痛效果具有指导意义。

Abstract:

Objective To explore the influencing factors of NBASS-APS in postoperative analgesia of colon cancer patients and the establishment of nomogram model.Methods The clinical data of 302 patients who underwent radical colon surgery in our hospital between November 1, 2017 and November 1, 2019 and applied NBASS-APS pain management model for postoperative analgesia were analyzed retrospectively. The sampling method divides the data into a training set (n=193) and a validation set (n=109). Univariate and Logistic regression were used to analyze the independent risk factors affecting the analgesic effects of the training set, and the relevant nomogram prediction model was established and verified.Results Age <60 years (OR=3.943, 95% CI: 1.636～9.503), preoperative anxiety and depression (OR=3.071, 95% CI: 1.307～7.216), incision length ≥10 cm (OR=2.699, 95% CI: 1.205～6.048), postoperative acute pain VAS scores ≥7 points (OR=3.434, 95% CI: 1.448～8.144), immature supervision by anesthetists (OR=3.138, 95% CI: 1.099～8.961) and poor patient compliance (OR=2.783, 95% CI: 1.080～7.173) were independent risk factors that affect the postoperative analgesic effect of the NBASS-APS pain management model in patients with colon cancer (P<0.05). The relevant nomograms were established on the base of Logistic regression model. The calibration curve verification showed that the predicted values of the training set and the verification set were basically the same as the actual measured values. The ROC curve verification showed that the C-index index was as high as 0.830 (95% CI: 0.793～0.867). The accuracy of the verification set was also as high as 81.6% (C-index value), indicating that the nomogram model had good accuracy and differentiation.Conclusion Age <60 years old, preoperative anxiety and depression, incision length ≥10 cm, postoperative acute pain VAS scores ≥7 points, immature supervision by anesthetists and poor patient compliance were independent risk factors that affected the postoperative analgesic effects of the NBASS-APS pain management model in patients with colon cancer. The nomogram model established on the base of Logistic regression model had reliable prediction ability. It had guiding significance for clinical improvement of NBASS-APS pain management model and enhancement of analgesic effect.