个体化混合痔患者术后中重度疼痛的列线图模型

doi:10.3969/j.issn.1006-5253.2023.06.00３

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摘要目的探讨混合痔患者术后中重度疼痛的危险因素，并建立混合痔患者术后中重度疼痛的列线图模型。方法选取2019年3月至2022年11月某医院行手术治疗的270例混合痔患者作为研究对象。采用lasso-logistic回归筛选混合痔患者术后中重度疼痛的预测因素，采用logistic回归筛选混合痔患者术后中重度疼痛的危险因素，采用R软件建立混合痔患者术后中重度疼痛的列线图模型，采用bootstrap法验证混合痔患者术后中重度疼痛的列线图模型。结果 270混合痔患者中有53例患者术后出现中重度疼痛，中重度疼痛的发生率为19.63%（53/270）（95%CI：0.712~0.846）。logistic回归分析结果显示，Ⅳ度混合痔、传统外剥内扎术、睡眠状况较差、饮酒史及糖尿病等是混合痔患者术后中重度疼痛的危险因素（P<0.05）。混合痔患者术后中重度疼痛的列线图模型的C-index是0.737（95%-CI：0.698~0.778）；校正曲线的预测值和实际值基本一致；模型的ROC曲线下面积是0.725（95%CI：0.684~0.767）；决策曲线显示阈值概率为8%~67%时，列线图预测混合痔患者术后中重度疼痛的净获益值较高。结论 Ⅳ度混合痔、传统外剥内扎术、睡眠状况较差、饮酒史及糖尿病等是混合痔患者术后中重度疼痛的危险因素，混合痔患者术后中重度疼痛的列线图模型具有较高的临床应用价值。

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	方郑洁
	郭爱粉

关键词 ：混合痔, , 手术治疗, , 中重度疼痛, , 列线图

Abstract：

Objective To investigate the risk factors of postoperative moderate to severe pain in patients with mixed hemorrhoids, and to establish a nomogram model of postoperative moderate and severe pain in patients with mixed hemorrhoids.Methods Two hundred and seventy patients with mixed hemorrhoids who underwent surgical treatment in a hospital from March 2019 to November 2022 were selected as the study objects. Lasso-logistic regression was used to screen the predictors of postoperative moderate and severe pain in patients with mixed hemorrhoids, logistic regression was used to screen the risk factors of postoperative moderate and severe pain in patients with mixed hemorrhoids, R software was used to establish the nomogram model of postoperative moderate and severe pain in patients with mixed hemorrhoids, and the nomogram model of postoperative moderate and severe pain in patients with mixed hemorrhoids was verified.Results Among 270 patients with mixed hemorrhoids, 53 patients had moderate and severe pain after the surgery, and the incidence of moderate and severe pain was 19.63% (53/270) (95%CI: 0.712-0.846). Logistic regression analysis showed that grade IV mixed hemorrhoids, traditional external stripping and internal ligation, poor sleep status, drinking history and diabetes were the risk factors for postoperative moderate and severe pain in mixed hemorrhoids patients (P<0.05). The C-index of the nomogram model for postoperative moderate and severe pain in patients with mixed hemorrhoids was 0.737 (95%CI: 0.698-0.778). The predicted value of the correction curve was basically consistent with the actual value. The area under ROC curve of the model was 0.725 (95%CI: 0.684-0.767). When the decision curve showed a threshold probability of 8%-67%, the net benefit value predicted by the nomogram for mixed hemorrhoids patients with postoperative moderate and severe pain was higher.Conclusion Grade IV mixed hemorrhoids, traditional external stripping and internal ligation, poor sleep status, drinking history and diabetes are the risk factors for postoperative moderate and severe pain in patients with mixed hemorrhoids. The nomography model of postoperative moderate and severe pain in patients with mixed hemorrhoids has high clinical application value.

Key words： mixed hemorrhoids surgical treatment moderate and severe pain nomograph

收稿日期: 2023-10-13

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通讯作者: 郭爱粉，Email：fangzhengjie1991@163.com

引用本文:

方郑洁，郭爱粉. 个体化混合痔患者术后中重度疼痛的列线图模型 [J]. 中国医院统计, 2023, 30(6): 412-417.
Fang Zhengjie，Guo Aifen. . Establishment of a nomogram model for moderate and severe postoperative pain in patients with individualized mixed hemorrhoids. journal1, 2023, 30(6): 412-417.

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［1］NAVALE P, GONZALEZ R S, VYAS M. Incidental secondary findings in hemorrhoidectomy specimens: A 16-year experience from a single academic center［J］. Hum Pathol, 2021, 109:12-20. DOI: 10.1016/j.humpath.2020.11.008.

［2］戢敏，王芳，代立霞，等．中药热奄包神阙穴外敷联合穴位针刺疗法治疗混合痔术后尿潴留效果观察［J］．山东医药，2022，62(29)：83-85．DOI: 10.3969/j.issn.1002-266X.2022.29.021.

［3］赵敏，桑畅野，闫长红，等．中重度混合痔的术式选择及疗效对比［J］．宁夏医科大学学报，2019，41(9)：939-943．DOI: 10.16050/j.cnki.issn1674-6309.2019.09.017.

［4］鲁振锋，张秀峰，沈忠，等．外剥内扎术联合荷包缝合术治疗Ⅲ、Ⅳ度混合痔的临床效果分析［J］．中华全科医学，2019，17(4)：574-576．DOI: 10.16766/j.cnki.issn.1674-4152.000738.

［5］黎淑玲，刘俊杰，蒋邦好，等．PPH联合直视下痔上动脉结扎治疗Ⅲ Ⅳ度混合痔的疗效及安全性［J］．安徽医学，2022，43(11)：1264-1267．DOI: 10.3969/j.issn.1000-0399.2022.11.004.

［6］彭军良，王琛，姚向阳，等．悬吊绑缚动脉结扎切除闭合术联合敛痔散外敷治疗重度混合痔疗效观察［J］．现代中西医结合杂志，2021，30(1)：12-18．DOI: 10.3969/j.issn.1008-8849.2021.01.003.

［7］许旭峰，刘良东，黄丽娟，等．外剥内扎术联合痔结扎术治疗环状混合痔的疗效研究［J］．局解手术学杂志，2021，30(1)：32-35．DOI: 10.11659/jjssx.07E020142.

［8］马静怡，龚建明，徐琴，等．弹力线套扎术与PPH术治疗Ⅱ、Ⅲ度混合痔疗效对比［J］．中国现代普通外科进展，2021，24(9)：732-733．DOI: 10.3969/j.issn.1009-9905.2021.09.014.

［9］武伟，宁豫勇，张瑜，等．保留肛垫整形术联合PPH治疗Ⅲ和Ⅳ度混合痔的疗效分析［J］．中国中西医结合外科杂志，2021，27(5)：758-763．DOI: 10.3969/j.issn.1007-6948.2021.05.017.

［10］美国结直肠外科医师协会标准化工作委员会，丁义江，皇甫少华，等．痔诊断和治疗指南:2010修订版［J］．中华消化外科杂志，2012，11(3)：243-247．DOI: 10.3760/cma.j.issn.1673-9752.2012.03.014.

［11］黄娅，李运明，雷丽．Lasso Logistic回归模型识别脂肪肝风险因素效果研究［J］．甘肃科学学报，2021，33(4)：45-51．DOI: 10.16468/j.cnki.issn1004-0366.2021.04.008.［12］石春雷，张修稳，赵辉．痔上黏膜次全切除术治疗Ⅲ～Ⅳ度混合痔的疗效评价［J］．中华保健医学杂志，2021，23(5)：528-529．DOI: 10.3969/j.issn.1674-3245.2021.05.032.

［13］余求祥，王艳芝，智从从，等．外剥内套保留齿线术治疗Ⅲ～Ⅳ度混合痔疗效观察［J］．中国临床医生杂志，2021，49(2)：195-198．DOI: 10.3969/j.issn.2095-8552.2021.02.020.

［14］刘玮玮，蒋厚记，冯宏俊，等．吻合器痔上黏膜环形切除术与传统外剥内扎术治疗混合痔的疗效对比研究［J］．现代生物医学进展，2021，21(17)：3388-3391．DOI: 10.13241/j.cnki.pmb.2021.17.040.

［15］孙静，肖淑珺．个体化预测早期食管癌内镜黏膜下剥离术术后中重度疼痛的列线图模型的建立［J］．消化肿瘤杂志(电子版)，2023，15(1)：51-57．DOI: 10.3969/j.issn.1674-7402.2023.01.010.

［16］王迪，缪长虹，陈万坤，等．胸腹部肿瘤手术患者术后中重度疼痛的危险因素［J］．中华麻醉学杂志，2020，40(9)：1071-1074．DOI: 10.3760/cma.j.cn131073.20200410.00909.

［17］刘盼盼，陈永学，李炜，等．老年患者膝骨性关节炎术后急性疼痛的危险因素及预测模型［J］．实用临床医药杂志，2023，27(6)：76-80．DOI: 10.7619/jcmp.20222461.

［18］WIESSMEYER J R, OZIMEK T, STRUCK J P, et al. Comprehensive nomogram for prediction of the uric acid composition of ureteral stones as a part of tailored stone therapy［J］. Eur Urol Focus, 2022, 8(1):291-296. DOI: 10.1016/j.euf.2021.02.001

［19］EL SHAROUNI M A, VAREY A H R, WITKAMP A J, et al. Predicting sentinel node positivity in patients with melanoma: External validation of a risk-prediction calculator (the Melanoma Institute Australia nomogram) using a large European population-based patient cohort［J］. Br J Dermatol, 2021, 185(2):412-418. DOI: 10.1111/bjd.19895.