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| 发育性髋关节脱位学龄前患儿Salter骨盆截骨术后中至重度疼痛的影响因素 |
| Influencing factors of moderate to severe pain after Salter pelvic osteotomy in preschool children with developmental dislocation of the hip |
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| DOI：10.12089/jca.2025.02.009 |
| 中文关键词: 小儿，学龄前 中至重度疼痛 骶管阻滞 发育性髋关节脱位；Salter骨盆截骨术 |
| 英文关键词: Child, preschool Moderate to severe pain Caudal block Developmental dislocation of the hip Salter pelvic osteotomy |
| 基金项目:江苏省卫生健康委医学科研重点项目（K2023066） |
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| 中文摘要: |
目的：分析学龄前患儿Salter骨盆截骨术后48 h内中至重度疼痛发生的影响因素。
方法：回顾性收集2023年2月至2024年2月择期行Salter骨盆截骨术的发育性髋关节脱位患儿123例，根据患儿术后48 h内疼痛评分将患儿分为两组：中至重度疼痛组（疼痛评分≥4分，n=51）和轻度疼痛组（疼痛评分＜4分，n=72）。采用单因素分析和二元Logistic回归分析Salter骨盆截骨术后48 h内中至重度疼痛发生的影响因素，构建术后疼痛发生的概率模型，并对模型进行Hosmer-Lemeshow拟合优度检验。
结果：与中至重度疼痛组比较，轻度疼痛组麻醉方式联合骶管阻滞明显增多，PCIA使用明显增多，居住地海拔明显增高，月龄明显增大（P＜0.05）。Logistics回归分析显示，麻醉方式联合骶管阻滞、镇痛方式选择PCIA、居住地为高海拔地区以及月龄增大是中至重度疼痛发生的保护因素（P＜0.05）。根据结果建立Logistic回归方程，Hosmer-Lemeshow拟合优度观测值为9.250（P=0.322）。以预测概率P=0.602作为阈值，Logistic回归模型预测中至重度疼痛发生的敏感性和特异性分别为82.40%、77.80%，受试者工作特征（ROC）曲线下面积为0.836（95%CI 0.765～0.908）。
结论：麻醉方式联合骶管阻滞、镇痛方式选择PCIA、居住地为高海拔地区以及月龄增大是行Salter骨盆截骨术的发育性髋关节脱位患儿术后48 h内中至重度疼痛发生的保护因素，以此建立的模型具有较好的预测效能。 |
| 英文摘要: |
Objective: To analyze the influencing factors of moderate to severe pain within 48 hours after Salter pelvic osteotomy in preschool children.
Methods: A total of 123 children who underwent elective Salter pelvic osteotomy from February 2023 to February 2024 were retrospectively collected, and the children were categorized into two groups according to the pain score within 48 hours after surgery: moderate to severe pain group (pain score ≥ 4, n = 51) and mild pain group (pain score < 4, n = 72). Univariate analysis and binary logistic regression were used to analyze the factors influencing the occurrence of moderate to severe pain within 48 hours after Salter pelvic osteotomy, to construct a probability model for the occurrence of postoperative pain, and to conduct the Hosmer-Lemeshow goodness-of-fit test for the model.
Results: Compared with the moderate to severe pain group, the mild pain group had significantly more anesthesia modality combined with caudal block, significantly more use of PCIA, significantly higher altitude of residence, and significantly higher age in months (P < 0.05). Logistics regression analysis showed that the anesthesia modality combined with caudal block, the choice of analgesic modality of PCIA, the residence of a high altitude, and the increase age in months were the protective factors for the occurrence of moderate to severe pain (P < 0.05). Logistic regression equations were established based on the results, and the observed value of Hosmer-Lemeshow goodness-of-fit was 9.250 (P = 0.322). Using the prediction probability P = 0.602 as the threshold, the sensitivity and specificity of the logistic regression model to predict the occurrence of moderate to severe pain were 82.40% and 77.80%, respectively, and the area under the receiver operating characteristic (ROC) curve was 0.836 (95% CI 0.765-0.908).
Conclusion: Anesthesia combined with caudal block, PCIA for analgesia, high altitude residence, and older age are protective factors for the occurrence of moderate to severe pain in children undergoing Salter pelvic osteotomy in the postoperative period of 48 hours, and the model thus developed has a good predictive efficacy. |
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