【摘要】 目的 分析超声引导下下肢神经阻滞术后发生暴发痛的影响因素，并构建列线图预测模型。方法 回顾性分析2022年12月至2024年7月在该院行下肢骨科手术的249例患者的临床资料，患者均行超声引导下下肢神经阻滞，按照7∶3的比例将患者分为建模队列(n=174)和验证队列(n=75)。比较建模队列中暴发痛组和非暴发痛组一般资料。多因素logistic回归分析超声引导下下肢神经阻滞术后发生暴发痛的影响因素，构建列线图预测模型，绘制校准曲线评估预测效能，Hosmer-Lemeshow检验、受试者工作特征(ROC)曲线下面积(AUC)评价校准度和区分度，决策曲线分析(DCA)评价临床获益度。结果 超声引导下下肢神经阻滞术后暴发痛总发生率为40.56%(101/249),建模队列暴发痛发生率为39.66%(69/174),验证队列暴发痛发生率为42.67%(32/75)。多因素logistic回归分析显示，年龄(OR=0.487,95%CI:0.375～0.632)、术前骨密度(OR=0.299,95%CI:0.108～0.832)、术前数字分级量表(NRS)评分(OR=9.037,95%CI:5.952～16.885)、麻醉方式(OR=2.939,95%CI:2.877～9.856)、神经阻滞方式(OR=1.622,95%CI:1.486～5.409)、应用局部麻醉药物佐剂(OR=5.494,95%CI:1.547～10.510)、WBC(OR=3.152,95%CI:1.859～5.343)是超声引导下下肢神经阻滞术后发生暴发痛的影响因素(P<0.05)。构建的列线图预测模型的预测结果与实际发生情况一致性较好，校准度和区分度良好，临床应用价值较高。结论 该研究构建的列线图预测模型有助于预测暴发痛的发生风险。更多还原

【Abstract】 Objective To analyze the influencing factors of breakthrough pain after ultrasound-guided lower extremity nerve block, and to construct a nomogram prediction model.Methods A retrospective analysis was conducted on the clinical data of 249 patients who underwent lower extremity orthopedic surgery at this hospital from December 2022 to July 2024.All patients received ultrasound-guided lower extremity nerve block.The patients were divided into a modeling cohort(n=174) and a validation cohort(n=75) in a 7∶3 ratio.The general data of the flare-up pain group and the non-flare-up pain group in the modeling cohort were compared.Multivariate logistic regression analysis was used to investigate the influencing factors of flare-up pain after ultrasound-guided lower extremity nerve block, and a nomogram prediction model was constructed.The calibration curve was drawn to evaluate the predictive efficacy.The Hosmer-Lemeshow test, the area under the receiver operating characteristic(ROC) curve(AUC) were used to evaluate the calibration and discrimination, and the decision curve analysis(DCA) was used to evaluate the clinical benefit.Results The overall incidence of burst pain after ultrasound-guided lower extremity nerve block was 40.56%(101/249),the incidence of burst pain in the modeling cohort was 39.66%(69/174),and the incidence of burst pain in the validation cohort was 42.67%(32/75).Multivariate logistic regression analysis showed that age(OR=0.487,95%CI:0.375-0.632),preoperative bone density(OR=0.299,95%CI:0.108-0.832),preoperative numeric rating scale(NRS) score(OR=9.037,95%CI:5.952-16.885),anesthesia method(OR=2.939,95%CI:2.877-9.856),nerve block method(OR=1.622,95%CI:1.486-5.409),application of local anesthetic adjuvant(OR=5.494,95%CI:1.547-10.510),and WBC(OR=3.152,95%CI:1.859-5.343) were the influencing factors for burst pain after ultrasound-guided lower extremity nerve block(P<0.05).The constructed nomogram prediction model had good consistency with the actual occurrence, good calibration and discrimination, and high clinical application value.Conclusion The prediction model of the nomograms constructed in this study is helpful for predicting the risk of outbreak pain.更多还原