Construction and validation of a nomogram prediction model for breakthrough pain after labor analgesia with programmed intermittent epidural bolustechnique
Objective To explore the construction and clinical application value of a nomogram prediction model based on the risk factors of breakthrough pain after labor analgesia with programmed intermittent epidural bolustechnique(PIEB).Methods A total of 242 patients who received labor analgesia with PIEB in Cangzhou People's Hospital from January 2021 to April 2023 were selected as the research objects.The patients were divided into training set(n=169)and validation set(n=73)according to the ratio of 7∶3 by the completely random method.In the training set,multivariate Logistic regression was used to analyze the risk factors of labor breakthrough pain and a nomogram prediction model was constructed,ROC curve and calibration curve were drawn to evaluate the predictive efficacy of the nomogram model,and the validation set was used to verify the nomogram model.At the same time,using decision curve analysis(DCA)nomogram model of labor breakthrough pain to evaluate the clinical application value.Results Breakthrough pain occurred in33 cases(19.53%)in the training set and 16 cases(21.92%)in the validation set.There was no significant difference in the incidence of breakthrough pain and clinical characteristics between the two sets(P>0.05).In the training set,chronic back pain with nerve root involvement,bigger fetal size,higher NRS score at 15 min after puncture,60 min interval of pulse administration and longer duration of the first stage of labor were independent risk factors for breakthrough pain in pregnant women receiving PIEB of labor analgesia(P<0.05),and a nomogram prediction model was further constructed.The nomogram model had good calibration and fit between prediction and actual values in the training set and validation set(C-index were 0.836 and 0.847,respectively;mean absolute error of coincidence between predicted value and actual value were 0.024 and 0.048,respectively;Hosmer-Lemeshow test P=0.718,0.901,respectively).The ROC curve showed that the AUC of the nomogram model for predicting breakthrough pain in pregnant women receiving PIEB of labor analgesia was 0.852(95%CI:0.777-0.927)in the training set and 0.899(95%CI:0.822-0.976)in the validation set,the sensitivity and specificity were 0.818,0.750 and 0.875,0.754,respectively.Conclusion The nomogram prediction model based on the risk factors of breakthrough pain after labor analgesia with PIEB is helpful for early prediction of labor breakthrough pain and guiding clinical decision-making,so as to minimize the risk of labor breakthrough pain and ensure the safety of mother and child.
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