混合痔术后患者疼痛灾难化发展轨迹及影响因素分析

Analysis of Development Trajectory and Influencing Factors of Pain Catastrophizing in Patients after Mixed Hemorrhoidectomy

摘要: 目的：分析混合痔术后患者疼痛灾难化发展轨迹及影响因素。方法：采用便利抽样法，于2023年11月~2025年11月，选取在湖南省张家界市某三级甲等医院胃肠疝及肛门外科行手术治疗的混合痔术后患者为研究对象。采用疼痛灾难化量表评估混合痔术后患者疼痛灾难化水平，分别于患者术后24小时(T1期)、48小时(T2期)、出院前(T3期) 3个时间点进行测量，通过潜变量混合增长模型识别疼痛灾难化，并通过Logistic回归分析明确其影响因素。结果：混合痔术后患者T1期、T2期、T3期的疼痛灾难化平均得分为(42.79 ± 4.35)分、(38.01 ± 5.86)分、(29.63 ± 6.62)分。潜变量混合增长模型共识别出3个类别轨迹：轻度疼痛灾难化组(41.5%)、中度疼痛灾难化组(28.4%)、重度疼痛灾难化组(30.1%)。Logistic回归分析结果显示，年龄、受教育程度、疼痛应对策略是混合痔术后患者疼痛灾难化进展变化轨迹潜在类别的独立影响因素。结论：基于潜变量混合增长模型探究混合痔术后患者疼痛灾难化变化轨迹，可分为3种，即：轻度疼痛灾难化组、中度疼痛灾难化组、重度疼痛灾难化组，且年龄、受教育程度、疼痛应对策略是混合痔术后患者疼痛灾难化进展变化轨迹潜在类别的独立影响因素。提示临床医护人员应根据混合痔术后患者疼痛灾难化发展轨迹类型及关键影响因素，制定个体化的疼痛干预策略。

Abstract: Objective: This paper aims to analyze the trajectory of pain catastrophizing development and its influencing factors in patients following mixed hemorrhoidectomy. Methods: Using convenience sampling, patients who underwent surgery for mixed hemorrhoids at a tertiary hospital’s gastrointestinal, hernia, and anorectal surgery department in Zhangjiajie City, Hunan Province, from November 2023 to November 2025 were recruited. The Pain Catastrophizing Scale was used to assess levels of pain catastrophizing at three time points: 24 hours post-surgery (T1), 48 hours post-surgery (T2), and before discharge (T3). Latent growth mixture model was applied to identify distinct trajectories of pain catastrophizing, and logistic regression analysis was conducted to determine associated influencing factors. Results: The mean scores for pain catastrophizing at T1, T2, and T3 were (42.79 ± 4.35), (38.01 ± 5.86), and (29.63 ± 6.62), respectively. The latent growth mixture model identified three distinct trajectory classes: mild pain catastrophizing group (41.5%), moderate pain catastrophizing group (28.4%), and severe pain catastrophizing group (30.1%). Logistic regression analysis revealed that age, education level, and pain coping strategies were independent predictors of the latent class membership in pain catastrophizing trajectory among patients after mixed hemorrhoidectomy. Conclusions: Based on latent growth mixture model, the trajectory of pain catastrophizing in patients following mixed hemorrhoidectomy can be classified into three types: mild, moderate, and severe. Age, education level, and pain coping strategies are significant independent factors influencing these trajectory patterns. These findings suggest that clinical healthcare providers should develop individualized pain management strategies based on the specific trajectory type and key influencing factors of pain catastrophizing in postoperative patients.