Study On Pain Status And Prognostic Factors Of Patients With Acute Pancreatitis At Early Admission

Objective To understand the occurrence status and prognosis of early admission pain in patients with acute pancreatitis(AP),analyze the influencing factors of prognosis in patients with acute pancreatitis,and explore the relationship between early admission pain and prognosis,so as to provide reference for standardized early clinical pain management and improvement of disease prognosis.Methods Medical records of patients with acute pancreatitis admitted to the emergency surgery department,the emergency medicine department and the gastroenterology ward of a Grade-III Class A hospital in Anhui Province from December 2021 to October2022 were collected and screened according to inclusion and exclusion criteria.Finally,307 patients were included in this study.After discharge,according to the course records in the electronic medical record system and the diagnosis of clinicians,according to the guidelines,the occurrence of local or systemic complications and the total length of hospital stay of patients were determined,and the patients were divided into complications group and no complications group,hospital stay < 7 days group and hospital stay ≥7 days group.General data,pain data,clinical data and psychosocial data of the two groups were collected in the early stage of admission.Univariate statistical analysis was used to analyze the different factors affecting the prognosis of patients with acute pancreatitis.The factors with statistical significance in univariate analysis were further analyzed by binary logistic regression,and P < 0.05 was considered statistically significant.A database of subjects was established.IBM SPSS 24.0software was used for descriptive analysis,chi-square test,rank sum test and binary logistic regression analysis.Results(1)307 patients were included in this study,and 81(26.4%)patients had occurred complications during hospitalization,and 196(63.8%)had prolonged hospitalization(≥7 days).(2)Univariate analysis showed that education level,smoking status,history of hypertension,duration of severe pain within 24 hours after admission,duration of mild to moderate pain and duration of severe pain within 24-48 hours after admission,total pain time within 48 hours after admission,and analgesia within 24 hours after admission,analgesia,analgesia frequency,fasting days,GCSI-R score,BISAP score,first defecation time,NLR,Glu,CRP,Ca,BUN,ALB,the anxiety score,the depression score and social support score within 24 to 48 hours after admission in the complication group and the non-complication group were statistically significant(P< 0.05).In the < 7-day hospital stay group and the ≥ 7-day hospital stay group,age,education level,smoking status,recurrence status,and history of hypertension were evaluated,previous history of hyperlipidemia,duration of severe pain within 24 hours of admission,duration of mild to moderate pain within 24-48 hours of admission and duration of severe pain,total duration of pain within 48 hours of admission,analgesia within 24-48 hours of admission,total duration of pain during treatment,number of fasting days,GCSI-R score,BISAP score,time of first defecation,NLR,Glu,CRP,Ca,ALB,TBIL,anxiety score,depression score and social support score,a total of 25 factors had statistical significance(P < 0.05).(3)Binary Logistic regression analysis showed that fasting days(OR=2.675,95%CI: 1.708-4.189),GCSI-R scores(OR=1.221,95%CI: 1.020-1.462),BISAP score(OR=3.005,95%CI:1.081~8.348),first defecation time(OR=0.637,95%CI:0.449~0.905),CRP(OR=1.009,95%CI:1.000~1.019),BUN(OR=1.215,95%CI:1.027~1.438),ALB(OR=0.857,95%CI:0.744~0.987),duration of severe pain within 24 hours after admission(OR=1.390,95%CI: 1.128-1.714)and severe pain duration within 24 to 48 hours after admission(OR=1.613,95%CI: 1.129-2.303)were independent factors for complications in AP patients,and the difference was statistically significant(P < 0.05).The prediction accuracy of the model was 94.8%,and the Hosmer-Lemeshow goodness of fit test model was well fitted(χ2=14.343,P=0.073).The number of fasting days(OR=1.748,95%CI: 1.285-2.380)and the total time of pain during treatment(OR=2.194,95%CI: 1.530-3.148)were independent risk factors for prolonged hospital stay in AP patients.The difference was statistically significant(P < 0.05),the accuracy of the model prediction was 63.8%,and the Hosmer-Lemeshow goodness of fit test was a good fit(χ2=12.164,P=0.144).Conclusion The incidence of pain in early admission of acute pancreatitis patients was high,most of which were severe and lasted for a long time.Attention should be paid to pain problems in patients with AP,especially those who develop severe pain,and timely administration of analgesic treatment can reduce the occurrence of complications and shorten the length of hospitalization;at the same time,attention should be paid to the function of the gastrointestinal tract,the severity of the disease and the related laboratory indicators in patients with AP,so as to take relevant interventions early to improve the prognosis.