【摘要】 目的 探讨胃肠手术患者参与术后疼痛治疗决策的现状及影响因素，为提高胃肠手术患者参与术后疼痛管理决策水平提供参考。方法 采用解释性序列混合研究设计。对107例胃肠手术患者使用一般资料问卷、患者参与治疗决策调查问卷、决策自我效能量表、数字疼痛评估量表进行调查，采用单因素分析、logistic回归分析患者参与术后疼痛治疗决策的影响因素；选取量性研究中11例患者进行半结构化访谈，使用内容分析法进行分析。结果 107例患者中，术后疼痛治疗决策参与态度积极73例(68.22%),态度消极34例(31.78%);实际参与程度积极26例(24.30%),消极81例(75.70%)。logistic回归分析显示，年龄、术后2 d疼痛评分是患者术后疼痛治疗决策参与态度的影响因素；年龄、自我效能是患者术后疼痛治疗决策实际参与程度的影响因素(均P<0.05)。质性研究提炼出5个主题：术后疼痛急性期的身心束缚、术后疼痛“正常化”的认知误解、信息鸿沟与理解障碍、自我效能感的缺失与权力让渡、经济导向的主动决策回避。结论 医护人员应重视患者在术后疼痛管理中的主动参与及偏好，以提升患者术后疼痛管理有效性、促进患者康复及降低疼痛引起的并发症、提升患者满意度。更多还原

【Abstract】 Objective To explore the current status and influencing factors of gastrointestinal surgery patients′ participation in posto-perative pain treatment decision-making, to provide references for improving the level of the participation. Methods A survey was conducted among 107 gastrointestinal surgery patients using a general information questionnaire, the Patient Participation in Treatment Decision-Making Questionnaire, Decision Self-Efficacy Scale, and the Numerical Rating Scale. Univariate analysis and logistic regression analysis were conducted to identify factors influencing patient participation in postoperative pain treatment decision-making. Semi-structured interviews were conducted with 11 patients selected from the quantitative study, and content analysis was used for the analysis. Results Pain treatment decision-making, while 34(31.78%) had a negative attitude. In terms of actual participation, 26 patients(24.30%) were actively involved, whereas 81 patients(75.70%) were not actively involved. Logistic regression analysis revealed that age and pain score on postoperative day 2 were factors influencing patients’ attitudes towards participating in postoperative pain treatment decision-making; age and self-efficacy were factors influencing patients′ actual participation in postoperative pain treatment decision-making(all P<0.05). The qualitative study identified five themes: the physical and mental constraints during the acute phase of postoperative pain, the cognitive misconception of "normalizing" postoperative pain, the information gap and comprehension barriers, the lack of self-efficacy and the relinquishment of power, and the economically driven avoidance of active decision-making. Conclusion Healthcare professionals should emphasize patients′ active participation and prefe-rences in postoperative pain managementin order to enhance the effectiveness of postoperative pain management, promote patient recovery, reduce complications caused by pain, and improve patient satisfaction.更多还原