A qualitative study on the experience of patients undergoing lung cancer surgery using self-controlled analgesia pumps under rapid recovery mode
快速康复模式下肺癌手术患者自控镇痛泵使用体验的质性研究

摘要

目的 在增强恢复外科（ERAS）模式背景下，探讨肺癌术后患者使用患者自控镇痛（PCA）泵的真实体验与需求，以期为术后镇痛管理提供循证参考。方法 采用目的抽样法于2023年5—7月对我院行肺癌手术并符合纳入标准的8例患者及1名胸外科医生、1名麻醉师、1名胸外科护士开展半结构式访谈，访谈经录音转录并采用Colaizzi七步法进行主题归纳与分析。结果 归纳出患者对PCA的（1）疼痛恐惧与镇痛需求、（2）对PCA工作原理与不良反应的认知不足、（3）对镇痛信息与宣教的高需求；医护方面存在对PCA不良反应判别与动态监测体系不健全的问题。结论 建议在ERAS路径中强化术前PCA宣教、建立麻醉—外科—护理三方协作的PCA管理流程与不良反应处置规范，并开展针对病区医护的镇痛培训，以提升患者满意度并促进术后康复。

Abstract

Objective To explore the real experiences and needs of postoperative lung cancer patients using Patient-Controlled Analgesia (PCA) pumps within the Enhanced Recovery After Surgery (ERAS) framework, and to provide an evidence-based reference for postoperative analgesia management.
Methods Using purposive sampling, semi-structured interviews were conducted from May to July 2023 with 8 patients who underwent lung cancer surgery and met the inclusion criteria, as well as 1 thoracic surgeon, 1 anesthesiologist, and 1 thoracic nurse in our hospital. The interviews were audio-recorded and transcribed verbatim, and Colaizzi's seven-step method was used for thematic analysis.
Results Three themes were identified regarding patients' experiences with PCA: (1) fear of pain and demand for analgesia; (2) insufficient understanding of PCA's working principle and adverse reactions; (3) high demand for analgesia-related information and education. On the healthcare provider side, issues were identified including an inadequate system for the identification and dynamic monitoring of PCA adverse reactions.
Conclusion   It is recommended to strengthen preoperative PCA education in the ERAS pathway, establish a standardized PCA management process and adverse reaction handling protocol through anesthesia-surgery-nursing tripartite collaboration, and conduct analgesia training for ward medical staff, so as to improve patient satisfaction and promote postoperative recovery.