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目的:探讨心脏外科手术后患者居家康复期间，疲劳在术后疼痛与重返工作自我效能中的中介效应。方法:采用便利抽样法，选取2023年1—12月在南方医科大学附属广东省人民医院行心脏外科手术出院后3个月以上的200例患者，其中男120例、女80例，年龄（45.23±11.67）岁，疾病类型：心脏瓣膜疾病121例、冠心病11例、感染性心内膜炎58例、其他10例，病程：<1年133例、1～5年33例、>5年34例。以中文版重返工作自我效能量表、疼痛评估量表和多维疲劳量表对患者进行调查。采用 t检验、单因素方差分析、Pearson相关性分析。 结果:重返工作自我效能的影响因素包括家庭经济负担（ t=4.075、 P=0.018）、疲劳程度（ t=12.444、 P<0.001）、是否服用止痛药物（ t=2.215、 P=0.028）以及疼痛分级（ t=20.093、 P<0.001）。心脏外科手术后患者重返工作自我效能与术后疼痛和疲劳呈负相关（ r=-0.450、-0.498，均 P<0.01）；疲劳与疼痛水平呈正相关（ r=0.521， P<0.01）。Bootstrap检验结果显示，疲劳对心脏外科手术后患者重返工作自我效能的负向预测作用显著（ B=-0.021， t=-5.153， P<0.01），该中介效应占总效应的40.91%。 结论:疲劳在术后疼痛和重返工作自我效能中起部分中介作用。医护团队应重视心脏外科手术后尤其是居家康复患者疼痛和疲劳的评估干预工作，制定针对性的干预措施，提高患者重返工作自我效能水平。

Objective:To explore the mediator effect of fatigue between pain and return-to-work self-efficacy (RTW-SE) during home-based rehabilitation in postcardiac surgery patients.Methods:The convenience sampling method was used to select 200 patients who were discharged from Guangdong Provincial People's Hospital, South Medical University for more than 3 months after cardiac surgery from January to December 2023. Among them, there were 120 males and 80 females, aged (45.23±11.67) years, the types of disease included 121 cases of valvular heart disease, 11 cases of coronary heart disease, 58 cases of infective endocarditis, and 10 cases of other diseases, and the duration of disease was <1 year in 133 cases, 1-5 years in 33 cases, and >5 years in 34 cases. The patients were surveyed using the Chinese version of the Return-to-Work Self-Efficacy Questionnaire, Global Pain Scale, and Multidimensional Fatigue Inventory. t test, one-way ANOVA, and Pearson correlation analysis were used. Results:The influencing factors of RTW-SE included economic burden ( t=4.075, P=0.018), fatigue level ( t=12.444, P<0.001), whether to take pain medication ( t=2.215, P=0.028), and pain level ( t=20.093, P<0.001). The RTW-SE of postcardiac surgery patients was negatively correlated with postoperative pain and fatigue ( r=-0.450 and -0.498, both P<0.01), and fatigue was positively correlated with pain level ( r=0.521, P<0.01). The results of Bootstrap test revealed that fatigue had a significant negative predictive effect on RTW-SE in postcardiac surgery patients ( B=-0.021, t=-5.153, P<0.01), and the mediating effect accounted for 40.91% of the total effect. Conclusions:Fatigue partially mediates pain and RTW-SE in postcardiac surgery patients. Healthcare teams should pay attention to the assessment and intervention of pain and fatigue in cardiac surgery patients, especially those undergoing home-based rehabilitation, and develop targeted interventions to improve their RTW-SE level.