癌痛规范化治疗的护理进展

癌症严重威胁人类的健康,而癌症疼痛严重影响癌症患者的生活质量。癌症疼痛系指肿瘤侵犯、压迫有关组织神经所导致的疼痛,是癌症临床常见症状之一。据统计,70%左右的晚期癌症病人伴有癌痛。2002年第十届国际疼痛大会把癌痛列入继呼吸、血压、脉搏、体温之后的第五大生命指征[1]。国内最近统计资料显示:中国癌痛的病人中仅有41%得到有效缓解,而晚期癌痛仅有     

盐酸曲马多缓释片对治疗癌痛效果的临床观察

癌痛是癌症患者的常见症状，晚期癌症患者的疼痛发生率约60％～80％，癌症疼痛患者可能生存数月或数年，如果得不到恰当的止痛治疗，他们将长期忍受癌痛的折磨。所以有效的消除癌痛，对患者来说非常重要。[第一段]     

患者相关癌痛控制障碍及影响因素的研究进展

癌痛是癌症患者普遍存在并急需解决的突出问题,30%～45%的患者在癌症的早期阶段便经历疼痛,而晚期阶段则有70%的患者饱受疼痛折磨[1]。虽然恰当应用现有的药物和非药物疗法可以使90%～95%的癌症疼痛得到有效缓解[2],但国内外调查显示,治疗是一个普遍现象，有研究显示约30％癌症患者的疼痛从未得到消除。癌痛使患者身心遭受痛苦，严重影响患者的生活质量。     

癌痛患者阿片类药源性便秘护理干预进展

<正>癌痛是恶性肿瘤本身或与肿瘤治疗有关的精神、心理和社会等原因所致的疼痛,是恶性肿瘤患者最常见和最难忍受的症状之一,严重影响了患者的生活质量,在癌瘤发展过程中,约有70%~87%的患者有不同程度的疼痛[1]。据统计,我国每天大约有100万癌症患者忍受着癌痛煎熬[2]。药物治疗是目前控制癌痛的主要方法。由于癌痛对中重度癌痛患者的生活质量影响最大,根据WHO提出的三阶梯治疗原则,临床上常首选阿片类     

发挥护士专业作用 促进癌痛规范化管理——访中国科学院大学附属肿瘤医院/浙江省肿瘤医院护理部主任吴婉英

正在晚期癌症患者中,疼痛是最常见的症状之一,发生率约60%～80%,其中1/3为重度疼痛,严重影响患者的生活质量。随着经济社会的发展和医学技术的进步,疼痛越来越受到医学界的广泛重视。1995年,美国疼痛学会把疼痛列为第五生命体征;2001年,亚太地区疼痛论坛提出"无痛是患者的一项基本人权"。规范的个体化治疗可以使90%以上癌痛患者的疼痛得到有效缓解,因此,为进一步提高癌痛规范化治疗水平,完善重大疾病规范化诊疗体系,2011年,卫生部启动"癌痛规范化治疗示范病房"创建活动;2015年,浙江省开展"癌痛规范化治疗示范医院"创建工作。     

艺术疗法在癌痛管理中的研究进展

正癌症全球发病率和死亡率逐年升高,2018年全球新增肿瘤1810万例,死亡960万例[1]。癌痛是恶性肿瘤患者最常见、最恐惧的症状之一,给患者的身心带来巨大痛苦,严重影响患者的生活质量及治疗依从性。研究显示[2],癌症患者抗肿瘤治疗期间疼痛发生率为55.0%,抗肿瘤治疗后疼痛发生率为39.3%,癌症晚期疼痛发生率为66.4%,     

癌性疼痛中医药外治法研究概况

正疼痛是指实际的或潜在的组织损伤所引起的不愉快的感觉和情感经历,或与这些损伤相关的描述[1]。癌症疼痛(简称癌痛)是指由癌症、癌症相关性病变、癌症治疗和伴随疾病等引起的疼痛。癌痛是晚期肿瘤患者最为常见的症状之一,约1/4新诊断的恶性肿瘤患者、1/3正在治疗的肿瘤患者和3/4的晚期肿瘤患者都合并有疼痛[2]。癌痛严重影响生活质量,而现代医学三阶梯治疗方案有一定的局限性,且副作用     

补充和替代医学干预癌性疼痛的研究现状

<正>癌性疼痛是由癌症本身以及癌症诊疗导致的疼痛[1]。癌性疼痛给患者的身心造成严重的不良影响,同时也危害着他们的家庭、社会功能和生活质量[2]。目前,癌性疼痛已受到临床工作者的普遍关注,但由于患者病情、经济状况、认知水平及医疗条件等因素的影响,许多患者的癌性疼痛并未得到有效的控制。全球每年约有1000万新发肿瘤患者,其中50%的患者存在癌痛症状,70%的癌症晚期患者     

针灸治疗癌痛研究简况

正疼痛是癌症患者最常见、最痛苦的症状之一,常比癌症引起的死亡更让人恐惧。目前,西医临床治疗癌痛的方法多种多样,大致有放化疗、激素疗法、核医学治疗、三阶梯止痛药物、神经阻滞与毁损术、神经外科治疗、物理治疗、心理治疗等。但目前仍有70%癌痛患者得不到满意的镇痛治疗[1]。且现今医学界关注的已不仅是癌症本身,对如何解除癌痛、改善患者心理状态、提高生存质量等同样注重[2]。针灸疗法以其安全     

家庭照顾者参与癌症患者疼痛管理的作用及障碍因素的综述

癌性疼痛.简称癌痛,主要由癌症、癌症相关性病变及抗癌治疗所引起,是癌症患者最常见且最具挑战性的症状之一。报告[1-2]显示,约有33%?64%的患者会出现癌性疼痛,其中31%?45%患者报告的疼痛为中重度,严重影响患者生活质量,并给社会带来巨大经济负担。与癌症相关的疼痛通常难以控制,但癌症疼痛管理不足也是一个不争的事实,癌症护理正在经历从医院到家庭的转变[3-4].家庭照顾者作为患者日常护理的一个重要角色,在患者护理的诸多挑战中,疼痛管理是家庭照顾者面临的最确定的负担之一[5]。     

Usefulness of the evidence-based medicine-supported cancer pain management guideline

The Japanese guidelines for the clinical practice of cancer pain management supported by evidence-based medicine were established by the Japanese Society for Palliative Medicine in 1999 [as their Evidence-based Medicine-supported Cancer Pain Management Guideline ]. To evaluate usefulness of the Guideline for the management of cancer pain, the same questionnaires were addressed to nurses and physicians of enrolled institutions twice. The first survey was conducted before the distribution of the Guideline in July, 1999 and the second was done after the distribution in January, 2000. Usefulness of the Guideline was examined by comparing the results of two surveys. Cancer patients were divided into two groups depending on their stages (conservative or terminal).(1) Morbidity of pain in cancer patients at each stage having some analgesics did not change at each survey period. (2) At the first survey the rate of pain relief in each stage of cancer patients was essentially unchanged from a previous result obtained in 1998. (3) The rate of pain relief shown in the second survey tended to be higher than that shown in the first in both groups of patients. (4) The rate of pain relief with per os morphine was shown to be significantly higher in the second survey than in the first for each group of patients at conservative or terminal stage. (5) The rate of pain relief of patients staying in the ward where the guidance for dosing of morphine had been carried out was 37.5% at the first survey versus 47.9% at the second. (6) The answers from physicians to questions about treatment of cancer pain remained unchanged between the first and the second survey.The usefulness of the Guideline for cancer pain management is partly confirmed by these results. The significance of the Guideline will be totally discussed by comparing its effects on nurses, pharmacists and physicians.     

Patient optimism and mastery-do they play a role in cancer patients' management of pain and fatigue?

In the present study, we investigated longitudinally (baseline, 10 weeks, 16 weeks) whether patient personality traits, such as dispositional optimism and mastery, play a role in patients' ability to effectively control the severity of their pain and fatigue in the context of a symptom control intervention among patients with cancer. Two hundred fourteen patients currently undergoing chemotherapy received a baseline interview followed by a 10-week, nurse-assisted symptom control intervention. At 10 weeks, patients received a second interview to assess the effectiveness of the intervention, with a final follow-up interview at 16 weeks. Random effects regression models were used to investigate the effects of mastery and optimism on the severity of pain and fatigue, adjusting for the effects of other important covariates, such as age, gender, cancer site, stage of disease, and comorbidity. Patients who were older, more optimistic, suffered from fewer comorbid conditions, or reported higher levels of mastery tended to report less severe pain, whereas higher levels of mastery and fewer comorbid conditions predicted lower fatigue severity scores. These findings underscore the need for physicians and nurses involved in the care of cancer patients to recognize, encourage, promote, and take advantage of these traits in their patients to help them more effectively manage their cancer care, so that they ultimately can achieve a better quality of life during the sequelae of the cancer experience.     

经微量泵持续低剂量输注5-Fu治疗晚期肿瘤的疗效观察

目的:探讨经微量泵持续低剂量输注及经静脉滴注5-Fu治疗晚期肿瘤的临床疗效。方法:将120例晚期胃癌、大肠癌及乳腺癌患者随机分成两组,观察组21例,对照组19例。两组患者按肿瘤的原发部位分别选用同类化疗方案,观察组从静脉置管处使用微量泵持续24 h输注5-Fu,连用4~24周。对照组静脉滴注5-Fu;每3周为1个周期,两组患者均在2个化疗周期以上。结果:观察组:胃癌CR PR 6例,有效率28.6%;大肠癌CR PR12例,有效率57.1%;乳腺癌CR PR 9例,有效率42.8%。对照组:胃癌CR PR 4例,有效率21%;大肠癌CR PR7例,有效率37%;乳腺癌CR PR 2例,有效率10.5%。两组有效率比较差异有统计学意义(P<0.05)。5-Fu不良反应:观察组:口腔溃疡5例(7.93%);腹痛、腹泻6例(9.52%);静脉炎7例(11.11%);白细胞下降9例(14.28%)。对照组:口腔溃疡18例(31.57%);腹痛、腹泻19例(33.33%);静脉炎9例(15.78%);白细胞下降13例(22.80%)。两组不良反应比较差异有统计学意义(P<0.05)。结论:经微量泵持续低剂量输注5-Fu治疗晚期肿瘤疗效肯定,不良反应轻,是化疗耐药的难治性晚期肿瘤患者和经济困难、不能应用昂贵新药方案化疗的晚期肿瘤患者的最佳选择。     

Developments in the treatment of cancer pain in Finland: the third nation-wide survey

This survey was designed to investigate the current status of the management of cancer pain in Finland. In 1995 a questionnaire was randomly sent to 5% (n=546) of Finnish physicians, excluding specialists not expected to treat cancer patients. Two previous surveys, using the same questionnaire, were conducted in 1985 and 1990 by Vainio. The response rate was 53%. Seventy-nine percent of the respondents treated one or less than one cancer patient a week. Sixty-seven percent of them assessed the severity of cancer pain in their patients as being at least moderate. In 10 years, the proportion of physicians suggesting the WHO analgesic ladder principle to their ‘typical cancer patient' had increased from 12% to 28%. At the same time, the suggestions of ‘analgesic' without definition had decreased from 48% to 6%. Three simulated patient cases were presented. The mean daily dose of opioids suggested for severe terminal cancer pain corresponded to 72 (18–300) mg of intramuscular morphine in 1995, being only 39 (1–77) mg in 1985 for the same simulated patient case. Continuous infusion of opioid was recommended by 59% of the respondents. Non-steroidal anti-inflammatory drugs as the treatment of choice for bone metastases pain in a patient with breast cancer, was recommended by 68% of the respondents. In the case of local severe pain due to recurrent rectal cancer, 63% of the physicians suggested anaesthetic intervention. Insufficient pain relief and lack of experience were the most common difficulties in pain management. Only one-third of the physicians thought that they had enough time and ability to give sufficient psychological support to their patients.     

A Pain Monitoring Program for nurses: effect on the administration of analgesics

Both physicians and nurses are responsible for adequate pain management. The aim of this study was to assess pain management behavior of physicians and nurses, and to evaluate the effects of a Pain Monitoring Program for nurses on the extent to which nurses administer analgesics. The Pain Monitoring Program consisted of two components: educating nurses about pain, pain assessment and pain management; and implementing daily pain assessment by means of a numeric rating scale. Several outcomes were distinguished to evaluate the administration of analgesics by nurses: the prescribed analgesics by physicians, the administered analgesics by nurses, and the discrepancy between the ordered and the administered analgesics. The effects of the Pain Monitoring Program on these outcomes were measured in a quasi-experimental design with a non-equivalent control group. In total, 703 patients participated: 358 patients in the control group and 345 in the intervention group. Patients were interviewed twice, i.e. at the beginning and at the end of hospitalization. Results of the control group showed that at the first interview 70% of the patients were prescribed analgesics by physicians and only 74% of those patients were actually administered analgesics by nurses. Consequently, 50% of the patients in pain received analgesics. The administered analgesics was in absolute agreement with the prescribed analgesics in 60% of the patients with routine analgesics and in 85% of the patients with PRN analgesics. The relative difference between ordered and administered routine analgesics was small, namely 15% for opioids and 20% for non-opioids. Similar results of the control group were found for the second interview. In addition, the results showed that the Pain Monitoring Program was effective in improving nurses' administration of analgesics. At the first interview more patients received analgesics that were prescribed on a PRN basis and the doses of administered routine non-opioids including PRN increased. At the time of the second interview, more patients received weak opioids. The Pain Monitoring Program was especially effective in patients with moderate to severe pain. However, the discrepancy between the analgesics ordered by physicians and actually administered by nurses did not change as a result of the Pain Monitoring Program. Based on this study it can be concluded that the use of a simple method such as a numeric rating scale together with pain education for nurses is effective in improving the administration of analgesics by nurses. These are important results because nurses play an essential role in helping patients to cope with their pain. Because the Pain Monitoring Program (PMP) was effective in a heterogeneous population in multiple care settings, the possibility of implementing the PMP in routine nursing practice should be considered.     

Attitudes, beliefs and self-reported competence about postoperative pain among physicians and nurses working on surgical wards

Scand J Caring Sci; 2012; 26; 545–552 Attitudes, beliefs and self‐reported competence about postoperative pain among physicians and nurses working on surgical wards Aims: To investigate attitudes, beliefs and self‐reported competence with regard to pain management in nurses and physicians on surgical wards. Interprofessional differences between physicians and nurses were also examined. Methods: A total of 795 physicians and nurses from different surgical departments in Norway were invited to complete a questionnaire measuring attitudes, beliefs and self‐reported competence about postoperative pain. Findings: In total, 128 physicians and 407 nurses completed the questionnaire (response rate 68%). Of these, 77% of physicians and 57% of nurses reported more than 4 years’ work experience with postoperative pain. Most of the physicians (95%) and nurses (86%) reported that patients ‘often’ or ‘very often’ achieved satisfactory pain relief. Overall, 69% of the sample evaluated themselves as being highly competent or competent in treating nociceptive pain, while only 16% reported they were highly competent or competent in treating neuropathic pain. There were no statistically significant differences between the professions regarding their self‐reported competence in pain management, and nurses and physicians only differed on three out of 18 conditions regarding their appraisal of conditions related to postoperative pain management after controlling for years of experience. Only 20% of respondents were satisfied with the annual updates for staff about pain relief for patients with postoperative pain. Conclusions:  Even though the majority of physicians and nurses described themselves as competent in management of nociceptive pain, and thought that patients often or very often achieved satisfactory pain relief, the respondents reported dissatisfaction with the annual updates in pain management and poor competence in treatment of neuropathic pain.     

Influence of clinicians' values and perceptions on use of clinical practice guidelines for sedation and neuromuscular blockade in patients receiving mechanical ventilation.

BACKGROUND: Although popular, clinical practice guidelines are not universally accepted by healthcare professionals. OBJECTIVES: To compare nurses' and physicians' actual and perceived rates of adherence to practice guidelines used in sedation of patients receiving mechanical ventilation and to describe nurses' and physicians' perceptions of guideline use. METHODS: Pairs of fellows and nurses caring for 60 eligible patients were asked separately about their rationale for medicating patients, effectiveness of medication, and their perceived adherence to the guidelines. Actual adherence was determined independently by review of medical records. An additional 18 nurses and 11 physicians were interviewed about perceptions of guideline use. RESULTS: Use of mechanical ventilation was the most common reason given by physicians (53%) and nurses (48%) for medicating patients, although reasons for administering medication to a given patient differed in up to 30% of cases. Physicians and nurses disagreed on the effectiveness of medication in 42% (P = .01) of cases. Physicians reported following guidelines in 69% of cases, but their actual adherence rate was only 20%. Clinicians sometimes had difficulty distinguishing among anxiety, pain, and delirium. Clinicians justified variations from guidelines by citing the value of individualized patient care. Nurses and physicians sometimes had different goals in the use of sedation. CONCLUSIONS: Physicians may think they are following sedation guidelines when they are not, and they may prescribe incorrect medications if the cause of agitation is misdiagnosed. Differences between physicians and nurses in values and perceptions may hamper implementation of clinical practice guidelines.     

无痛病房规范化管理对控制晚期癌症患者疼痛的影响

目的:探讨无痛病房规范化护理对控制晚期癌症患者疼痛的影响。方法:将我院肿瘤科2012年2月~2013年9月收治的中重度癌痛患者152例作为研究对象,按照无痛病房管理的实施时间分为对照组和观察组,均采用三阶梯镇痛治疗,对照组62例给予常规疼痛管理;观察组90例给予无痛病房规范化管理,2周后比较两组患者癌痛缓解率和满意度。结果:观察组患者癌痛缓解率及护理服务满意度明显高于对照组,差异有统计学意义(P0.05)。结论:无痛病房规范化管理提高了癌痛患者治疗依从性,有效控制了癌痛,对实现癌痛患者的无痛化管理目标起到了积极的促进作用,并提高了患者满意度。     

Quality control programme for acute pain management in emergency medicine: a national survey.

OBJECTIVE: This national survey was carried out to evaluate the quality programme for acute pain management in the emergency department (ED) and in pre-hospital emergency medical services (EMS). METHODS: Two types of questionnaires were sent to the chief consultant and the chief nurse of all ED and EMS. Data collected were: the type of structure, quality programme organization, acute pain management, and the training needs to initiate a pain quality programme. RESULTS: A total of 363 questionnaires were recorded (198 from chief consultants) with 98% of questionnaires being usable. A pain management committee existed in 71% of cases, a quality committee in 83%. A complete quality control procedure existed in 53% of units. An audit on pain management was carried out in only 23% of cases. Training in quality was performed for 64% of physicians and 68% of nurses. Training specifically for pain management was carried out for physicians in 56% of cases and for nurses in 68% of cases. Pain therapeutics protocols existed in 69% of cases. Pain intensity was evaluated 'systematically or often' in 64% at the beginning of patient management, and in 56% at the end of patient management. The staff was 'not very motivated' for a pain management quality programme in less than 3% of responses. A total of 61% of chief consultants and 58% of chief nurses requested advice. CONCLUSION: Most ED and EMS units seem to master the quality control programme methodology. Units are highly motivated to initiate a quality control programme on pain. Nevertheless, its implementation could benefit from some external support.     

Community Hospital Physician and Nurse Attitudes About Pain Management

An interdisciplinary committee was established and charged with examining pain management and developing interventions at a 148 bed community hospital. To examine strategies on managing pain from both healthcare provider and patient perspectives, the committee surveyed the attitudes of physicians and nurses toward pain management and patients' opinions about the pain management they received in the hospital. A separate survey instrument was developed for physicians, nursing staff and patients. Physicians and nursing staff from all departments were asked to complete the survey during departmental meetings in Autumn 2000, and all patients for whom pain medication were ordered during the month of May 2000 were asked to participate. A total of 45 physicians, 142 nurses and 169 patients responded. Results showed that the majority of physicians (88.9%, n = 40) and nurses (83.0%, n = 118) were satisfied with the pain management outcomes in their patients, andthat91.1% of physicians and 90.2% of nurses included their patients in the pain management decision-making process. Nearly all patients believed their pain was adequately managed, but the results indicated a need to improve the use of pain assessment scales by the hospital staff and a need to educate and involve all patients in their pain management options. Survey data also showed a desire for staff education on pain management.