规范化癌痛护理干预对肿瘤患者癌痛控制及生活质量的影响

目的探讨规范化癌痛护理干预对肿瘤患者癌痛控制及生活质量的影响。方法选取2014年2月至2016年2月间陕西省肿瘤医院收治的80例癌痛患者,采用随机数表法分为观察组与对照组,每组40例。在常规癌痛药物治疗的基础上,观察组患者采用规范化癌痛护理干预,对照组患者采用常规护理干预。3个月后,观察比较两组患者干预前后的癌痛程度和生活质量改善情况。结果两组患者治疗后疼痛数字分级法(NRS)评分均较治疗前下降,且观察组下降幅度显著大于对照组,差异均有统计学意义(均P<0.01)。观察组患者护理干预后,躯体功能、角色功能、情绪功能、认知功能、社会功能、总健康状况和总生活质量均高于对照组患者,差异均有统计学意义(均P<0.05)。观察组患者护理干预后,各症状评分均低于对照组患者,差异均有统计学意义(均P<0.05)。结论规范化癌痛护理干预可有效缓解癌痛患者躯体疼痛,提高患者生活质量,临床应用价值高。     

护理干预对恶性肿瘤患者化疗依从性和生活质量及心理状况的影响

目的探讨护理干预对恶性肿瘤患者化疗依从性、生活质量及心理状况的影响。方法采用抽签法将100例恶性肿瘤化疗患者随机分为治疗组和对照组,每组50例。治疗组患者在肿瘤常规护理的基础上实施护理干预方法(包括入院后全面评估、化疗前心理干预、化疗不良反应护理干预、出院后护理指导),对照组患者仅给予肿瘤常规护理方法。观察护理干预前后两患者对化疗的依从性,并通过问卷调查患者生活质量及心理状况的变化。结果治疗组患者依从率为96.0%,对照组为76.0%,组间差异有统计学意义(P<0.05)。治疗组护理干预后总体生活质量维度和5个功能维度(躯体功能、角色功能、认知功能、情绪功能、社会功能)评分均明显高于护理干预前,差异有统计学意义(P<0.05)。治疗组的护理干预后3个症状维度(恶心、呕吐、疲乏、疼痛)和6个特异性条目(食欲下降、呼吸困难、腹泻、便秘、失眠、经济困难)评分显著低于护理干预前得分,差异有统计学意义(P<0.05)。对照组患者常规护理前后患者生活质量变化差异无统计学意义(P>0.05)。治疗组患者护理干预后的心理状况评分与护理前比较,差异有统计学意义(P<0.05)。对照组患者护理前后差异无统计学意义(P>0.05)。结论有效的护理干预能够提高肿瘤患者化疗依从性,提高患者生活质量,改善患者心理健康状况。     

疼痛管理路径在非小细胞肺癌癌痛患者中的应用

目的探讨疼痛管理路径在非小细胞肺癌癌痛患者中的镇痛效果。方法选取2013年7月至2016年8月间第三军医大学第二附属医院收治的98例非小细胞肺癌患者,采用随机数表法分为观察组与对照组,每组49例。两组患者均给予相同药物镇痛治疗,观察组患者采用疼痛管理路径护理,对照组患者采用常规护理,比较两组患者护理前和护理10天后的疼痛程度、用药依从性、疾病认知率、睡眠质量、总体满意度及生活质量。结果护理后,两组患者疼痛程度评分均降低,且观察组明显低于对照组,差异均有统计学意义(均P<0.05)。护理后,观察组患者用药依从性及对疾病的认知率均高于对照组患者,差异均有统计学意义(均P<0.05)。护理干预后,观察组患者睡眠质量评分为(7.36±3.89)分,低于对照组患者的(9.69±4.09)分,差异有统计学意义(P<0.05)。观察组患者总体满意度评分为(8.56±1.70)分,高于对照组患者的(6.40±1.57)分,观察组患者生活质量评分为(74.58±14.73)分,高于对照组患者的(63.41±15.12)分,差异均有统计学意义(均P<0.05)。结论疼痛管理路径能明显减轻非小细胞肺癌癌痛患者的疼痛程度,提高患者用药依从性、对疾病的认知率、睡眠质量、总体满意度和生存质量。     

全程疼痛护理干预对直肠癌癌痛患者负性情绪和服药依从性及爆发性疼痛的影响

目的探讨全程疼痛护理干预对直肠癌癌痛患者负性情绪、服药依从性及爆发性疼痛的影响。方法选取2015年1月至2016年12月间重庆市北碚区中医院收治的98例直肠癌癌痛患者,按照不同护理方式将患者分为观察组与对照组,每组49例。对照组患者采用常规护理干预及健康指导,观察组患者采用全程疼痛护理干预,比较两组患者的负性情绪、服药依从性及爆发性疼痛情况。结果干预前,两组患者的焦虑和抑郁评分比较,差异无统计学意义(P>0.05);干预后,两组患者的焦虑和抑郁评分均改善,且观察组患者改善程度明显高于对照组,差异均有统计学意义(均P<0.05)。干预前,两组患者服药依从性及爆发性疼痛率比较,差异无统计学意义(P>0.05);干预后,两组患者的服药依从性明显上升,爆发性疼痛率明显下降,且观察组患者服药依从性明显高于对照组(98.0%vs 61.2%),爆发性疼痛明显低于对照组(8.2%vs 51.0%),差异均有统计学意义(均P<0.05)。结论直肠癌癌痛患者采用全程疼痛护理干预,能明显改善患者负性情绪,降低爆发性疼痛发生率,缓解疼痛情况,提高服药依从性与生活质量,值得临床推广。     

针对性护理对肺癌患者围手术期疼痛的影响

目的分析针对性护理对肺癌手术患者围手术期疼痛的影响。方法选取2012年7月至2015年7月间接受肺癌手术治疗的112例患者,依照随机数字表法分成观察组和对照组,每组56例。观察组患者给予针对性护理,对照组患者给予常规围术期护理。比较两组患者护理前后的镇痛知识掌握评分、疼痛评分、疼痛程度和治疗依从情况。结果护理后,两组患者镇痛知识掌握评分均上升,但观察组患者上升幅度高于对照组;两组患者疼痛评分均下降,但观察组患者下降幅度高于对照组,差异均有统计学意义(均P<0.05)。观察组患者的疼痛程度轻于对照组,差异有统计学意义(P<0.05)。观察组患者的治疗依从度好于对照组,差异有统计学意义(P<0.05)。结论针对性护理可有效地控制肺癌手术患者的围术期疼痛情况,增加其治疗依从性,效果较好,值得临床推广。     

系统性护理干预对中重度癌痛患者及家属生活质量的影响

目的探讨系统性护理干预对中重度癌痛患者及家属生活质量的影响。方法选取2013年9月至2015年7月间河北工程大学附属医院收治的94例肺癌晚期伴中重度癌痛患者,采用随机数表法分为观察组与对照组,每组47例。观察组患者给予系统性护理干预,对照组患者给予常规护理,干预一个月后,比较两组患者的癌痛缓解程度、依从性和治疗满意程度,采用焦虑自评量表(SAS)和抑郁自评量表(SDS)对患者焦虑和抑郁程度进行评价,并比较两组患者和家属的生活质量与心理状态。结果经过系统性护理干预后,观察组患者的依从性、癌痛缓解有效率及对治疗的总满意率,均显著高于对照组患者,两组组间比较,差异有统计学意义(P<0.05);两组患者疼痛视觉模拟评分表(VAS)、SAS和SDS评分均明显下降,且观察组各指标下降更明显,组间比较,差异有统计学意义(P<0.05);组内治疗前后比较,两组患者的食欲、睡眠、精神状态、日常活动、抑郁、焦虑、恐惧、消极和自信程度均有显著改善,差异有统计学意义(P<0.05);组间治疗后比较,除食欲外的上述指标均表现为观察组好于对照组,组间比较,差异有统计学意义(P<0.05);家属生活质量与心理状态治疗后比较,全部指标均表现为观察组好于对照组,差异有统计学意义(P<0.05)。结论系统性护理干预能改善中重度癌痛患者的依从性,缓解癌痛,提高患者的治疗满意度,并提高患者和家属的生活质量。     

心理支持护理对老年恶性肿瘤患者负性情绪和生活质量的影响

目的探讨心理支持护理对老年恶性肿瘤患者负性情绪和生活质量的影响。方法选取2015年1月至2016年1月间成都市第七人民医院收治的70例老年恶性肿瘤患者,采用随机数表法将分为观察组和对照组,每组35例。观察组患者在常规护理基础上给予心理支持护理,对照组常规护理给予常规护理,共进行6周。对两组患者生活质量、负性情绪以及治疗依从性进行分析比较。结果护理后,观察组患者生存质量的情绪功能、躯体功能、认知功能、角色功能、社会功能及总体生活质量各项评分均比对照组患者高,差异均有统计学意义(均P<0.05)。护理后,观察组患者各项负性情绪评分均较对照组患者低,观察组患者依从性更好,差异均有统计学意义(均P<0.05)。结论心理支持护理能够缓解患者抑郁和焦虑情绪,减轻患者心理压力,提高治疗依从性,改善患者生活质量。     

基于微信平台提供的延续性护理对癌痛患者疼痛及生活质量的影响

目的:探讨延续性护理对于癌痛患者NRS评分、服药依从性、QOL及SAS评分的影响。方法:选取84例入院时均需服用阿片类药物治疗的重度癌痛患者,随机分为对照组和观察组,每组各42例,对照组实施常规护理及出院指导,观察组在此基础上同时进行院外延续性护理,比较两组患者出院4周后服药依从性及疼痛控制程度以及QOL评分的差异。结果:观察组患者服药完全依从率明显高于对照组完全依从率;部分依从及不依从率,均明显低于对照组的部分依从及不依从率;观察组疼痛完全缓解率、部分缓解率高于对照组的完全缓解率及部分缓解率,而观察组的疼痛无效率低于对照组;观察组患者的QOL评分改善大于对照组;治疗后观察组的SAS评分低于对照组。结论:院外延续性护理可提高癌痛患者的服药依从性;缓解患者疼痛症状;提高患者生活质量,减轻患者抑郁状态。     

规范化癌痛护理在晚期癌痛患者中的临床体会

目的:采用规范化癌痛护理晚期癌痛患者可提高并改善患者生活质量及延长生存期。方法:选取2015年3月至2017年3月收治的240例晚期癌痛患者,随机数字表法分成观察组和对照组,各组120例,对照组以常规止痛护理,观察组以规范化癌痛护理。比较两种不同护理方式对患者生活质量及疼痛评分的影响。结果:观察组患者SDS、SAS、疼痛评分、患者社会/家庭状况、生理状况、功能状况、情感状况评分均明显优于对照组(P<0.01)。结论:规范化癌痛护理有利于改善并提高晚期癌痛患者生活质量,同时可延长生存时间。     

自我效能感干预对恶性肿瘤患者癌痛和化疗效果的影响

目的探讨自我效能感干预在恶性肿瘤化疗患者中的应用效果。方法将80例恶性肿瘤化疗患者随机分为观察组和对照组,每组40例。对照组采用常规护理,观察组在对照组的基础上进行自我效能感干预,比较两组患者在癌痛、化疗效果和生活质量上的差异。结果两组患者的化疗效果比较,差异无统计学意义(P>0.05),但观察组患者护理后的癌痛发生情况低于对照组,差异有统计学意义(P<0.05)。观察组患者在活动、日常生活、健康等生活质量方面的评分均显著高于对照组,差异有统计学意义(P<0.05)。结论自我效能感干预能够增强恶性肿瘤患者的治疗信心,减少癌痛的发生,提高生活质量。     

Difficult pain syndromes: bone pain, visceral pain, and neuropathic pain

Cancer pain is prevalent in approximately two thirds of all cancer patients and can undermine the quality of life in this patient population. Uncontrolled pain can cause physical as well as psychological distress in cancer patients. As the disease progresses in cancer, pain and suffering increase. Knowledge about pain management is paramount in the comprehensive treatment of cancer patients. Difficult cancer pain syndromes may arise from interruption of bone, viscera, and neural structures by malignant spread of the disease. Familiarity with opioids, adjuvants, and procedures that can abate pain in cancer patients is discussed in a practical manner for clinical application in this text.     

Post-tonsillectomy pain: Different modes of pain relief

Sixty patients aged 15 to 40 years of either sex, American Society of Anaesthesiologists (ASA) grade I and II, undergoing tonsillectomy, were randomly allocated to receive either preroperative intramuscular diclofenac sodium(group A) or pre- incisional bilateral infiltration of bupivacaine in the peritonsillar fossa (group B) or post operative Trunscutaneous Electric Nerve Stimulation - TENS (group C) at fixed time intervals. Pain scores (Visual analogue scale VAS, 0- 100 mm) were assessed at rest and on deglutition at 1,3,6,9,12 and 24 hours after surgery. Pentazocine 1actale 15 mg IV was given as rescue analgesic whenever VAS estimation was more than 30 mm at rest (not deglutition). Constant incisional pain was significantly less ( p < 0.01 ANOVA) in group C after 3 hours of surgery as compared to group A and B. Similarly pain on deglutition was significantly less (p <0.01, ANOVA) in group C during the entire study period as compared to Group A and B. There was significant reduction of VAS (p< 0.01) immediately after TENS therapy at 0, 4 and 8 hours. Rescue analgesic consumption was significantly lower in TENS group. Thus, TENS seems to be an effective therapeutic modality for post tonsillectomy pain relief as compared to the other two methods.     

Challenges in cancer pain management--bone pain

Whilst not strictly a neuropathic injury, cancer-induced bone pain (CIBP) is a unique state with features of neuropathy and inflammation. Recent work has demonstrated that osteoclasts damage peripheral nerves (peptidergic C fibres and SNS) within trabeculated bone leading to deafferentation. In addition, glia cell activation and neuronal hyperexcitability within the dorsal horn, are all similar to a neuropathy. Gabapentin and carbamazepine (both anti-convulsants that modulate neuropathy) are effective at attenuating dorsal horn neuronal excitability and normalizing pain-like behaviours in a rat model of CIBP. However alterations in neuroreceptors in the dorsal horn do not mimic neuropathy, rather only dynorphin is upregulated, glia cells are active and hypertrophic and c-fos expression is increased post-noxious behavioural stimulus. CIBP perhaps illustrates best the complexity of cancer pains. Rarely are they purely neuropathic, inflammatory, ischaemic or visceral but rather a combination. Management is multimodal with radiotherapy, analgesics (opioids, NSAIDs), bisphosphonates, radioisotopes and tumouricidal therapies. The difficulty with opioids relates to efficacy on spontaneous pain at rest and movement-related pain. Potential adjuvants to standard analgesic therapies for CIBP are being explored in clinical trials and include inhibitors of glutamate release.     

癌症患者疼痛量表的应用

癌痛本质上是患者的主观感受,因此患者的疼痛表述是评估的依据,患者自评量表也由此在临床实践和研究中被广泛采用。一维量表常用于评估癌痛的强度,其中的数字评估量表（Numerical Rating Scale,NRS）被欧洲姑息治疗研究协作组所推荐;多维量表,如简式疼痛问卷（Brief Pain Inventory,BPI）或修订后的简式麦吉尔疼痛问卷（Short-Form McGill Pain Questionnaire,SF-MPQ-2）可更全面的评估癌痛;评估肿瘤患者的爆发痛、神经病理性疼痛时可选择有针对性的量表;对认知功能受损的患者,脸谱法评估有助于癌痛筛查,要评估癌痛还需采用多维量表。无论选择何种评估工具,均强调对癌痛进行动态评估。简便易行的电子评估量表是目前癌痛新量表研制的趋势。      

Nurses' perceptions of their pain assessment skills, pain management practices, and attitudes toward pain

Nursing pain assessments are influenced by the length of available tools, patient characteristics, patient pathology, concern about addictive behavior, and characteristics of the nurse. The relationship among these variables was explored in a sample of community hospital nurses (N = 59) and ONS members (N = 19). Although a number of interesting similarities were found in the two groups, age, professional and continuing education, and care setting appear to be related to differences in pain assessment practices. Implications for practice, research, and education include teaching nurses to: assess factors related to quality of life in the pain experience, assess and validate data from families, assess coping skills, and teach patients to use behavioral pain management strategies. The findings also suggest that further study is needed concerning the relationship between personal beliefs and experiences and the assessment and management of pain. Membership in professional organizations appears to be associated with comprehensive approaches to the assessment and management of cancer pain and should be addressed in further research.     

Transformation of acute cancer pain to chronic cancer pain syndromes

For many cancer survivors, disease-related long-term morbidities and the application of advanced cancer treatments have resulted in the development of a chronic pain state. This brief review explores the relationship between what is known about the treatment of active cancer pain syndromes-both continuous pain and breakthrough pain-and persisting pain syndromes in cancer survivors. We also posit that because there is evidence to suggest that poorly treated acute pain can lead to protracted pain conditions, acute pain should be recognized and treated promptly, both for short- and long-term gain. In the short term, better acute pain treatment can improve functionality and psychological well-being, whereas in the long term, mounting evidence suggests that it could prevent of future chronic pain.     

Cancer-related pain

Cancer-related pain affects approximately 90% of those in all stages of the disease. Pain is both a sensation and an emotional experience, and thus it has been defined as total pain. The type of cancer pain management decided upon depends on the underlying pathophysiological mechanisms, which are classified as nociceptive(somatic and visceral), neuropathic, and idiopathic. Pain management as part of routine cancer care has been forcefully advanced by the World Health Organization( WHO)-analgesic ladder. The clinical application of pain management should be employed only after a complete and comprehensive assessment and evaluation. The present overview article focuses on nonsteroidal anti-inflammatory drugs (NSAIDs), opioids and adjuvant analgesia.     

Management of cancer pain: basic principles and neuropathic cancer pain

Pain is one of the commonest symptoms in patients with cancer occurring in as many as 90% of patients during their illness. Pain is a complex phenomenon, which can be exacerbated by numerous other factors. This paper discusses the common strategies for the management of cancer pain in general and also neuropathic cancer pain. Using the World Health Organisation (WHO) analgesic ladder for cancer pain relief, 80% of cancer pain can usually be controlled. It follows therefore that 20% of cancer pain can be difficult to control. Neuropathic cancer pain is often in this category and the use of adjuvant analgesics such as amitriptyline and gabapentin is important. Optimum cancer pain control is achieved by integrating standard analgesic approaches during tumouricidal therapy or any other active cancer treatment.