癌性疼痛护理的现状及进展

癌症病死率很高 ,而癌性疼痛使癌症患者饱受折磨。据报道每天有 35 0万以上的癌症患者有疼痛症状 ,晚期癌症患者70 %左右以疼痛为主诉 ,其中 5 0 %属于剧烈疼痛。近年来 ,国内外控制疼痛的方法不断发展及完善 ,本文对癌性疼痛护理的研究现状及进展作一综述。1　疼痛产生的机理疼痛是一种复杂的生理心理活动 ,它包括两个成分 :一是伤害刺激机体所引起的痛感觉 ;二是个体对伤害性刺激的痛反应 ,并伴有较强烈的情绪色彩 ,疼痛的病理基础至今未完全搞清 ,学者认为 [4] ,由于伤害性刺激作用于伤害性感受器 ,变成电信号 ,通过未梢神经纤纤维传至脊…     

癌性疼痛的护理进展

解除癌症病人的疼痛是一个重要而经常被忽视的医疗问题，据wTO的估计，全世界每天有300～350万人遭受着癌痛的折磨，得不到及时处理，晚期病人50％～70％以疼痛为主诉，其中50％属于剧烈疼痛，严重影响病人的生活质量。疼痛不仅给病人躯体带来不适，而且对精神、心理、体质等方面也会产生不同程度的影响，有人说：“疾病可以伤害肉体，而疼痛可以摧毁灵魂”，对癌症患者的护理可以说就是对疼痛的护理。现将近几年癌性疼痛的护理状况综述如下。     

癌性疼痛病人的心理护理

疼痛是癌症常见的伴随症状，也是癌症病人痛苦的主要原因之一、由于疼痛感觉是主观性的，在很大程度上依赖并取决于病人的个体耐受性差异，因此，控制疼痛的对策也不能太单调，在药物控制的同时还需结合适当的心理护理，这样才有助于使病人保持良好的心境来减轻疼痛，接受治疗，提高和巩固疗效。才能有助于消除负性情绪，减少痛苦，也才可能避免生理上的疼痛反馈影响情绪，而造成心理痛苦而使病情恶化。做好癌性疼痛病人的心理护理。有以下几个方面。     

老年冠心病患者的个性化护理

目的探讨个性化护理对老年冠心病患者的护理效果。方法对我院2010年4月~2013年4月收治的50例老年冠心病患者采用个性化护理。结果 49例患者病情好转出院,无护理并发症发生。结论个性化护理提高了老年冠心病患者的治疗有效性和安全性。     

个性化护理联合心理干预应用于老年高血压患者的临床效果

目的:研究对老年高血压患者给予个性化护理和心理干预的效果.方法:于我院高血压老年患者中随机抽取80例,分为2组,对照组给予常规护理,观察组应用个性化护理联合心理干预,对比两组患者护理效果.结果:经本文研究,2组护理后血压水平、情绪评分、并发症对比,差异显著(P<0.05).结论:对高血压老年患者给予个性化护理以及心理护...     

毫米波治疗晚期肺癌癌性疼痛的临床疗效

目的　观察毫米波治疗仪对晚期肺癌癌性疼痛的止痛疗效。方法　对 34例晚期肺癌合并肿瘤所致疼痛患者 ,其中轻度疼痛 2 2例 ,中度 11例 ,重度 1例。采用毫米波治疗仪治疗 (毫米波频率 36 GHz,波长 8.3mm) ,主辐射器照射主穴 ,副辐射器照射副穴 ,每次 30 min,每日 1～ 2次 ,每周 5日 ,一疗程 2 0次。结果　轻度患者止痛总有效率 (CR+PR+MR) 78.18% ,中度患者总有效率 72 .18% ,所有患者总有效率 70 .5 9%。治疗后疼痛打分下降 ,治疗时起效时间缩短 ,疼痛缓解时间延长 ,差别有极显著意义 (p<0 .0 1) ,未见明显不良反应。结论　毫米波治疗对轻、中度肺癌癌性疼痛有较好的治疗作用 ,值得进一步深入研究和推广     

单纯持续鞘内注射吗啡治疗老年晚期癌症重度癌性疼痛的效果

目的分析单纯持续鞘内注射吗啡治疗老年晚期癌症重度癌性疼痛的临床效果。方法抛硬币法将71例老年晚期癌症重度癌性疼痛患者随机分为对照组(n=35)和观察组(n=36)。对照组给予常规途径吗啡镇痛,观察组给予持续鞘内注射吗啡镇痛,对比两组镇痛效果、免疫功能及安全性差异。结果①T1(镇痛前1 d)、T3(镇痛后第7天)时两组T淋巴细胞及自然杀伤(NK)细胞百分比对比无显著差异(P0.05);T2(镇痛后第1天)时观察组CD3~+、CD4~+、CD4~+/CD8~+、NK细胞百分比明显低于对照组(P0.05);T4(镇痛后第15天)、T5(镇痛后第30天)时两组T淋巴细胞及NK细胞百分比对比差异有统计学意义(P0.05)。②T1时两组各项炎性因子对比无显著差异(P0.05);T2时观察组白细胞介素(IL)-2明显低于对照组,IL-4、IL-17明显高于对照组(P0.05);T3时观察组IL-10明显低于对照组(P0.05);T4、T5时观察组IL-2、干扰素(IFN)-γ明显高于对照组,IL-4、IL-10、IL-17明显低于对照组(P0.05)。③两组患者T1时数字分级法(NRS)评分对比无明显差异(P0.05),镇痛后两组上述评分均明显下降,但两组T2、T3、T4、T5时NRS评分组间对比无统计学差异(P0.05)。④观察组不良反应发生率为13.9%,明显低于对照组(60.0%),差异有统计学意义(P0.05)。结论单纯持续鞘内注射吗啡用于老年晚期癌症重度癌性疼痛治疗效果显著,具有安全性高、免疫抑制小等优势。     

疼痛控制护理在老年手术患者术后疼痛中的应用效果分析

目的分析评价疼痛控制护理在老年手术患者术后疼痛中的临床应用效果。方法选取2013-05~2014-07该院就诊的老年手术患者100例,随机分为两组。对照组采用常规护理,实验组在对照组常规护理的基础上行疼痛控制护理。比较两组患者疼痛评分、焦虑和抑郁自评量表及患者满意度。结果实验组疼痛评分及焦虑抑郁自评得分明显低于对照组,实验组总满意率为98.0%,对照组总满意率为84.0%,组间比较差异有统计学意义(P0.05)。结论疼痛控制护理能有效减轻老年手术患者术后疼痛程度,具有较高的有效率和满意度,值得临床进一步推广。     

老年拔牙患者的疼痛特征与舒适护理干预研究

目的 研究老年拔牙手术患者的疼痛特征,以及舒适护理干预的效果,为寻求减轻拔牙手术疼痛的有效方法提供依据.方法 选择接受拔牙手术的70例老年患者作为研究对象(老年组),另选择70例接受拔牙手术非老年患者作为非老年对照组.两组患者接受相同的拔牙手术和护理.进一步将老年组患者随机分为舒适护理亚组和常规护理亚组,每组35例.常规护理亚组行常规治疗和常规护理,舒适护理亚组行与常规护理亚组相同的常规拔牙手术和常规护理的基础上增加舒适护理.采用视觉模拟评分法对所有患者的咀嚼痛和咬痛程度进行量化评分,对评分结果进行分析与比较.结果 拔牙后1d和2d老年组的咀嚼痛和咬痛评分均明显高于非老年对照组(P＜0.05、0.01).拔牙后1d和2d舒适护理组的咀嚼痛和咬痛症状均比常规护理组有明显的改善(P＜0.05).结论 老年患者拔牙后的咀嚼痛和咬痛程度显著高于非老年患者,拔牙时牙科医师应当充分重视老年患者的疼痛特征,有利于进行拔牙手术;舒适护理能够改善老年拔牙手术患者的疼痛,具有较大的临床实用价值.     

三阶梯药物止痛法联合四磨汤和穴位敷贴治疗老年癌性疼痛的临床分析

目的 探究三阶梯药物止痛法联合四磨汤和穴位敷贴对癌性疼痛患者的临床疗效.方法 选取2018年6月-2020年6月遂宁市中心医院收治的78例癌性疼痛患者,根据随机数字表法分为3组:A组(n=26)、B组(n=26)与C组(n=26).A组患者予以常规三阶梯药物止痛法治疗,B组患者予以三阶梯药物止痛法联合四磨汤治疗,C组予...     

Geriatric assessment in the elderly cancer patient

Lost and remaining functions are of special importance in geriatric medicine. The level of functional deficits ultimately determines the remaining quality of life and the patient's ability to continue independently. In contrast, the actual severity of a disease measured by common standards becomes less important. Geriatric assessment is increasingly used to describe the impact of disease and to focus on the functional losses and problems that are particularly relevant to the individual elderly patient. When developing a treatment plan for older cancer patients, it is essential to consider the functional deficits caused by age-related changes or comorbidity, the remaining compensation mechanisms and the patient's expectations. Cancer treatment has to be adapted to the individual needs of elderly patients. As the number of cancer patients is rising in all areas of medical practice, a close collaboration between oncologists and geriatricians will become increasingly important. Received: 12 January 2000 / Accepted: 25 January 2000     

The quality of pain management in pancreatic cancer: A prospective multi-center study

Background/objectivesPancreatic ductal adenocarcinoma (PDAC) is frequently associated with severe pain. Given the almost inevitably fatal nature of the disease, pain control is crucial. However, data on quality of pain management in PDAC is scarce.MethodsThis is a multi-center, prospective study to evaluate the quality of pain management in PDAC. Insufficient pain treatment (undertreatment) was prevalent if there was an incongruence between the patients level of pain and the potency of analgesic drug therapy. Determinants of pain and undertreatment were identified using multivariable logistic regression.Results139 patients with histologically confirmed PDAC were analyzed. The prevalence of pain was 63%, with approximately one third of the patients grading their pain as moderate to severe. Palliative stage (OR: 3.37, 95%CI: 1.23–9.21, p = 0.018) and localization of the primary tumor in the body or tail (OR: 2.57, 95%CI: 1.05–6.31, p = 0.039) were independent determinants of pain. Of those reporting pain, 60% were undertreated and in 89% pain interfered with activities and emotions. Age ≥ 70 years (OR: 3.20, 95%CI: 1.09–9.41, p = 0.035) was an independent predictor of undertreatment. Patients with longer-known PDAC ( ≥ 30 days) showed improved pain management compared to new cases (OR: 0.19, 95%CI: 0.05–0.81, p = 0.025). Treatment by gastroenterologists (OR: 0.22, 95%CI: 0.05–0.89, p = 0.034) was associated with less undertreatment.ConclusionsThe results show a high proportion of PDAC patients with pain, pain interference and undertreatment, whose characteristics could help to identify patients at risk in the future. Several changes in the management of cancer-related pain are necessary to overcome barriers to optimal treatment.     

芬太尼透皮贴剂治疗肺癌癌痛疗效分析

目的：探讨芬太尼透皮贴剂在中重度肺癌癌痛治疗中的应用特点。方法：69例中重度肺癌癌痛患随机分成芬太尼透皮贴剂组和口服硫酸吗啡控释片组，评价其疗效和副反应。结果：芬太尼组36例中，未缓解3例，轻度缓解6例，部分缓解10例，明显缓解12例，完全缓解5例。口服硫酸吗啡按释片组分别为3例，5例，11例，10例及4例，两组相似。但是口服硫酸吗啡控释片组的消化道副反应明显。结论：对于慢性中重度肺癌癌痛患，芬太尼透皮贴剂是一种方便有效的镇痛药。     

Osteoarthritis pain assessment in family practice

Purpose. The objective is to study the assessment of pain severity, following the conventional family physician routines, in patients with peripheral osteoar-thritis. Methods. The patient's perception of pain and the physician's assessment of the pain were measured by means of questionnaires and were compared in a study population of 198 patients with osteoarthritis. Results. A rather low association was found between a patient's perception of pain and the physician's assessment of pain. Conclusions. It is an accepted fact that too much treatment can have undesirable effects, and that inadequate management of symptoms seems to be associated with a reduced quality of life in osteoarthritic patients. In the absence of a high correlation between patient's perception and physician's assessment of pain severity, it is concluded that a patients' pain questionnaire could be a very useful instrument for improving the care given to patients with osteoarthritis in family practice.     

Assessment of pain, fatigue, sleep and quality of life (QoL) in elderly hospitalized cancer patients

As the proportion of older adults in the population continues to grow, the number of patients with cancer is expected to increase proportionally. In the previously conducted studies, data on elderly cancer patients were generally compared with the QoL scores of elderly patient group and with the data of non-cancer individuals. The purpose of this study was to examine differences in reported pain, fatigue, sleep problems and QoL between middle-aged and elderly hospitalized patients with cancer. We included 53 middle-aged (between 18 and 50 years) hospitalized cancer patients and 47 elderly (>60 years) hospitalized cancer patients in this study. Pain (visual analog scale = VAS, verbal pain rating), fatigue (brief fatigue inventory = BFI), sleep problems, QoL (Short Form 36 = SF36), and European Organization for Research and Treatment of Cancer (EORTC)-QoL-C30 data were gathered using standardized measures. In the elderly group, no significant difference was detected in terms of VAS, verbal pain rating, fatigue, fatigue type, sleep problems and QoL scores (p > 0.05). When the two age groups were compared, BFI scores were found to be significantly high among the elderly patients (p < 0.05). A significant relationship was observed in both age groups between the scores of pain, fatigue and sleep problems, and QoL (p < 0.05). Elderly hospitalized cancer patients did not demonstrate a distinctive difference in terms of pain, sleep and QoL compared to the younger group. The relationship between pain, fatigue, sleep and QoL should be definitely kept in mind in clinical practice.     

优质护理服务在心血管内科临床护理中的应用

目的对优质护理服务在心血管内科临床护理中的应用进行研究探讨,总结相关的工作经验,为优质护理服务在心血管内科临床护理中的应用提供临床依据。方法选取2013年1月-11月期间收治的心血管内科的患者100例,将这100例患者按照随机分配的原则随机分为两组,一组是观察组,另外一组为对照组,每组各50例患者,对照组进行一般的常规护理,而观察组则是结合患者的实际情况,专门为患者制定一套综合的优质护理服务,然后将不同护理的两组病人状况和心理状态进行对比。结果对照组和观察组的护理结果也不一样,对照组经过一般护理之后,有效率为84%,观察组有效率为96%;对照组对护理工作的满意度90%,观察组的满意率为98.3%。结论 100例患者经过不同分组进行护理后,在心血管内科临床护理中对病患提供优质的护理服务有助于病患的治疗和恢复,对于病患的身体和心理方面的治疗都有极大的帮助。     

Persistent nonmalignant pain and analgesic prescribing patterns in elderly nursing home residents

OBJECTIVES: To determine the prevalence of analgesics used, their prescribing patterns, and associations with particular diagnoses and medications in patients with persistent pain. DESIGN: Cross-sectional study. SETTING: Nursing homes from 10 U.S. states. PARTICIPANTS: A total of 21,380 nursing home residents aged 65 and older with persistent pain. MEASUREMENTS: Minimum Data Set (MDS) assessments on pain, analgesics, cognitive, functional, and emotional status were summarized. Logistic regression models identified diagnoses associated with different analgesic classes. RESULTS: Persistent pain as determined using the MDS was identified in 49% of residents with an average age of 83; 83% were female. Persistent pain was prevalent in patients with a history of fractures (62.9%) or surgery (63.6%) in the past 6 months. One-quarter received no analgesics. The most common analgesics were acetaminophen (37.2%), propoxyphene (18.2%), hydrocodone (6.8%), and tramadol (5.4%). Only 46.9% of all analgesics were given as standing doses. Acetaminophen was usually prescribed as needed (65.6%), at doses less than 1,300 mg per day. Nonsteroidal antiinflammatory drugs (NSAIDs) were prescribed as a standing dose more than 70% of the time, and one-third of NSAIDs were prescribed at high doses. CONCLUSION: In nursing home residents, persistent pain is highly prevalent, there is suboptimal compliance with geriatric prescribing recommendations, and acute pain may be an important contributing source of persistent pain. More effective provider education and research is needed to determine whether treatment of acute pain could prevent persistent pain.     

老年晚期恶性肿瘤患者疼痛特征分析

目的分组了解中青年和老年晚期恶性肿瘤患者疼痛的特点,分析老年肿瘤疼痛患者疼痛评分与疼痛部位、性质及所致影响问的相关性。方法共收集127例晚期恶性肿瘤伴疼痛的患者,对其进行全面疼痛评估,分为中青年组和老年组进行比较,并对老年组资料进行相关性分析。结果患者最高疼痛评分96．8％属中重度疼痛,平均疼痛评分88．2％属轻度疼痛,疼痛部位以腹、腰、背、肩颈为主,性质通常为间歇痛、钝痛、刺痛、胀痛等。疼痛对睡眠、食欲、活动能力、情绪及人际关系均造成不良影响,中青年组和老年组比较差异无统计学意义。老年组中,平均疼痛评分与转移部位数、疼痛部位数、背部疼痛、臀髋部疼痛、酸痛、胀痛及焦虑之间呈正相关,与缓解因素之不触碰呈负相关。最高疼痛评分与疼痛部位数、胸痛、绞痛、加重因素之触碰、入睡困难及抑郁呈正相关,与无明确加重因素呈负相关。结论晚期恶性肿瘤合并疼痛者中重度疼痛发生率高,全面地评估、控制及治疗疼痛是提高晚期肿瘤疼痛患者,尤其是老年患者生活质量的关键措施。