癌痛患者的三阶梯止痛护理

疼痛是癌症患者最常见和最难以忍受的症状之一。据统计，全世界有癌症患者约1400万，每年新发癌症患者有700万，其中30％-60％伴有不同程度的疼痛。我国现有癌症患者200万，每年新发癌症患者有160万，疼痛的发生率40％-50％，50％的疼痛为中度至重度，其中30％为难以忍受的重度疼痛。癌症疼痛（癌痛）从心理、生理、精神和社会多个方面影响患者的生活质量。调查资料表明，癌痛得不到充分的治疗和护理是个普遍现象，控制癌痛是个不容忽视的全球性公共健康问题。1982年WHO卫生组织提出的癌症三阶梯止痛原则的应用可以使90％的癌痛患者达到无痛。现就癌痛的三阶梯止痛治疗和护理方法综述如下。     

三阶梯止痛治疗晚期癌痛临床观察

疼痛是中、晚期癌症患者的主要症状之一,控制癌痛是世界卫生组织(WHO)列入肿瘤控制的一项主要课题。我们于1992年1月至1996年12月采用“三阶梯治疗方案”治疗晚期癌痛病人120例,报道如下。 1 临床资料 1.1 一般资料:本组男性78例,女性42例,年龄19～72岁,均为中、晚期癌症患者。其中肝癌31例,肺癌27例,胃癌25例,结直肠癌术后复发11例,乳腺癌9例,胰腺癌5例,多发性骨髓瘤3例,食     

晚期癌痛的第三阶梯药物镇痛

癌性疼痛是晚期癌症患者常见的并发症 ,是患者最痛苦的原因之一。控制癌痛 ,是从事肿瘤工作的重要环节。1995年 1月至 1998年 1月 ,对 6 8例晚期癌痛患者 ,使用第三阶梯镇痛药 ,主动、按时、按个体差异给药 ,取得了良好的止痛效果。疼痛缓解率达 98.5 %。1　临床资料男 46例 ,女 2 2例。原发性肝癌 18例 ,胰腺癌 16例 ,结直肠癌 14例 ,胃癌 8例 ,乳腺癌 6例 ,肺癌 4例 ,前列腺癌 2例。疼痛程度分级 :按是否需要使用止痛剂划分 [1 ] : 级 42例 , 级 2 6例。2　分组及用药方法组 1:32例 (肝癌 8例、胰腺癌 8例 ,结直肠癌 7例 ,胃癌 4例 ,乳腺…     

穴位埋线联合三阶梯止痛治疗癌痛临床观察

目的:观察穴位埋线联合三阶梯止痛止癌痛的效果。方法:采用随机对照法,将癌症病人60例随机分配到治疗组30例,对照组30例,对照组予止痛药,中度疼痛曲马多缓释片,100mg/次,Q12H,连服10d;重度疼痛硫酸吗啡控释片30mg/次,Q12H,连服10d;治疗组在以上基础上,辅予穴位埋线止癌痛,5d为1个疗程,1个疗程埋线1次,连续2个疗程,共10d。记录每个疗程治疗前后的疼痛观察和生存质量评分量表,并进行统计处理。结果:治疗组显效率和对生存质量的改善明显优于对照组,P<0.05。结论:穴位埋线治疗是控制癌痛的有效手段,进而改善患者生存质量,可作为临床上治疗癌痛的手段之一。     

45例癌症三阶梯止痛法的临床观察

癌症的三阶梯止痛法是根据患者的疼痛程度不同而分别使用不同等级止痛药物为治疗原则的止痛方法,为世界卫生组织（WHO）大力推荐。已广泛地应用于治疗各类慢性持续性疼痛,和爆发性疼痛。     

癌痛三阶梯止痛法的临床护理特点

我科1995年3月～1998年3月对88例经病理学证实为晚期恶性肿瘤伴有不同程度疼痛的患者,采用三阶梯止痛法使用镇痛药物止痛,取得了显著临床效果。现报告如下。1　材料与方法11　临床资料111　一般资料　本组病例共88例,其中男性75例,女性13例,年龄20～77岁,平均52岁。全部病例除病理学检查证实诊断外,并经ＣＴ、ＭＲ、Ｂ超、ＥＣＴ等相关辅助检查发现已有远隔部位转移,均为晚期患者,伴有程度不同的多部位疼痛。112　原发肿瘤部位以肺、肝癌多见,其次为胃、食管及结肠癌。本组病例分类情况(表1)。表1　　原发肿瘤分布情况原发肿瘤例数百分比(%)…     

癌症三阶梯止痛治疗的护理

我院肿瘤科根据WHO推行的“癌症三级阶梯止痛方案”为癌症患止痛，获得了良好的效果。现将护理体会报告如下。     

三阶梯止痛法用于癌痛患者153例疗效观察及护理

对153例癌痛患者按三阶梯原则使用止痛药物并进行疗效观察及护理.结果总有效率为91.5%,完全缓解75.16%(115/153),部分缓解16.33%(25/153).提示三阶梯止痛法是行之有效的癌痛治疗方法,配合护理可以提高患者的生活质量,减轻痛苦,值得推广.     

晚期癌痛患者的护理

疼痛是癌症患者最常见的症状之一,由于患者对疼痛的认知不足及对止痛药物易造成成瘾的认知误区,致使很多患者不如实报告疼痛,从而造成医务人员对患者疼痛的评估不足,使得疼痛不能得到有效控制。通过NRS法正确评估患者的疼痛程度,应用三级阶梯止痛法,采用规范化的流程,能有效缓解疼痛,提高患者的生命质量。     

三阶梯治疗癌症疼痛138例临床观察与护理

目的:探讨癌症疼痛三阶梯治疗的临床效果与护理方法。方法:采用自身对照比较138例癌症晚期患者应用三阶梯治疗前后的镇痛效果、生活质量及不良反应情况。结果:治疗后完全缓解(CR)114例(82.6%),部分缓解(PR)15例(10.9%),轻度缓解(MR)9例(6.5%),有效率达93.5%。结论:规范三阶梯治疗能安全有效地控制癌症疼痛,改善患者生活质量,值得推广。     

A Randomized Clinical Trial of Analgesia in Children with Acute Abdominal Pain

OBJECTIVE: To evaluate the effects of intravenous morphine on pain reduction, physical examination, and diagnostic accuracy in children with acute abdominal pain. METHODS: A randomized, double-blind, placebo-controlled clinical trial was conducted at an emergency department of a tertiary care children's hospital. Children aged 5-18 years with abdominal pain of < or =5 days' duration, pain score > or =5 on a 0-10 visual analog scale, and need for surgical evaluation were eligible. Following the initial assessment, patients were randomized to receive either 0.1 mg/kg morphine or an equal volume of saline. The pediatric emergency medicine physician and surgical consultant independently recorded the areas of tenderness to palpation and percussion, and their diagnoses before the study medication and 15 to 30 minutes later. RESULTS: Sixty patients were enrolled, and 29 received morphine and 31 received saline. The demographic characteristics between the two groups were similar. The median reduction of pain score between the two study groups was 2 (95% CI = 1 to 4; p = 0.002). There was no significant change in the areas of tenderness in both study groups. Children with surgical conditions had persistent tenderness to palpation and/or percussion. There was no significant change in the diagnostic accuracy between the study groups and between the physician groups. All patients requiring laparotomy were identified and no significant complication was noted in the morphine group. CONCLUSIONS: Intravenous morphine provides significant pain reduction to children with acute abdominal pain without adversely affecting the examination, and morphine does not affect the ability to identify children with surgical conditions.     

多模式镇痛方法对脊柱融合术患者止痛效果的影响

目的观察多模式镇痛方法对脊柱融合术患者止痛效果的影响。方法将2012年2月至2013年2月42例脊柱融合术患者按随机数字表法分为两组,观察组采用多模式镇痛方法,对照组采用常规镇痛方法,比较两组患者术后不同时间点的疼痛评分以及疼痛对患者的影响。结果观察组患者术后不同时间点疼痛评分均低于对照组,差异有统计学意义(P0.01);观察组患者术后1~3d的活动次数均多于对照组,恶心和嗜睡的发生率低于对照组,对住院过程及康复效果的满意度高于对照组,差异有统计学意义(P0.05或P0.01)。结论采用多模式镇痛方法可以有效缓解脊柱融合术后患者的疼痛,提高患者术后活动能力,减少不良反应的发生,为脊柱融合术后早期镇痛提供了一种有益的选择。     

Adult Cancer Pain: An Evidence-Based Update

Cancer often produces excruciating pain, which sends waves reverberating through the person's body, mind, spirit, and social interactions diminishing their quality of life and that of those closest to them. This updated review will summarize the latest research exploring the biologic mechanisms, psychosocial impact, and evidence-based approaches to treating cancer pain. Persons with cancer should not live or die with needless pain because of the detrimental effects it has on longevity and quality of life. This review intends to inform nurses of evidence-informed best practices they can use to prevent avoidable suffering that results from cancer pain.     

Visual Analog Pain Scores Do Not Define Desire for Analgesia in Patients with Acute Pain

Increased attention to improving the provision of analgesia has led to calls for increased use of pain measurement systems, including visual analog scales, which have not been validated for use in clinical care. OBJECTIVE: To evaluate the ability of the visual analog scale to differentiate between patients with acute, painful conditions requiring pain medication, and those not requiring analgesia. METHODS: This was a prospective, observational study of a convenience sample of patients with acute pain. Subjects were asked about their desire for medication. Visual analog scale pain scores were determined. RESULTS: One hundred four patients participated. Patients requesting pain medication had a mean visual analog scale score of 66. The mean score for those not requesting medication was 45. The difference between the means was 21 [95% confidence interval (95% CI) for difference between the means was 10.7]. The area under the receiver operating characteristic curve for the visual analog scale was 0.72 (95% CI = 0.61 to 0.82). CONCLUSIONS: The visual analog scale cannot adequately discriminate between those patients who do and do not desire analgesia.     

围术期患者镇痛认知调查分析

目的了解手术患者在手术前后对镇痛的认知及需求。方法采用自制问卷对114名患者进行术前、术后镇痛认知调查。结果手术前后患者对疼痛强度、镇痛方式和镇痛剂的认知差异有显著性意义(P<0.01);患者对疼痛危害的认识手术前、后差异无显著性意义(P>0.05)。结论术前护士应加强对患者镇痛知识的宣教力度,术后需落实镇痛措施,提高患者对镇痛方式和镇痛剂的认识。     

曲马多用于术后PCIA的临床对比研究

【目的】观察曲马多病人静脉自控镇痛 (PCIA)术后镇痛的临床效应 ,评定曲马多用于PCIA的恶心、呕吐等不良反应发生率以及在呼吸循环方面的安全性 ,为临床PCIA用药选择提供依据。【方法】择期手术病人 6 0例随机分为两组 :Ⅰ组曲马多组 (n =30 ) ,镇痛药为曲马多 80 0mg +氟哌利多 5mg +生理盐水至10 0ml;Ⅱ组吗啡组 (n =30 )镇痛药为吗啡 4 0mg +氟哌利多 5mg +0 .9%生理盐水至 10 0ml。PCIA选择负荷剂量 +维持剂量 +PCIA给药模式 (持续注射 2ml/h ,PCA剂量 0 .5ml/15min)。镇痛时间为术后 4 8h ,术后 4、8、12、2 4、4 8h随访并记录血压、脉搏、呼吸及药物用量、疼痛评分、恶心呕吐、皮肤瘙痒等情况。【结果】两组镇痛效果差异无显著性 (P >0 .0 5 ) ,曲马多组不良反应低于吗啡组。【结论】曲马多用于术后PCIA静脉镇痛是可行的。     

对癌症病人疼痛信念及遵医行为的研究

目的 :了解癌症病人疼痛信念及遵医行为情况 ,分析其影响因素。方法 :随机抽取陕西省 3所医院的 2 17名癌症病人 ,采用疼痛信念量表及遵医行为自测问卷进行调查 ,并对结果进行统计学分析。结果 :病人的疼痛信念依次为对疼痛的药物信念、对疼痛的耐受信念、对疼痛的失能信念、对疼痛的情绪信念、对疼痛的控制信念 ,且与疼痛程度及受教育程度有一定的关系 ;病人的遵医行为与疼痛的控制感呈负相关 ,与疼痛的药物呈正相关。结论 :癌症病人对疼痛的药物信念、耐受信念、失能信念较强 ,对疼痛的控制信念与遵医行为相关。提示护理时应考虑疼痛信念对病人遵医行为 ,特别是对止痛药物使用的影响。     

Patient-Controlled Analgesia in Chronic Pain Patients: Experience with a New Device Designed to be Used with Implanted Programable Pumps

? Abstract Background: Intrathecal drug delivery using implantable pumps is an effective method to control stable chronic pain. However, the appropriate alleviation of unpredictable pain fluctuations remains challenging. A possible solution is the use of patient‐controlled analgesia (PCA) by means of a specific device—the personal therapy manager (PTM)—designed to be used with implanted programable pumps. Methods: A multicenter (n = 17), open‐label registry recording 168 patients suffering from chronic pain with unsatisfactory control of pain episodes was initiated. While 79 patients (47%) (group A) already carried an implanted pump at enrollment, all other patients were implanted after being registered in the study (group B). Parameters assessed included pain relief (visual analog score, VAS), quality of life (EQ‐5D), patient and physician satisfaction, medication use, PTM programming parameters and adverse events. Final follow‐up was at 12 months. Results: At 12 months, there was a significant reduction (29%) of the overall average VAS compared with baseline (P < 0.01) in patients with newly implanted devices (group B). All patients tended to decrease the concomitant pain medication and the quality of life tended to improve (10% on the EQ‐5D scale). In total, 85% of patients were satisfied with the PTM. No serious adverse events related to the use of the PTM device were observed. Conclusions: Patient‐controlled analgesia using a PTM with a programable, implantable pump system is an effective therapy for the treatment of chronic pain and allows patients to feel that they have more control over unpredictable pain fluctuations. ?     

氯胺酮经静脉超前镇痛用于甲状腺次全切除术的临床观察

[目的]观察氯胺酮超前镇痛对甲状腺次全切除手术患者术后疼痛的影响.[方法]选择择期行甲状腺次全切除患者40例,随机分成两组,K、C组,K组患者切皮前3 min静脉注射氯胺酮1.0 mg/kg及术中持续静脉注射0.5 mg/(kg·h)至术毕;C组切皮前及术中给予相同容量生理盐水.记录术后视觉模拟评分(VAS)及观察药物不良反应.[结果]K组术后VAS疼痛评分显著性低于C组(P＜0.05);两组不良反应发生率的差异无显著性(P＞0.05).[结论]氯胺酮经静脉行超前镇痛用于甲状腺次全切除手术患者,效果确切,不良反应发生率低.