培训课件--术后疼痛指南徐建国.pptVIP

镇痛药物的联合应用 阿片类或曲马多与对乙酰氨基酚联合 对乙酰氨基酚的每日量1.5~2.0 g，可节俭阿片类药物20%~40% 对乙酰氨基酚与NSAIDs联合 两者各使用常规剂量的1/2，可发挥镇痛协同作用 阿片类或曲马多与NSAIDs联合 使用常规剂量的NSAIDs可节俭阿片类药物20%~50%，尤其是可能达到患者清醒状态下的良好镇痛。在脑脊液中浓度较高的COX-2抑制剂 如帕瑞昔布 术前开始使用具有抗炎、抑制中枢和外周敏化作用，并可降低术后疼痛转化成慢性疼痛的发生率。 阿片类与局麻药联合用于PCEA 阿片受体激动-拮抗剂布托啡诺亦可单独或与NSAIDs、对乙酰氨基酚、曲马多等合用于PCIA，与局麻药合用于PCEA 氯胺酮、可乐定等也可与阿片类药物联合应用，偶尔可使用三种作用机制不同的药物实施多靶点镇痛。 镇痛方法的联合应用 主要指局部麻醉药切口浸润 区域阻滞或神经干阻滞 与全身性镇痛药 NSAIDs或曲马多或阿片类 的联合应用。病人镇痛药的需要量明显降低，疼痛评分减低，药物的不良反应发生率低。 多模式镇痛的实施 轻度疼痛 中度疼痛 重度疼痛 如: 腹股沟疝修补术 静脉曲张 腹腔镜检查 如: 髋关节置换术 子宫切除术 颌面外科 如: 开胸术 上腹部手术 大血管 主动脉 手术 全膝、髋关节置换术 1 对乙酰氨基酚和局麻药伤口浸润 2 NSAIDs 排除禁忌症 3 硬膜外局麻药复合阿片类或外周神经阻滞或神经丛阻滞或曲马多或阿片类药物注射 PCIA 1 对乙酰氨基酚和局麻药伤口浸润 2 NSAIDs 排除禁忌症 和 3 外周神经阻滞 单次或持续注射 或曲马多或阿片类药物注射 PCIA 1 对乙酰氨基酚和局麻药伤口浸润 2 NSAIDs 排除禁忌症 和 3 区域阻滞加弱阿片类药物或曲马多或必要时使用小剂量强阿片类药物静脉注射 * * IASP是什么 * To elevate awareness of the unmet need for effective pain treatment, the American Pain Society APS has redefined pain as the Fifth Vital Sign?.1 It is recommended that healthcare professionals assess patients for pain every time they check temperature, blood pressure, pulse, and respiration1 The APS urges healthcare professionals to take patients’ complaints of pain seriously1 Reference: 1. Pain: the 5th Vital Sign?. American Pain Society Web site. Available at: /advocacy/fifth.htm. Accessed November 14, 2003. * * * 250 patients who had undergone surgical procedures in- and outpatient in the past year completed a questionnaire about their experiences with pain before and after surgery. The most common concern that patients expressed prior to surgery was experiencing pain 59% , which was cited more often than concerns about whether the surgery would improve their condition 51% or whether they would fully recover 46% . 58% of the sample reported pain prior to surgery. Despite receiving treatment for pain, 82% reported pain in the immediate postsurgical period end of surgery up to 2 weeks after discharge and 75% reported pain after discharge. More than two thirds