恶心和呕吐的姑息性处理目的.ppt.ppt

恶心和呕吐的姑息性处理 目的 简要地回顾晚期癌症恶心和呕吐的原因 描述常用止吐药物的作用部位和机制 研究晚期癌症不同类型的恶心和呕吐的识别和处理 Management of Nausea and Vomiting in Palliative CareDr.Charlie Bond, Sir michael Sobell House, Oxford Aims To briefly review the causes of nausea and vomiting in advanced cancer To describe the site and mechanism of action of the common anti-emetics To consider the recognition and management of the different patterns of nausea and vomiting in advanced cancer Causes of Nausea and Vomiting in Advanced Cancer晚期癌症患者恶心和呕吐的原因 Cancer 癌症 Visceral neuropathy 内脏神经病 Bowel obstruction 肠梗阻 Brain Metastases 脑转移 Raised Calcium 血钙升高 Renal Failure 肾功衰 Anxiety 焦虑 Cough 咳嗽 General Debility 全身衰竭 Constipation 便秘 Oral/Oesophageal candida 口/食管念珠菌病 Infections 感染 Treatment/Drugs 治疗/药物 Chemotherapy 化疗 Radiotherapy 放疗 Opioids 阿片类药物 NSAIDS/Aspirin T NSAIDS/阿司匹林 Anti-biotics 抗生素 Iron tablets 铁剂 Concurrent Conditions 合并症 Dyspepsia/peptic ulcer 消化不良/消化性溃疡 Alcoholic gastritis 酒精性胃炎 Renal failure 肾功衰 Diabetic Ketoacidosis 糖尿病性酮症酸中毒 恶心和呕吐 - 7 种临床原因 化学性/代谢性 胃停滞/胃排空梗阻 反流 肠梗阻 颅脑疾病/治疗性原因 与运动相关的因素 原因不明/多种原因 Nausea and vomiting - 7 clinical pictures Chemical/metabolic Gastric stasis/gastric outlet obstruction Regurgitation Bowel obstruction Cranial disease/treatment Movement related Cause unclear/multiple causes 恶心和呕吐的处理 纠正可逆转的因素 非药物治疗 药物治疗 处理焦虑 Management of Nausea and Vomiting Correct the correctable Non - drug treatment Drug treatment Manage anxiety 化学性/代谢性因素 原因 药物 (包括阿片类药物) 尿毒症 高钙血症 癌病 临床表现 难治性/ 持续性恶心 呕吐常常不会缓解恶心症状 Chemical/Metabolic Causes Drugs (including opioids) Uraemia Hypercalcaemia Carcinomatosis Clinical Picture Persistent/