癌痛治疗与阿片类药物讲解课件.ppt

Opioid analgesic drugs may help relieve moderate to severe pain, especially nociceptive pain. Opioids for episodic (noncontinuous) pain should be prescribed as needed, rather than around the clock. Long-acting or sustained-release analgesic preparations should be used for continuous pain. Exacerbations of pain should be treated with fast-onset, short-acting preparations.23 Titration should be conducted carefully. Serious side effects of opioids are infrequent, especially when doses are started low and escalated slowly (“start low and go slow”), allowing steady-state blood levels to be reached at each dose prescribed.23 Respiratory depression is the chief hazard in elderly or debilitated patients, usually following large initial doses in nontolerant patients, or when opioids are given with other agents that depress respiration. According to the guidelines, fixed-dose combinations of opioids with acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) may be useful for moderate to moderately severe pain. The maximum recommended dose should not be exceeded, to minimize acetaminophen or NSAID toxicity. If the maximum safe dose is reached without sufficient pain relief, switching to single-entity preparations is recommended.23 Nonopioid analgesic medications may be appropriate for some patients with neuropathic pain and some other persistent pain conditions.23 癌痛已成为全球关注的问题。为了加强对疼痛治疗的指导，早在80年代初，世界卫生组织（WHO）就将缓解癌痛列为癌症综合规划的四项重点之一，在全球范围内推广“三阶梯止痛方案”，并提出了“让癌症病人无痛”的目标。 WHO三阶梯止痛方案的基本原则是： 1、按阶梯给药，即根据疼痛分级，选择不同治疗药物，轻度疼痛先选用非阿片类药物治疗，逐渐提高剂量；中、重度疼痛，如果非阿片类药物不能满足止痛需要，应考虑弱阿片类药物直至强阿片类药物的使用； 2、口服给药，强调病人长期用药的方便性； 3、按时给药，而不是按需给药； 4、个体化给药，即药量因人而异，以疼痛消失为剂量标准。 5、注意具体细节。 长期大量的临床实践证明，按照WHO三阶梯止痛原则给药，可以使90％以上的严重疼痛得到缓解，能明显改善疼痛病人的生存质量。 　　 The World Health Organization (WHO) in 1986 established a comprehensive 3-step “analgesic ladder” approach to cancer pain management, as shown in this slide, the principles of which apply to other types of pain.6 Step 1: For mild to moderate pain, use (unless