癌痛管理的发展趋势.ppt

内容 癌痛：问题之所在 WHO阶梯治疗策略仍然可行吗? 目前的临床实践指南 癌痛：行之有效的治疗策略（药物） 指南推荐的药物 Ferrel et al. Assessment and treatment of cancer pain. Seattle: IASP Press, 1998 Fincke et al.J Gen Intern Med 1998 直接启动口服缓释阿片类药物(羟考酮)和按需给予即释阿片类药物 解释： 每日使用5–6次吗啡，非常烦琐且降低依从性 患者对用药过度的认知(频繁大量服药)与依从性降低有关 简化治疗，降低依从性差的风险，从而提高治疗效果 举例说明 吗啡缓释片 羟考酮缓释片 奥施康定?：快速起效 Reder RF et al.. Clin Ther 1996; 18:95-105 单剂量 稳态 溶解和扩散 溶解 奥施康定? 双相释放和吸收模式: 快速起效(1 h以内) 12 h持续缓解疼痛 无剂量封顶效应 清除 t?短，24 h内达到稳态(可用于滴定和维持) 良好的依从性(超过80%的患者至少使用总剂量的90%) 长期使用有效(3月) 总结 尽管WHO镇痛阶梯治疗应用已经36年，癌痛仍然非常普遍 阿片类药物是癌痛管理的基石 积极快速地进行药物的剂量滴定 不要在2阶梯的药物上浪费时间，尽早的使用强效阿片类药物 癌痛需要综合处理 谢 谢！ * Trends in cancer pain management WHO stepladder: a modern vision * * Background: Despite the abundant literature on this topic, accurate prevalence estimates of pain in cancer patients are not available. Study investigated the prevalence of pain in cancer patients according to the different disease stages and types of cancer. Patients and methods: A systematic review of the literature was conducted. Results: Fifty-two studies were used in the meta-analysis. Pooled prevalence rates of pain were calculated for four subgroups: (i) studies including patients after curative treatment, 33% [95% confidence interval (CI) 21% to 46%]; (ii) studies including patients under anticancer treatment: 59% (CI 44% to 73%); (iii) studies including patients characterised as advanced/metastatic/terminal disease, 64% (CI 58% to 69%) and (iii) studies including patients at all disease stages, 53% (CI 43% to 63%). Of the patients with pain more than one-third graded their pain as moderate or severe. Pooled prevalence of pain was 50% in all cancer types with the highest prevalence in head/neck cancer patients (70%; 95% CI 51% to 88%). * * * By the mouth: alternative routes such as rectal, transdermal, sublingual, and parenteral may be indicated in patients with dysphagie, uncontrolled vomiting, or GI obstruction By the clock: after titration ATC scheme (around the clock) By the ladder For the indiv