课件：晚期癌症疼痛控制.ppt

* 度冷丁： 肌注不方便 易出现肌肉震颤 易成瘾 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 contraindicated) aspirin, acetaminophen, or nonsteroidal anti-inflammatory drug (NSAID).6 Step 2: When pain persists or increases, add an opioid.6 Step 3: If pain continues or becomes moderate to severe, increase the opioid potency or dose.6 Some types of pain respond to nonopioid drugs alone. Pain of greater severity can be relieved by combining a low-dose opioid preparation with the nonopioid, and more severe pain requires a higher-dose opioid preparation. It is important to be aware that the doses of opioids available in combination with a nonopioid are limited by the upper recommended dose limit of the nonopioid.5 There have been concerns that by progressing through each step, many patients will be without adequate pain relief for some time.8 However, the principles of the WHO 3-step analgesic-ladder approach include selecting the appropriate analgesic for the patient’s pain intensity and individualizing the dose.6 Physicians should individualize treatment in every case, initiating therapy at the appropriate point along a progression from nonopioid analgesics to opioids. At any of these levels, adjuvants may be useful as coanalgesics or to counteract side effects.5,6 无创给药，强调病人长期用药的方便性 口服：无创、方便、安全、经济 常用药物有盐酸吗啡片（即释）、盐酸吗啡缓释片（美菲康）、可待因、扑热息痛等。 其它途径给药：透皮贴剂、直肠栓剂等。如多瑞吉贴剂、消炎痛栓等。 WHO推荐能口服的尽量口服。 不提倡使用度冷丁。 按阶梯给药，即根据疼痛分级，选择不同治疗药物 疼痛强度是选择相应阶梯药物的主要依据，根据疼痛的性质、部位选择相应的辅助药物。 轻度疼痛：非甾体类抗炎药（以阿斯匹林为代表、第一阶梯） 中度疼痛：弱阿片类药物（以可待因为代表、第二阶梯）±NSAIDs±辅助药物 重度疼痛：强阿片类药物（以吗啡为代表、第三阶梯）±NSAIDs±辅助药物 WHO 镇痛治疗三阶梯 疼痛持续或增强 弱阿片类药物± 非阿片类药物± 辅助用药 2 疼痛持续或增强 非阿片类药物±辅助用药 1 疼痛 World Health Organization, Cancer Pain Relief. 1996. 摆脱疼痛 3 强阿片类药物± 非阿片类药物± 辅助用药 WHO推荐的常用止痛药 非阿片类止痛药（一阶梯）：非甾体类抗炎药，包括水杨酸类药物（阿司匹林）和非水杨酸类药物（布洛芬）；扑热