课件：癌痛规范化治疗演示课件.ppt

癌痛规范化治疗—团队努力 肿瘤科 药剂科 疼痛科 护理部 骨科 外科 心理科 中医科 精神科 疼痛治疗必须规范化评估 规范化评估是治疗的前提 示范病房创建是优质医疗服务的内容之一 患者无痛才是我们创建无痛病房最终目标 总结 早期、评估、规范、滴定 谢谢！ 携手共创无痛世界 THANK YOU SUCCESS * * 可编辑 在全球范围内，诸多癌症患者正在饱受疼痛的煎熬 全世界重视的原因。基本概念之一 * 无论是哪个临床部门的医生，在进行癌性疼痛控制的过程中，需要明确一点： 评估和滴定的过程不是疼痛控制初始阶段的一次性工作，是需要贯穿在整个疼痛治疗过程中的。 这些步骤并不是可有可无的，它们一环衔接一环，构成疼痛治疗的重要架构。 在实际工作中，当熟练应用评估和滴定的方法后，就会自然而然的将这些基础步骤穿插在疼痛治疗中了。 * 面部表情分级量表对于难以使用其他量表的患者可能更加有效，例如，儿童、老年人，以及存在语言或文化差异或其他交流障碍的患者。 评分时作简要的语言指导：让儿童指着每张脸谱用语言描述相应的疼痛程度。要求儿童从中选择最能形容其疼痛程度的脸谱，并记录相应的数字。 Lancet Oncol 2012; 13: e58–68 * 10. McNicol E, et al. J Clin Oncol 2004; 22:1975-1992.11. Marinangeli F, et al. J Pain Symptom Manage 2004; 27:409-416. systematic review10 of six trials compared the efficacy of an NSAID versus a “weak” opioid (three were single-dose trials and two were multiple-dose trials, and the duration of one trial was unclear). Again, the results failed to show the superiority of “weak” opioids over NSAIDs, although adverse events were either comparable or more frequent in the opioid-treated patients. An additional eight trials were con- ducted in 833 patients to compare an NSAID with the combina- tion of an NSAID and an opioid. The results showed that the difference in the analgesic outcome measure for each trial was less than 25%. The new algorithm proposes the following three stages of treatment for cancer pain. (1) For mild pain, non-opioid analge- sic treatment should be initiated. If pain is not adequately con- trolled, then low doses of “strong” opioids should be added and titrated according to the individual patient’s needs. (2) For mod- erate pain, low doses of “strong” opioids should be initiated and titrated, with or without non-opioids. (3) The treatment of se vere pain obviously requires the immediate use of “strong” opioids, with or without non-opioids. Invasive procedures such as neurolytic blocks, if available, should be considered as an alternative or adjunct to pharmacotherapy at any stage of dis- ease in patients with moderate