便秘和肠梗阻姑息性处理.ppt

便秘和肠梗阻的姑息性处理 目的 讨论姑息关怀领域便秘的病因和处理 通过使用一个病例来阐明继发于晚期癌症的肠梗阻的 内科处理 Management of constipation and bowel obstruction in palliative care Dr. Charlie Bond. Sir michael Sobell House. oxford Aims To consider the causes and management of constipation in palliative care To demonstrate, through the use of a case example, the medical management of bowel obstruction secondary to advanced cancer. 便秘一病因 药物阿片类药物(引起过多分节) 抗毒蕈碱类药物 虚弱制动 脱水 癌症高钙血症 瘤旁内脏神经病 Constipation-causes Drugs Opioids( cause hypersegmentation) Antimuscarinics Debility Inactivit Dehydration Paraneoplastic visceral neuropath 缓泻剂 刺激剂-增加蠕动例如:番泻叶,便塞停 渗透性药物一增加水的含量&软化氢氧化镁,乳果糖 表面润湿剂一例如:多库酯钠 润滑剂一液体石蜡(矿物油) Laxatives Stimulant- increase peristalsis Osmotic- increase water content soften Magnesium hydroxide, Lactulose Surface wetting agents e.g Docusate sodium Lubricants Liquid Paraffin(mineral oil) Oral laxative classification 口服缓泻剂的分类 Predominantly Liquid Paraffin(mineral oil) Softening 液体石蜡(矿物油 以软化为主 Bulk- forming laxatives e.g Methyl cellulose, ispaghula 容积性缓泻剂,例如甲基纤维素 Polyethylene glycol聚乙二醇 Docusate Sodium多库酯钠 Lactulose乳果糖 Predominantly Magnesium Hydroxide氢氧化镁 peristalsis Senna and Danthron Stimulating 番泻叶和丹蒽醌 以刺激蠕动为主 Bisacodyl, sodium picosulphate 便塞停(吡沙可啶),匹可硫酸钠 便秘的处理 纠正可逆转的因素:脱水;高钙血症;药物 非药物治疗:液体;饮食一果汁,纤维素;腹部按摩;针灸 药物治疗:刺激性缓泻剂+/-软化性缓泻剂;栓剂/灌肠剂 Management of Constipation Correct the correctable Dehydration Hypercalcaemia D Non drug treatment Fluids Diet- Fruit juice, fibre Abdominal massage Acupuncture Drug treatment Stimulant Laxative +/-softening laxative Suppositories/enemas