麻醉学课件：癌痛诊疗理念及难治性癌痛治疗进展.ppt

scheduling and titration Opioid doses should be titrated to take effect as rapidly as possible. Titration is a process in which the dose of the opioid is speedily modi?ed to obtain the tailored dose which provides adequate relief of pain with an acceptable degree of side effects. Normal-release morphine has a short half-life and is indicated: during the titration phase; for treating BTP episodes; and for treating predictable episodes of acute pain in patients on regular analgesics (administration should take place 20-30 minutes before the predictable episode of acute pain). Intravenous titration is indicated in patients with severe pain (table 3)[63]. . 模板来自 / * 2010版成人癌痛指南 * * * Key points of the low complication implant technique include: Paramedian oblique placement Reduces catheter fractures/breaks Eases catheter advancement V-wing anchor at fascia entry point Reduces catheter dislodgements Two-piece connector used as primary anchor Reduces catheter dislodgements Strain-relief sleeve on connectors Reduces catheter kinks Loop of catheter under pump Reduces catheter kinks Slack in catheter by connector Reduces catheter kinks Thick wall proximal catheter Reduces catheter kinks Strain-relief sleeve on connectors Reduces catheter holes Thick wall proximal catheter Reduces catheter holes 上腹下神经丛毁损术 1）上腹下神经丛毁损术的适应证：盆腔原发肿瘤或转移瘤所致的下腹部及会阴内脏痛患者。 2）上腹下神经丛毁损术的禁忌证同射频热凝术的禁忌证，详见上文 3）上腹下神经丛毁损术的不良反应： ①穿刺损伤、出血、感染等 ②如阻滞范围广，可导致大、小便障碍 ③如经椎间盘路径可能导致椎间盘炎 4）临床推荐意见：推荐使用上腹下神经丛毁损术治疗盆腔肿瘤所致下腹部内脏痛 奇神经节毁损术 1）奇神经节毁损术的适应证：直肠癌或其他恶性肿瘤导致的肛门会阴区局限性疼痛。 2）奇神经节毁损术的禁忌证同射频热凝术的禁忌证，详见上文。 3）奇神经节毁损术的不良反应为直肠穿孔、感染、瘘管形成、出血等，罕见不良反应为毁损药物扩散至腰骶脊神经周围或进入硬膜外导致的截瘫。 4）临床推荐意见：由于奇神经节存在解剖学变异，疗效不确切，药物治疗效果欠佳者可尝试使用。 经皮椎体成形术（percutaneous vertebroplasty，PVP） PVP和后凸成形术能有效缓解因脊柱转移瘤或者椎体压缩性骨折导致的疼痛、改善脊柱稳定性。 PVP的适应证 1）恶性肿瘤所致的椎体转移性疼痛 2）存在骨折风险 3）经核磁共振成像或核素成像证实的有症状的椎体微骨折和（或）CT提示溶骨性病变且椎体高度无明显变小 4）骨转移放疗后疼痛不能缓解的患者 PVP的禁忌证1）聚甲基丙烯酸甲酯或造影剂过敏；2）椎体压缩性骨折高度>70%；3）存在脊髓压迫；4）成骨性骨转移。 PVP的常见不良反应由于骨转移造成骨皮质不完整，有骨水泥泄露可能。如骨水泥泄露到椎旁、椎间隙、骨周围软组织，可能造成疼痛；如骨水泥泄