癌性疼痛的处理ppt课件.ppt

不推荐 混合性激动-拮抗剂 喷他佐辛，布托啡诺，纳布啡，地佐辛 - 与激动剂竞争?撤药状态 - 镇痛的天花板效应 - 喷他佐辛和布托啡诺的拟精神病性不良反应的风险高 Not recommended Mixed agonist-antagonists Pentazocine, butorphanol, nalbuphine, dezocine - Compete with agonists ? withdrawal - Analgesic ceiling effect - High risk of psychotomimetic adverse effects with pentazocine, butorphanol * * Single dose studies in the late 60’s found that the potency and duration of action similar to morphine. Remember long 1/2 life and its variability. (13 - 58 hours with average ~ 24 hours). Duration of effect changes as drug levels stabilize. Initially duration of effect is short…3 - 4 hours, but as blood levels stabilize, then duration of effect may be 8 - 12 hours. * * * * EPEC 癌性疼痛的处理WHO 3-阶梯镇痛疗法Management of Cancer PainWHO 3 – Step Analgesic Ladder Terence L. Gutgsell, MD Hospice of the Bluegrass Lexington, KY 目标 比较，对比感受伤害性的和神经病性的疼痛 了解癌痛镇痛处理的阶梯 了解阿片类镇痛剂给药的其他途径 讲解维持镇痛时阿片类药物间互相转换的技巧 Objectives Compare, contrast nociceptive, neuropathic pain Know steps of analgesic management of cancer pain Know alternative routes for delivery of opioid analgesics Demonstrate ability to convert between opioids while maintaining analgesia 躯体的疼痛Physical Pain 情感的 疼痛 Emotional Pain 社交 障碍 Social Discord 宗教的困扰Spiritual Distress 病痛=总体的疼痛 Suffering = Total Pain 总的原则 多因素对患者反应的影响 环境 心理/社会状态 年龄 性别 多系统疾病和障碍 复合用药 General Principles Influences on patient’s response to Rx Environment Psycho/social status Age Sex Multi-system disease and disorders Polypharmacy 普遍原则 “拇指原则” 诊断可能的机制,个体化治疗 ATC和PRN用药,保持简单 反复评价,注意细节 General Principles “Rules of Thumb” Diagnose underlying mechanism Individualize treatment ATC and PRN medications Keep it simple, Reassess Attention to Detail 疼痛的病理生理学 急性疼痛 已明确的原因，缓解时间：数日到数周 通常是感受伤害性的 慢性疼痛 原因常不易确定，多因素的 持续时间不确定 感受伤害性的和/或神经病理性的 Pain pathophysiology Acute pain Identified event, resolves days–weeks