姑息关怀中的皮肤护理幻灯片.ppt

姑息关怀中的皮肤护理Skin care in palliative care  Dr. Z. Zylicz Hospice in the Weald Pembury, Tunbridge Wells, UK 皮肤护理 Skin care 放射治疗过程中的皮肤护理 skin care during radiotherapy 皮肤瘙痒 / 瘙痒症 itchy skin / pruritus 蕈状瘤，出血 fungating cancer, bleeding 患处疼痛 painful wounds 某些因素可加剧放疗后皮肤反应，包括： There are some things that can make the skin reactions to radiotherapy more severe. These include: 在接受放疗前曾行化疗，或放化疗同时进行 having chemotherapy before or at the same time as radiotherapy 体重超重 being overweight 合并其它疾病 （如糖尿病） having other health problems such as diabetes 光敏感肤质 having sun-damaged skin 吸烟 Smoking 化疗期间的皮肤护理Skin care during radiotherapy 有证据表明以下措施可以帮助减低皮肤反应的严重程度 there is evidence that the following activities can help to reduce the severity of skin reactions: 选用温和的皂性溶液或清洁剂清洗皮肤 Wash: with a mild soap or cleansing agent 使用温和的的润肤霜增加皮肤湿度 Moisturise: with a light moisturising cream 为了缓解症状病人能做些什么？ What can patient do to relieve symptoms? 如果皮肤出现发红，发痒，变干，起水疱，医生（或护士）建议使用乳剂涂搽并加以敷料覆盖患处，以缓解症状，使病人感觉更舒适。 if skin becomes red and dry, itchy, or develops blisters, the doctor or nurse can recommend creams and dressings to help reduce your symptoms and make the patient more comfortable. 瘙 痒 症 Pruritus = itch 瘙痒症的分类 Classification of Itch 周围性 Peripheral 皮肤性（瘙痒感受性的） cutaneous (‘pruritoceptive’) 神经病性，例如多发性硬化，神经损伤 neuropathic, e.g. MS, nerve damage 中枢性 Central 神经病性，例如 脑脓肿/脑肿瘤 neuropathic, e.g. brain abscess/tumour 神经源性，例如 服用阿片类药物，胆汁淤积 neurogenic, e.g. opioid, cholestasis 精神性 Psychogenic 混合性 Mixed 尿毒症性 Uraemic 术 语Terminology 神经病性瘙痒：指瘙痒感源于皮肤感受性发生改变的区域，通常是由于局部神经结构遭破坏而引起。 neuropathic pruritus: pruritus experienced in the area of changed sensitivity, usually by damage of the neural structure 神经源性瘙痒症：指由能够干扰痒觉传导及神经系统功能的瘙痒介质所致瘙痒症 neurogenic pruritus: pruritus caused by pruritic mediators interfering with