癌痛的評估與護理(漢譯英)

1、最新 料推薦癌痛的評估與護理疼痛是癌癥病人普遍存在的癥狀。盡管在止痛方面取得了巨大進展，但仍有三分之二的癌癥病人到晚期都要忍受癌痛的折磨。 因此，需要護士具備處理癌痛的多方知識， 掌握正確評估方法和治療技術(shù)及恰當?shù)淖o理?，F(xiàn)就其綜述如下。1 癌性疼痛的護理評估1.1視覺模擬評分法(Viraal AualortScale，簡稱 VAS) ：該法比較靈敏，有可比性。具體做法是：在紙上面劃一條10 cm 的橫線，橫線的一端為0，表示無痛；另一端為10，表示劇痛； 中間部分表示不同程度的疼痛。讓病人根據(jù)自我感覺在橫線上劃一記號，表示疼痛的程度。輕度疼痛平均值為 2.57 1.04；中度疼痛平均值為 5.

2、18 1.41；重度疼痛平均值為 8.41 1.35。1.2評估表法：它是由美國的McmilLan 設(shè)計的疼痛估計表。即0 等于無痛， 1 等于有疼痛感，但不嚴重；2 等于輕微疼痛，病人不舒服；3 等于疼痛，病人痛苦；4 等于疼痛較劇烈，有恐懼感； 5 等于劇痛。通過問答形式由病人做出具體描述。內(nèi)容包括：疼痛程度、部位、性質(zhì)、發(fā)作情況及伴發(fā)癥狀等。據(jù)報道此表設(shè)計合理，實用性強。1.3口述評估法 (Verbal Report) ：Melzack 擬定了 1 份形容疼痛程度詞匯，如輕度疼痛、重度疼痛、 陣痛、可怕的痛及無法忍受的疼痛等來幫助病人描述自己的疼痛， 使病人更好地把疼痛加以表達，按 0

3、10 分次序報告， 0 分表示無痛， 10 分表示劇痛。此法簡單，但不易發(fā)覺細微變化。2 癌痛的止痛治療2.1 藥物治療： 世界衛(wèi)生組織 (WHO) 提出 2000 年消除癌癥患者疼痛的奮斗目標。其提出的三級止痛方案是目前世界各地都在大力推行的癌前藥物治療準則。也稱“按需給藥”，即一級止痛：輕度疼痛使用非麻醉性鎮(zhèn)痛藥。如阿斯匹林、撲熱息痛等。二級止痛：中度持續(xù)性疼痛或加重，使用弱麻醉劑。如強痛定、可待因、美散痛等。三級止痛：強烈持續(xù)性疼痛，使用強麻醉劑，直到疼痛消失。如嗎啡、杜冷丁等。其主要給藥途徑有以下幾種：2.1.1 消化道給藥： 藥物給藥近來提倡口服為主，對慢性癌痛采用布羅芬與美散痛合用

4、取得了良好效果，用布羅芬600 mg 與美散痛2.5 5 mg 合用，效果優(yōu)于單獨應(yīng)用美散痛，而不增加副作用。 且對骨轉(zhuǎn)移癌痛也有較好的止痛效果。研究中未發(fā)現(xiàn)布羅芬對十二指腸粘膜有損傷， 認為布羅芬的安全性和較低的副作用是可取的。近年來開發(fā)的鹽酸雙氫嗎啡控釋片，克服了嗎啡的某些副反應(yīng)，又增加了鎮(zhèn)痛效果。已成為需要麻醉止痛時的首選藥物。不能口服者也可直腸給藥。芬太尼、buprenophine 也可舌下給藥。2.1.2 連續(xù)皮下或靜脈給藥：當大量口服止痛藥不能控制疼痛時，或有嚴重的胃腸道反應(yīng)如惡心、嘔吐等副作用時，需采用連續(xù)皮下或靜脈內(nèi)輸入麻醉劑：Sheider 評估了這種方法，肯定了其給藥的安全

5、性和效能，現(xiàn)已普遍應(yīng)用。2.1.3 皮膚給藥： 近年來由于皮膚生理研究和制藥技術(shù)的發(fā)展，皮膚與粘膜已經(jīng)作為給藥的新途徑。有報道，一次芬太尼貼敷止痛可達72 h 。雖使用方便，但價格昂貴。另外，中藥外治法能使藥物經(jīng)皮膚吸收，起效快、安全、方便、毒副作用小。用藥10 min 即可見效，總有效率 79.2%。2.1.4 病人控制的止痛 (Patient Controleel Analgesir ，簡稱 PCA) ：PCA 方法 1984 年在美國被有效地應(yīng)用。 其方法是患者擁有一個用計數(shù)電子儀控制的注藥泵。它可提供麻醉劑的劑量、劑量增減范圍和估計2 次劑量的間隔最短時間， 以及提供一個穩(wěn)定的注藥間隔

6、周期。能更好地取得疼痛控制效果，減少麻醉劑用量，減少副作用。但其缺點是必須有一定設(shè)備，且價格昂貴。并可引起藥物外滲、靜脈炎及感染等。目前已研制出新型控制止病人的痛藥泵，分家庭用、護士用及防止用藥過量的PCA 3 種類型。不僅可防止病人用藥過量，還可通過1最新 料推薦電腦程序控制持續(xù)輸液中的止痛藥濃度，以維持穩(wěn)定的止痛效果，防止病人出現(xiàn)劇痛。2.1.5麻醉技術(shù)控制癌痛：神經(jīng)阻滯在晚期癌痛病人中已應(yīng)用了多年，近年來提倡在早期癌痛患者中應(yīng)用。 通過導(dǎo)管或泵， 連續(xù)或間斷將藥物輸入硬膜外或鞘內(nèi)。 此法避免了口服給藥和其他方法給藥的副作用， 同時還減少了輔助藥物的應(yīng)用。 但也有人報道， 全身先用阿片類藥

7、物治療的病人，脊柱內(nèi)再給阿片類藥物則無治療效果。2.1.6 神經(jīng)外科技術(shù)控制癌痛： 手術(shù)治療的目的是在周圍神經(jīng)與中樞神經(jīng)之間某一點切斷產(chǎn)生疼痛的途徑。3 癌痛的護理3.1護理觀念的更新：迅速有效地減輕癌痛是護理的基本要求，也是護士基本的責任。因此， 護士應(yīng)盡力發(fā)展提高癌痛的護理水平。癌痛的控制往往受病人、 護士、藥物組合多種因素的綜合影響， 而護士的密切觀察和及時提供適應(yīng)的止痛方法是控制癌痛重要因素。這就需要護理教育計劃從基礎(chǔ)和臨床上對藥物的藥理學(xué)和用藥方式進一步加強，樹立果斷采取各種治療手段， 設(shè)法解除病人痛苦， 提高病人生存質(zhì)量延長生命的新觀念，嚴格遵守有效控制疼痛的指導(dǎo)原則。3.2護士的

8、作用3.2.1準確評估： 在對癌痛控制過程中，疼痛的評估是第一重要環(huán)節(jié)。護士不僅要客觀地判斷疼痛是否存在， 還要確定疼痛的程度。在用藥前護士必須根據(jù)個體疼痛作出準確的判斷，采取相應(yīng)措施，才能有效地減輕病人的痛苦。通過對1 400 名注冊護士問卷調(diào)查表明，最佳處理疼痛的主要障礙是對疼痛估計不足，處理疼痛的知識不夠及病人不愿報告疼痛。因此，對護士而言更重要的是有關(guān)疼痛的處理和用以解除癌痛的標準教育。3.2.2 準確及時給藥： 觀察效果及副作用。 包括了解治療的基本原則，向病人說明接受治療的效果及幫助病人正確用藥，評估治療效果，向醫(yī)生報告以及副作用的防治等。3.2.3心理護理：要幫助病人樹立信心。因

9、勢利導(dǎo)，調(diào)動病人積極的心理因素，幫助克服其消極的心理因素。爭取病人信任，增強病人的安全感，穩(wěn)定情緒，解除焦慮。注意分散病人注意力。建立“舒適家庭病房” ，因為舒適可使心理生理異常減輕到最低程度。Assessment and care of cancer painPain is common symptom of cancer patients. Despite the pain has made tremendous progress, but there are still two-thirds of cancer patients to have to put upwith advance

10、d cancer pain of torture. Therefore, nurses have the knowledge of handling multi-cancer pain, to master the correct assessment and treatment techniques and appropriate care. Is on its review as follows.1A nursing assessment of cancer pain1.1Visual analogue scale (Viraal Aualort Scale, referred to as

11、 VAS): The moresensitivemethod,thereare comparable.Specifically:In the paper,draw a 10 cmabove the horizontal line, horizontal line of the end of 0, indicating no pain; the otherside of 10, said the pain; the middlepart of the varyingdegreesof pain. Feel thepatient accordingto a uniformmark on the h

12、orizontalline, indicatingthe degreeofpain. Mild pain, mean 2.571.04; moderate pain an average of 5.181.41;moderateto severe pain, average 8.411.35.2最新 料推薦1.2Evaluation form method: It was designed by the American Pain McmilLanestimated table. That 0 equals no pain, 1 is equal to a pain, but not seri

13、ous; 2 equalsmild pain, patient discomfort; 3 is equal to the pain, the patient suffering; 4 is equal tomore severe pain, there is fear; 5 equal to severe pain. Made through the Q & Aspecificdescriptionof the patient.Include:pain intensity,location,nature,and theconcomitantonset of symptoms.It i

14、s reportedthat this table design is reasonable,practical.1.3 Oral Assessment Act (Verbal Report):Melzack 1 developed vocabulary to describe the degree of pain, such as mild pain, severe pain, pain, terrible pain andcould not bear the pain to help patients describe their pain, so be patient to better

15、 express the pain, according to 0 the order of 10 reports, 0 points indicating no painand 10 points indicating severe pain. This method is simple, but difficult to notice subtle changes.2Analgesic treatment of cancer pain2.1Drug treatment:World Health Organization (WHO) proposed in 2000 toeliminate

16、pain in patients with the goal of cancer. The proposed three-tier program ispain all over the world promoting the use of pre-cancerous drug treatment guidelines.Alsocalledon-demanddelivery,thatis apain:mildpain,useofnon-narcoticanalgesics.Suchasaspirin,paracetamolandsoon.Secondpain:moderatepersisten

17、t pain or increase, the use of weak anesthetic. If given strong pain, codeine,methadonepain.Threelevelsofpain:astrongpersistentpain,witha stronganesthetic,untilthepaindisappears.Such asmorphine,pethidineandso on. Themain route of administration are the following:2.1.1Gastrointestinal drug delivery:

18、Recently, the main advocate of oral drugdelivery, chronic cancer pain using Bu Luofen methadone combined with the UnitedStates andachieved good results, with theUnitedStateswithBuLuofen600 mgmethadone2.55mgcombination,moreeffectivethanmethadonealonepain,without increased side effects. And the pain o

19、f bone metastasis has a better analgesiceffect. Study found no Bu Luofen duodenal mucosa injury, that the Bu Luofen securityandlowersideeffectsisdesirable.Inrecentyearsthedevelopmentofcontrolled-release morphine hydrochloride tablets hydrochlorothiazide and overcomesome of the side effects of morphi

20、ne, increased the analgesic effect. Has become thefirst choice when the need for narcotic pain drugs. Those who can not be oral or rectaladministration. Fentanyl, buprenophine also sublingual administration.2.1.2Continuoussubcutaneousorintravenousinjection:Whenalargenumberoforalpainmedicationcannotc

21、ontrolthepain, orhaveseriousgastrointestinal reactionssuch as nausea, vomiting andother sideeffects, requirestheuseofcontinuoussubcutaneousorintravenousanestheticinput:Sheiderassessmentofthisapproach,confirmedthesafetyofitsadministrationandperformance, is now widely used.2.1.3Skin dose:In recent yea

22、rs, the physiology of the skin and pharmaceuticaltechnology, drug delivery skin and mucous membranes have been used as a new way.It has been reported, a fentanyl pain patching up to 72 h. Although easy to use, butexpensive.In addition,the Chineseexternaltreatmenttomakedrugsabsorbed3最新 料推薦through the

23、 skin, rapid onset, safety, convenience, drug side effects. 10 min treatment to be effective, total effective rate 79.2%.2.1.4Patient-controlled analgesia (Patient Controleel Analgesir, referred to asPCA):1984 PCA method was applied effectively in the United States. The method isthat the patient has

24、 an electronic instrument controlled by counter drug infusion pump.It provides ane sthetic dose, dose range and the estimated increase or decrease theinterval between 2 doses of the shortest time, and provide a stable interval betweeninjectioncycles.Betteraccesstoeffectivepaincontrol,reducetheamount

25、ofanesthetic agents, reduce side effects. But its drawback is that there must be someequipment, and expensive. And can cause drug extravasation, phlebitis and infection.Has developed a new type of control only the patients pain medication pumps, domestic use, the nurse and to prevent overdose PCA 3

26、types. Not only prevent overdose patients, but also sustained by the computer program control pain infusiondrug concentration in order to maintain a stable analgesic effect, prevent the patient developed severe pain.2.1.5 Anesthesia control cancer pain: Nerve block in patients with advanced cancer h

27、as been in use for many years, in recent years to promote the application of early cancer pain. Through the catheter or pump, continuous or intermittent epiduralor intrathecal drug importation. This method avoids the administration of oral medication and side effects of other methods, but also reduc

28、e the application of adjuvants. However, some reports, the body first with opioid therapy in patients withspinal opioids to give no treatment.2.1.6 Neural control of cancer pain surgical techniques: The purpose of surgical treatment of peripheral nerve and central nervous system is a point between t

29、he way off to pain.3Cancer Pain Care3.1Renewingcare:Quicklyandeffectivelytoreduce painisthebasicrequirement of care is a basic responsibility of nurses. Therefore, nurses should try todevelop standards to improve the care of cancer pain. Cancer pain control are oftenaffected by patients, nurses, dru

30、g combinations combined effects of many factors, andnursestoprovideclose observationandtimelyadaptationto painisanimportantfactor in controlling cancer pain. This requires that nursing education programs frombasic and clinical pharmacology of drugs and drug use means to further strengthenand establi

31、sha firmto takea varietyof treatments to tryto relievethe suffering ofpatients and improve the quality of life in patients with life-prolonging new ideas, strictcompliance with effective control of pain guidelines.3.2The role of nurses3.2.1Accurate assessment of:In the course of pain control, pain a

32、ssessmentis the first important part. Nurses not only to objectively determine whether there ispain, but also to determine the degree of pain. Former nurse in the treatment of painmust be based on the individual to make accurate judgments, to take correspondingmeasures, can effectively reduce the pain. By 1 400 register