癌症病痛的三级治疗
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">病痛</span>是癌症<span style="color: black;">病人</span>最<span style="color: black;">平常</span>的症状之一，严重影响癌症<span style="color: black;">病人</span>的生活质量。据统计，我国癌症病人已超过700万，初诊癌症<span style="color: black;">病人</span>的<span style="color: black;">病痛</span><span style="color: black;">出现</span>率约为25%，晚期癌症<span style="color: black;">病人</span>的<span style="color: black;">病痛</span><span style="color: black;">出现</span>率约为60%～80%，其中1/3<span style="color: black;">病人</span>为重度<span style="color: black;">病痛</span>。<span style="color: black;">药品</span>治疗是癌痛治疗最为<span style="color: black;">要紧</span>和常用的<span style="color: black;">办法</span>，规范、有效的<span style="color: black;">药品</span>治疗能够缓解80%～90% 癌症病人的<span style="color: black;">病痛</span>症状。常用<span style="color: black;">药品</span><span style="color: black;">包含</span>非甾体类抗炎药（NSAID）、阿片类<span style="color: black;">药品</span>和辅助<span style="color: black;">止疼</span><span style="color: black;">药品</span>（镇静剂、抗惊厥类<span style="color: black;">药品</span>和抗抑郁类<span style="color: black;">药品</span>等）。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">在规范化癌痛治疗中，应先进行<span style="color: black;">病痛</span><span style="color: black;">评定</span>。癌痛<span style="color: black;">评定</span>是<span style="color: black;">恰当</span>且有效进行<span style="color: black;">止疼</span>治疗的前提，<span style="color: black;">按照</span><span style="color: black;">评定</span>结果按“癌痛三阶梯<span style="color: black;">止疼</span>治疗”原则给予<span style="color: black;">止疼</span>药，给药时<span style="color: black;">尤其</span><span style="color: black;">重视</span>以下几个原则：</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（1）口服给药：口服给药简单方便，为癌痛治疗的首选给药途径，对不宜口服的病人可<span style="color: black;">选择</span>其他给药途径，如直肠给药、皮肤贴剂、静脉注射等。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（2）按阶梯用药：遵循三阶梯给药原则，有针对性地<span style="color: black;">选择</span>不同强度的<span style="color: black;">止疼</span><span style="color: black;">药品</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">l</span><span style="color: black;"><span style="color: black;">第1</span>阶梯（轻度<span style="color: black;">病痛</span>）：可<span style="color: black;">选择</span>非甾体类抗炎<span style="color: black;">药品</span>（如阿司匹林、对乙酰氨基酚）。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">l</span><span style="color: black;">第二阶梯（中度<span style="color: black;">病痛</span>）：可<span style="color: black;">选择</span>弱阿片类<span style="color: black;">药品</span>（如可待因）或低剂量的强阿片类<span style="color: black;">药品</span>。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">l</span><span style="color: black;">第三阶梯（重度<span style="color: black;">病痛</span>）：首选强阿片类药（如吗啡），并可合用非甾体类抗炎<span style="color: black;">药品</span>或对乙酰氨基酚以及辅助<span style="color: black;">止疼</span><span style="color: black;">药品</span>。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">第<span style="color: black;">1、</span>二阶梯<span style="color: black;">药品</span>在<span style="color: black;">运用</span>时,其药效有一个最高极限(即天花板效应) ，若<span style="color: black;">病痛</span>仍<span style="color: black;">不可</span><span style="color: black;">掌控</span>，应<span style="color: black;">选取</span>第三阶梯<span style="color: black;">药品</span>。此阶梯<span style="color: black;">药品</span><span style="color: black;">没</span>“天花板效应”。<span style="color: black;">倘若</span>病人就诊时<span style="color: black;">病痛</span><span style="color: black;">已经是</span>中度<span style="color: black;">病痛</span>，则从第二阶梯给药<span style="color: black;">起始</span>治疗。三阶梯疗法的治疗<span style="color: black;">次序</span>绝对不<span style="color: black;">能够</span>颠倒。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（3）按时给药：<span style="color: black;">根据</span>规定的间隔时间规律性给药，如每隔12 h一次，<span style="color: black;">没</span>论当时病人<span style="color: black;">是不是</span><span style="color: black;">病痛</span><span style="color: black;">爆发</span>都要给药，而不是按需给药。按时给药有助于维持稳定、有效的血药浓度。 </span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（4）个体化给药：<span style="color: black;">按照</span>病人个体差异制订个体化用药<span style="color: black;">方法</span>。<span style="color: black;">麻木</span><span style="color: black;">药物</span>的<span style="color: black;">敏锐</span>度个体差异很大，<span style="color: black;">因此</span>阿片类<span style="color: black;">药品</span>并<span style="color: black;">无</span>标准量，应<span style="color: black;">按照</span>个体对阿片类<span style="color: black;">药品</span>的耐受程度决定用药剂量。凡是能够缓解使<span style="color: black;">病痛</span>并<span style="color: black;">没</span>严重副<span style="color: black;">功效</span>的剂量<span style="color: black;">便是</span>正确剂量。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（5）<span style="color: black;">重视</span><span style="color: black;">详细</span>细节：对<span style="color: black;">运用</span><span style="color: black;">止疼</span><span style="color: black;">药品</span>的病人，要密切观察止痛效果和<span style="color: black;">药品</span>副<span style="color: black;">功效</span>，<span style="color: black;">发掘</span><span style="color: black;">反常</span><span style="color: black;">即时</span><span style="color: black;">减少</span>或停药，尽可能减少<span style="color: black;">药品</span>的不良反应，<span style="color: black;">加强</span>病人的生活质量。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">参考文献：</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">1.</span><span style="color: black;">癌症<span style="color: black;">病痛</span>管理药学专家共识</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">2.</span><span style="color: black;">癌症<span style="color: black;">病痛</span>管理药学专家共识</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3.江苏省成人癌症<span style="color: black;">病痛</span>诊疗规范（2020 年版）</span></p>
回顾过去一年，是艰难的一年；展望未来，是辉煌的一年。 论坛是一个舞台，让我们在这里尽情的释放自己。 同意、说得对、没错、我也是这么想的等。 “BS”（鄙视的缩写） 感谢你的精彩评论，为我的思绪打开了新的窗口。
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