WHO癌症三阶梯止痛
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> 肿瘤<span style="color: black;">病人</span>的<span style="color: black;">病痛</span><span style="color: black;">出现</span>率高达70%，是<span style="color: black;">病人</span>最恐惧的症状之一，<span style="color: black;">非常多</span>肿瘤<span style="color: black;">病人</span>告诉<span style="color: black;">咱们</span>：“<span style="color: black;">医生</span>，只要不让我痛就行”。</span><span style="color: black;">是的，所有人都害怕<span style="color: black;">病痛</span>，抗击<span style="color: black;">病痛</span>从来都是肿瘤科<span style="color: black;">大夫</span>最应该<span style="color: black;">把握</span>的技能，它贯穿肿瘤治疗的始终。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="http://mmbiz.qpic.cn/mmbiz_jpg/qDeLc4kueibKDUwKbFlcplPMGXTSmj5p9r94XWzmxURFicgFDksJH3OzaNpAApQR49w7NN3bNCUl5ywBOWibm1QmA/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1986年世界卫生组织（WHO）<span style="color: black;">举荐</span>三阶梯止痛法，我国于1994年<span style="color: black;">颁布</span>的《癌症病人三阶梯止痛疗法的<span style="color: black;">指点</span>原则》提出了癌痛<span style="color: black;">药品</span>治疗<span style="color: black;">必要</span>遵守的五大原则。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><img src="http://mmbiz.qpic.cn/mmbiz_jpg/qDeLc4kueibJ3na4rUaWu5l3gMzLxoY5NlD6ewHgiaj0XdN55eeibNJq8Sb57uiaqnkwb1XQLcicc6k4NIsybSrIF4w/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">“三阶梯”<span style="color: black;">止疼</span><span style="color: black;">方法</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;">第1</span>阶梯</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">轻度<span style="color: black;">病痛</span>给予非阿片类(非甾类抗炎药)加减辅助止痛药。<span style="color: black;">重视</span>：非甾类止痛药存在最大有效剂量(天花板效应)的问题。常用<span style="color: black;">药品</span><span style="color: black;">包含</span>扑热息痛、阿司匹林、双氯芬酸盐、加合百服宁、布洛芬、芬必得(布洛芬缓释胶囊)、消炎痛、吲哚美辛、意施丁(吲哚美辛控释片)等。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">第二阶梯</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> 中度<span style="color: black;">病痛</span>给予弱阿片类加减非甾类抗炎药和辅助止痛药。弱阿片类<span style="color: black;">药品</span><span style="color: black;">亦</span>存在天花板效应。 常用<span style="color: black;">药品</span>有可待因、强痛定、曲马多、奇曼丁(曲马多缓释片)、双克因(可待因控释片)等等。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">第三阶梯</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">重度<span style="color: black;">病痛</span>给予阿片类加减非甾类抗炎药和辅助止痛药。强阿片类<span style="color: black;">药品</span><span style="color: black;">没</span>天花板效应，但可产生耐受，需适当<span style="color: black;">增多</span>剂量以克服耐受现象。以往认为用吗啡止痛会成瘾，<span style="color: black;">因此</span>不愿给<span style="color: black;">病人</span>用吗啡，<span style="color: black;">此刻</span>证明这个观点是错误的———<span style="color: black;">运用</span>吗啡的癌痛<span style="color: black;">病人</span>极少产生成瘾性。此阶梯常用<span style="color: black;">药品</span>有吗啡片、美菲康(吗啡缓释片)、美施康定(吗啡控释片，可直肠给药)等等。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><img src="http://mmbiz.qpic.cn/mmbiz_jpg/qDeLc4kueibKDUwKbFlcplPMGXTSmj5p9FzsIKWSQQ6fiax7AOZgW6Ee2RcAPwBbXQ55maDvPNia8qjH0zkMehA7g/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></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;"> “五原则”为：</span></span><span style="color: black;">按阶梯给药、口服、按时给药、个体化、<span style="color: black;">重视</span><span style="color: black;">详细</span>细节。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><img src="http://mmbiz.qpic.cn/mmbiz_png/qDeLc4kueibKDUwKbFlcplPMGXTSmj5p9wDSmX0L6bjic0cKBRZkV6GKh3ia3WYwLRGsvWiaf58SKkVOn6lAxBTfuQ/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> 1、按阶</span><span style="color: black;">梯给药</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2、口<span style="color: black;">吃下</span>药：口服依然是首选给药途径。能口服的<span style="color: black;">尽可能</span>口服，仅在严重恶心、呕吐，<span style="color: black;">不可</span>吞咽等<span style="color: black;">状况</span>下的<span style="color: black;">病人</span>才<span style="color: black;">思虑</span>其它给药途径。</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><span style="color: black;">药品</span>的半衰期及<span style="color: black;">功效</span>时间，<span style="color: black;">按时</span>给药，目的是使<span style="color: black;">病痛</span>得到<span style="color: black;">连续</span>的缓解。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4、用药个体化：<span style="color: black;">按照</span><span style="color: black;">病人</span><span style="color: black;">病痛</span>强度、性质，对生活质量的影响，对<span style="color: black;">药品</span>的耐受性、偏爱性、经济承受能力，个体化的<span style="color: black;">选取</span><span style="color: black;">药品</span>，确定剂量.</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：对用止痛药的<span style="color: black;">病人</span>要<span style="color: black;">重视</span>监护，密切观察其反应。使<span style="color: black;">病人</span><span style="color: black;">得到</span>最佳疗效而<span style="color: black;">出现</span>的副<span style="color: black;">功效</span>最小，<span style="color: black;">加强</span><span style="color: black;">病人</span>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;"><img src="http://mmbiz.qpic.cn/mmbiz_jpg/qDeLc4kueibKDUwKbFlcplPMGXTSmj5p9DIrCrz8zYnMjYRI5T0tu2d80xKd5cibqdJBdY3n1u8fdp8jCuNwITWg/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></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;"><span style="color: black;">按时用癌痛药治疗，90%以上的癌症病人<span style="color: black;">能够</span>得到缓解，部分病人<span style="color: black;">因为</span></span><span style="color: black;">病痛</span><span style="color: black;">的消失，使<span style="color: black;">自信心</span>增</span></span><span style="color: black;">加，得以改善<span style="color: black;">存活</span>质量，延长生命。</span></span></p>
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