癌痛的评估与护理(汉译英)

1、癌痛的评估与护理疼痛是癌症病人普遍存在的症状。尽管在止痛方面取得了巨大进展，但仍有三分之二 的癌症病人到晚期都要忍受癌痛的折磨。因此，需要护士具备处理癌痛的多方知识，掌握正确评估方法和治疗技术及恰当的护理。现就其综述如下。1癌性疼痛的护理评估1.1 视觉模拟评分法（Viraal Aualort Scale ，简称VAS）:该法比较灵敏，有可比性。具体做法是：在纸上面划一条10 cm的横线，横线的一端为0,表示无痛；另一端为10,表 示剧痛；中间部分表示不同程度的疼痛。让病人根据自我感觉在横线上划一记号，表示疼痛的程度。轻度疼痛平均值为2.57 ±1.04 ；中度疼痛平均值为 5.18

2、 ±1.41 ；重度疼痛平均值为 8.41 ±1.35。1.2 评估表法：它是由美国的McmilLan设计的疼痛估计表。即0等于无痛，1等于有疼痛感，但不严重；2等于轻微疼痛，病人不舒服；3等于疼痛，病人痛苦；4等于疼痛较 剧烈，有恐惧感；5等于剧痛。通过问答形式由病人做出具体描述。内容包括：疼痛程度、部位、性质、发作情况及伴发症状等。据报道此表设计合理，实用性强。1.3 口述评估法（Verbal Report） : Melzack拟定了 1份形容疼痛程度词汇，如轻度疼痛、重度疼痛、阵痛、可怕的痛及无法忍受的疼痛等来帮助病人描述自己的疼痛，使病人更好地把疼痛加以表达，按01

3、0分次序报告，0分表示无痛，10分表示剧痛。此法简 单，但不易发觉细微变化。2癌痛的止痛治疗2.1药物治疗：世界卫生组织（WHO）提出2000年消除癌症患者疼痛的奋斗目标 。其 提出的三级止痛方案是目前世界各地都在大力推行的癌前药物治疗准则。也称 按需给药”，即一级止痛：轻度疼痛使用非麻醉性镇痛药 。如阿斯匹林、扑热息痛等。二级止痛：中度持续性疼痛或加重 ，使用弱麻醉剂。如强痛定、可待因、美散痛等。三级止痛：强烈 持续性疼痛，使用强麻醉剂，直到疼痛消失。如吗啡、杜冷丁等。其主要给药途径有以下 几种：消化道给药：药物给药近来提倡口服为主，对慢性癌痛采用布罗芬与美散痛合用取得了良好效果，用布罗芬6

4、00 mg与美散痛2.55 mg合用，效果优于单独应用美散 痛，而不增加副作用。且对骨转移癌痛也有较好的止痛效果。研究中未发现布罗芬对十二指肠粘膜有损伤，认为布罗芬的安全性和较低的副作用是可取的。近年来开发的盐酸双氢吗啡控释片，克服了吗啡的某些副反应，又增加了镇痛效果。已成为需要麻醉止痛时的首 选药物。不能口服者也可直肠给药。芬太尼、buprenophine也可舌下给药。连续皮下或静脉给药：当大量口服止痛药不能控制疼痛时，或有严重的胃肠道反应如恶心、呕吐等副作用时，需采用连续皮下或静脉内输入麻醉剂：Sheider评估了这种方法，肯定了其给药的安全性和效能 ，现已普遍应用。2.1.3 皮肤给药：

5、近年来由于皮肤生理研究和制药技术的发展，皮肤与粘膜已经作为给药的新途径。有报道，一次芬太尼贴敷止痛可达72 h。虽使用方便，但价格昂贵。另外，中药外治法能使药物经皮肤吸收，起效快、安全、方便、毒副作用小。用药10 min即可见效，总有效率79.2%。2.1.4 病人控制的止痛(Patient Controleel Analgesir ,简称 PCA): PCA 方法 1984 年在美国被有效地应用。其方法是患者拥有一个用计数电子仪控制的注药泵。它可提供麻醉剂的剂量、剂量增减范围和估计2次剂量的间隔最短时间，以及提供一个稳定的注药间隔周期。能更好地取得疼痛控制效果，减少麻醉剂用量，减少副作用。但

6、其缺点是必须有一定设备，且价格昂贵。并可引起药物外渗、静脉炎及感染等。目前已研制出新型控制止病 人的痛药泵，分家庭用、护士用及防止用药过量的PCA 3种类型。不仅可防止病人用药过量，还可通过电脑程序控制持续输液中的止痛药浓度，以维持稳定的止痛效果，防止病人出现剧痛。麻醉技术控制癌痛：神经阻滞在晚期癌痛病人中已应用了多年，近年来提倡在早期癌痛患者中应用。通过导管或泵，连续或间断将药物输入硬膜外或鞘内。此法避免了口服给药和其他方法给药的副作用，同时还减少了辅助药物的应用。但也有人报道，全身先用阿片类药物治疗的病人，脊柱内再给阿片类药物则无治疗效果。神经外科技术控制癌痛：手术治疗的目的是在周围神经与

7、中枢神经之间某一点切断产生疼痛的途径。3癌痛的护理3.1 护理观念的更新：迅速有效地减轻癌痛是护理的基本要求，也是护士基本的责任。因此，护士应尽力发展提高癌痛的护理水平。癌痛的控制往往受病人、护士、药物组合多种因素的综合影响，而护士的密切观察和及时提供适应的止痛方法是控制癌痛重要因 素。这就需要护理教育计划从基础和临床上对药物的药理学和用药方式进一步加强，树立果断采取各种治疗手段，设法解除病人痛苦，提高病人生存质量延长生命的新观念，严格遵守有效控制疼痛的指导原则。3.2护士的作用准确评估：在对癌痛控制过程中，疼痛的评估是第一重要环节。护士不仅要客观地判断疼痛是否存在，还要确定疼痛的程度。在用药

8、前护士必须根据个体疼痛作出准确 的判断，采取相应措施，才能有效地减轻病人的痛苦。通过对1 400名注册护士问卷调查 表明，最佳处理疼痛的主要障碍是对疼痛估计不足，处理疼痛的知识不够及病人不愿报告疼痛。因此，对护士而言更重要的是有关疼痛的处理和用以解除癌痛的标准教育。准确及时给药：观察效果及副作用。包括了解治疗的基本原则，向病人说明接受治疗的效果及帮助病人正确用药，评估治疗效果，向医生报告以及副作用的防治等323 心理护理：要帮助病人树立信心。因势利导，调动病人积极的心理因素 ，帮助 克服其消极的心理因素 。争取病人信任，增强病人的安全感，稳定情绪，解除焦虑。注意 分散病人注意力。建立舒适家庭病

9、房”，因为舒适可使心理生理异常减轻到最低程度 。Assessment and care of cancer painPain is com mon symptom of can cer patie nts. Despite the pain has madetreme ndous progress, but there are still two-thirds of can cer patie nts to have to putup with adva need cancer pain of torture. Therefore, nu rses have the kno wledge of

10、handling multi-cancer pain, to master the correct assessment and treatmenttechniques and appropriate care. Is on its review as follows.1 A n urs ing assessme nt of cancer pain1.1 Visual an alogue scale (Viraal Aualort Scale, referred to as VAS): The moresensitive method, there are comparable. Specif

11、ically: In the paper, draw a 10 cmabove the horiz on tal li ne, horiz on tal li ne of the end of 0, in dicati ng no pain; theother side of 10, said the pain; the middle part of the vary ing degrees of pai n. Feelthe patie nt accord ing to a uniform mark on the horiz on tal li ne, in dicat ing the de

12、greeof pain. Mild pain, mean 2.57± 1.04; moderaiteapairage of 5.18± 1.41;moderate to severe pain, average 8.41± 1.35.1.2 Evaluati on form method: It was desig ned by the America n Pai n McmilLa n estimated table. That 0 equals no pain, 1 is equal to a pain, but not serious; 2 equals m

13、ild pain, patient discomfort; 3 is equal to the pain, the patient suffering; 4 is equalto more severe pain, there is fear; 5 equal to severe pain. Made through the Q & A specific description of the patient. Include: pain intensity, location, nature, and the con comita nt on set of symptoms.

14、It is reported that this table desig n is reas on able, practical.1.3 Oral Assessme nt Act (Verbal Report):Melzack 1 developed vocabulary to describe the degree of pain, such as mild pain, severe pain, pain, terrible pain and could not bear the pain to help patients describe their pain, so be patien

15、t to better express the pain, accord ing to 0 the order of 10 reports, 0 points in dicati ng no pain and 10 points indicating severe pain. This method is simple, but difficult to notice subtle cha nges.2 An algesic treatme nt of cancer pain2.1 Drug treatme nt:World Health Orga nization (WHO) propose

16、d in 2000 toeliminate pain in patients with the goal of cancer. The proposed three-tier program is pain all over the world promoting the use of pre-cancerous drug treatment guideli nes.Also called "on-dema nddelivery," that is a pain: mild pain, use ofnon-narcotic analgesics. Such as aspir

17、in, paracetamol and so on. Second pain: moderate persiste nt pain or in crease, the use of weak an esthetic. If give n strong pain, codei ne, methad one pain. Three levels of pai n: a strong persiste nt pai n, with a strong an esthetic, un til the pain disappears. Such as morphi ne, pethidi ne and s

18、o on. The main route of administration are the following:2.1.1 Gastr oin testi nal drug delivery: Rece ntly, the mai n advocate of oral drug delivery, chronic cancer pain using Bu Luofen methadone combined with the United States and achieved good results, with the United States with Bu Luofen 600 mg

19、 methad one 2.5 5 mg comb in ati on, more effective tha n methad one alone pain,without in creased side effects. And the pain of bone metastasis has a better an algesic effect. Study found no Bu Luofe n duode nal mucosa injury, that the Bu Luofen security and lower side effects is desirable. In rece

20、nt years the development of controlled-release morphine hydrochloride tablets hydrochlorothiazide and overcome some of the side effects of morphi ne, in creased the an algesic effect. Has become the first choice when the need for narcotic pain drugs. Those who can not be oral or rectaladm ini strati

21、 on.Fentanyl,bupre no phi nealso subli ngualadm ini strati on.2.1.2 Continuoussubcutaneousorintravenousinjection: Whena largenumber oforal painmedication cannot controlthe pain, or haveseriousgastr oin testi nal reacti ons such as n ausea, vomiti ng and other side effects, requiresthe use ofcon ti n

22、u oussubcuta neousorin trave nousan esthetic in put:Sheiderassessme ntof this approach, con firmedthe safetyof its adm ini strati on andperforma nee, is now widely used.2.1.3 Skin dose:In recent years, the physiology of the skin and pharmaceuticaltech no logy, drug delivery skin and mucous membra ne

23、s have bee n used as a new way. It has bee n reported, a fentanyl pain patchi ng up to 72 h. Although easy to use, but expe nsive. In additi on, the Chin ese exter nal treatme nt to make drugs absorbed through the skin, rapid on set, safety, convenien ce, drug side effects. 10 min treatme nt to be e

24、ffective, total effective rate 79.2%.2.1.4 Patie nt-c on trolled an algesia (Patie nt Con troleel An algesir, referred to asPCA): 1984 PCA method was applied effectively in the Un ited States. The method is that the patie nt has an electr onic in strume nt con trolled by coun ter drug in fusi on pum

25、p. It provides ane sthetic dose, dose range and the estimated in crease or decrease the in terval betwee n 2 doses of the shortest time, and provide a stable in terval betwee n injection cycles. Better access to effective pain con trol, reduce the amount of an esthetic age nts, reduce side effects.

26、But its drawback is that there must be some equipme nt, and expe nsive. And can cause drug extravasati on, phlebitis and in fecti on. Has developed a new type of con trol only the patie nt's pai n medicati on pumps, domestic use, the nurse and to preve nt overdose PCA 3 types. Not only preve nt

27、overdose patie nts, but also susta ined by the computer program con trol pain in fusi on drug concen trati on in order to mai ntain a stable an algesic effect, preve nt the patie nt developed severe pain.2.1.5 An esthesia con trol cancer pai n:Nerve block in patie nts with adva needcan cer has bee n

28、 in use for many years, in rece nt years to promote the applicati on of early cancer pain. Through the catheter or pump, continuous or intermittent epiduralor intrathecal drug importation.This method avoids the administrationof oralmedicati on and side effects of other methods, but also reduce the a

29、pplicati on of adjuvants. However, some reports, the body first with opioid therapy in patients with spinal opioids to give no treatme nt.2.1.6 Neural control of cancer pain surgical techniques: The purpose of surgical treatme nt of peripheral n erve and cen tral n ervous system is a point betwee n

30、the way off to pain.3 Cancer Pai n Care3.1 Renewing care: Quickly and effectively to reduce pain is the basic requireme nt of care is a basic resp on sibility of nu rses. Therefore, nu rses should try to develop sta ndards to improve the care of cancer pain. Can cer pain con trol are ofte n affected

31、 by patie nts, n urses, drug comb in ati ons combi ned effects of many factors,and nurses to provide close observationand timely adaptation to pain is animportantfactor in controllingcancer pain. This requires that nursing educationprograms from basic and cli ni cal pharmacology of drugs and drug us

32、e means to further stre ngthe n and establish a firm to take a variety of treatme nts to try to relieve the suffering of patients and improve the quality of life in patients with life-prolonging new ideas, strict compliance with effective control of pain guidelines.3.2 The role of n urses3.2.1 Accur

33、ate assessme nt of:In the course of pain con trol, pain assessme ntis the first important part. Nurses not only to objectively determine whether there is pain, but also to determine the degree of pain. Former nurse in the treatment of pain must be based on the in dividual to make accurate judgme nts, to take corresp onding measures, can effectively reduce the pain. By 1 400 registered nurses survey show