专访瑞金医院肿瘤科专家张俊：病痛不是错，癌痛不要忍
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">21世纪经济<span style="color: black;">报告</span>记者 武瑛港 实习生 孙航星 北京<span style="color: black;">报告</span> </strong>“<span style="color: black;">大夫</span>和<span style="color: black;">病人</span>要密切关注胃肠道肿瘤诊疗中可能<span style="color: black;">显现</span>的<span style="color: black;">病痛</span>。<span style="color: black;">并不</span>仅是胃肠道肿瘤，几乎所有瘤种的诊疗都要<span style="color: black;">注意</span>和关注癌痛管理，一方面要加强对癌痛的科普，转变<span style="color: black;">病人</span>及其家属的认知误区，癌痛不是错，规范<span style="color: black;">运用</span><span style="color: black;">止疼</span><span style="color: black;">药品</span>可有效缓解<span style="color: black;">病痛</span>，另一方面医务人员要对<span style="color: black;">病痛</span>进行科学<span style="color: black;">评定</span>，<span style="color: black;">知道</span><span style="color: black;">出现</span><span style="color: black;">原由</span>、确定治疗<span style="color: black;">目的</span>，对<span style="color: black;">病人</span>进行针对性、个性化诊疗。” <span style="color: black;">近期</span>，上海交通大学医学院<span style="color: black;">附庸</span>瑞金医院肿瘤科<span style="color: black;">专家</span>张俊在接受21世纪经济<span style="color: black;">报告</span>专访时<span style="color: black;">暗示</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q6.itc.cn/q_70/images03/20240401/03eac708b83f471c8c88b4ddca833e64.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">上海交通大学医学院<span style="color: black;">附庸</span>瑞金医院肿瘤科<span style="color: black;">专家</span>张俊</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2024年2月《国家癌症中心杂志》<span style="color: black;">颁布</span>了基于国家癌症中心肿瘤登记及随访监测的“2022年中国恶性肿瘤疾病<span style="color: black;">包袱</span><span style="color: black;">状况</span>”<span style="color: black;">关联</span>数据，2022年中国恶性肿瘤新发病例482.47万，总死亡人数为257.42万，排名前五的癌种分别为肺癌（106.06万）、结直肠癌（51.71万）、甲状腺癌（46.61万）、肝癌（36.77万）和胃癌（35.87万）。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">病痛</span>是癌症<span style="color: black;">病人</span>的<span style="color: black;">平常</span>症状之一，《2020中国癌症<span style="color: black;">病人</span><span style="color: black;">存活</span>质量白皮书》<span style="color: black;">说到</span>，57.4%的癌症<span style="color: black;">病人</span>会<span style="color: black;">显现</span><span style="color: black;">区别</span>程度的<span style="color: black;">病痛</span>，病理分期越晚，<span style="color: black;">病痛</span>程度高的<span style="color: black;">病人</span>占比越多。然而部分肿瘤早诊的<span style="color: black;">状况</span>似乎并不<span style="color: black;">阳光</span>，<span style="color: black;">因为</span><span style="color: black;">都数</span><span style="color: black;">初期</span>胃癌<span style="color: black;">病人</span><span style="color: black;">没</span>症状或症状与其他胃病<span style="color: black;">类似</span>，我国<span style="color: black;">初期</span>胃癌的诊断率不到10%。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因此呢</span><span style="color: black;">怎样</span>最大程度地减少肿瘤<span style="color: black;">病人</span>的<span style="color: black;">病痛</span>，已<span style="color: black;">作为</span>临床诊疗中不可<span style="color: black;">忽略</span>的<span style="color: black;">要紧</span>环节。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">癌痛不要忍，<span style="color: black;">病痛</span>别愧疚</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">癌痛<span style="color: black;">不仅</span>是肿瘤<span style="color: black;">引起</span>，张俊对21世纪经济<span style="color: black;">报告</span>记者<span style="color: black;">暗示</span>，在治疗过程中<span style="color: black;">有些</span><span style="color: black;">关联</span>不良反应<span style="color: black;">亦</span>可能会<span style="color: black;">引起</span><span style="color: black;">病痛</span>或不适，如神经的牵涉、肿块的压迫、<span style="color: black;">长时间</span>化疗用药<span style="color: black;">引起</span>的外周神经毒性<span style="color: black;">导致</span>的四肢麻木以及打升白针<span style="color: black;">导致</span>的关节<span style="color: black;">病痛</span>等，<span style="color: black;">另一</span>，酸胀有时<span style="color: black;">亦</span>是痛的一种<span style="color: black;">表现</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">“<span style="color: black;">咱们</span>还要关注胃肠道肿瘤诊疗中比较典型的<span style="color: black;">病痛</span>，<span style="color: black;">例如</span>胃部痉挛、胃肠道梗阻<span style="color: black;">导致</span>的绞痛和胃肠道穿孔<span style="color: black;">导致</span>的剧烈<span style="color: black;">病痛</span>，<span style="color: black;">病人</span><span style="color: black;">显现</span>后两者<span style="color: black;">病痛</span>，<span style="color: black;">必定</span>要<span style="color: black;">即时</span>寻求<span style="color: black;">大夫</span><span style="color: black;">帮忙</span>。”张俊强调。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">据<span style="color: black;">认识</span>，癌性<span style="color: black;">病痛</span>由多种<span style="color: black;">原因</span><span style="color: black;">引起</span>，<span style="color: black;">包含</span>肿瘤细胞浸润、压迫神经、空腔脏器梗阻和组织坏死等，属于中晚期癌症<span style="color: black;">病人</span><span style="color: black;">平常</span>的<span style="color: black;">伴同</span>症状，<span style="color: black;">关联</span><span style="color: black;">科研</span><span style="color: black;">表示</span>，中晚期癌症<span style="color: black;">病人</span>癌性<span style="color: black;">病痛</span>的<span style="color: black;">出现</span>率<span style="color: black;">达到</span>60%～80%，且重度<span style="color: black;">病痛</span>占30%以上。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因为</span>癌痛<span style="color: black;">拥有</span><span style="color: black;">显著</span>的<span style="color: black;">繁杂</span>性，张俊告诉21世纪经济<span style="color: black;">报告</span>，<span style="color: black;">大夫</span><span style="color: black;">首要</span>要对<span style="color: black;">病痛</span>进行科学的<span style="color: black;">评定</span>，并<span style="color: black;">知道</span>可能<span style="color: black;">引起</span><span style="color: black;">病痛</span>的<span style="color: black;">原由</span>，找到<span style="color: black;">病痛</span>管理<span style="color: black;">必须</span>治疗的<span style="color: black;">详细</span><span style="color: black;">目的</span>，<span style="color: black;">而后</span>才是<span style="color: black;">选取</span><span style="color: black;">止疼</span>方式，利用<span style="color: black;">药品</span>或其他医疗手段治疗。“<span style="color: black;">由于</span>癌性<span style="color: black;">病痛</span>有时不仅是单纯的痛，<span style="color: black;">病痛</span>虽然讲起来<span style="color: black;">仅有</span>两个字，但其实有<span style="color: black;">非常多</span><span style="color: black;">区别</span>表现，<span style="color: black;">暗地里</span>又可能是<span style="color: black;">区别</span>的<span style="color: black;">原由</span>，针对<span style="color: black;">详细</span><span style="color: black;">原由</span>分析之后，<span style="color: black;">咱们</span>会采取<span style="color: black;">区别</span>的办法来应对。”</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">据介绍，关于癌痛的<span style="color: black;">评定</span>，临床实践中较多运用数字分级法进行量化<span style="color: black;">评定</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">“<span style="color: black;">病痛</span><span style="color: black;">通常</span>分三种程度，轻度、中度和重度，<span style="color: black;">咱们</span><span style="color: black;">通常</span>以0~10分来<span style="color: black;">评定</span>，0~4分属于轻度<span style="color: black;">病痛</span>，4~7分属于中度<span style="color: black;">病痛</span>，7分以上属于重度<span style="color: black;">病痛</span>。<span style="color: black;">针对</span><span style="color: black;">区别</span>程度<span style="color: black;">病痛</span>，癌痛治疗<span style="color: black;">必须</span>依据WHO规定的‘三阶梯治疗基本原则’开展用药。” 除了<span style="color: black;">评定</span>标准，张俊进一步强调，更<span style="color: black;">要紧</span>的是<span style="color: black;">病人</span>要将主观<span style="color: black;">病痛</span>感受<span style="color: black;">即时</span><span style="color: black;">通知</span>医护，<span style="color: black;">才可</span>便于后续病情分析和治疗。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">然则</span><span style="color: black;">日前</span>似乎仍有不少肿瘤<span style="color: black;">病人</span>对<span style="color: black;">病痛</span>缺乏正确的认知，认为<span style="color: black;">病痛</span>应该忍耐、<span style="color: black;">不该</span>该讲出来。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">张俊对21世纪经济<span style="color: black;">报告</span><span style="color: black;">暗示</span>，<span style="color: black;">非常多</span>肿瘤<span style="color: black;">病人</span>对<span style="color: black;">病痛</span>有愧疚感，认为是自己的错，<span style="color: black;">必定</span>要忍住、克服<span style="color: black;">病痛</span>，羞于表达<span style="color: black;">病痛</span>，这些认识都不正确，<span style="color: black;">病人</span>会<span style="color: black;">没</span>时<span style="color: black;">没</span>刻都在被<span style="color: black;">病痛</span>煎熬，反而影响<span style="color: black;">疾患</span>治疗，<span style="color: black;">因此呢</span><span style="color: black;">咱们</span><span style="color: black;">必须</span>做好<span style="color: black;">病痛</span>管理知识的普及，纠正这些误区。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">“要<span style="color: black;">晓得</span>，世界卫生组织将<span style="color: black;">病痛</span>与血压、体温、<span style="color: black;">呼气</span>、脉搏<span style="color: black;">一块</span>列为人类五大生命体征，<span style="color: black;">病痛</span>是生命体征的<span style="color: black;">要紧</span>指标，关于<span style="color: black;">病痛</span>的<span style="color: black;">科研</span><span style="color: black;">亦</span>越来越被<span style="color: black;">注意</span>。”张俊<span style="color: black;">暗示</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">张俊进一步指出，还有部分<span style="color: black;">病人</span>及家属会对阿片类<span style="color: black;">药品</span>产生恐惧，担心用量和成瘾等问题。“<span style="color: black;">她们</span>觉得<span style="color: black;">病痛</span>要吃吗啡，吗啡<span style="color: black;">便是</span>鸦片，就相当于‘抽大烟’，岂不是<span style="color: black;">成为了</span>吸毒者，这是非常不科学的、陈旧的想法，但<span style="color: black;">长时间</span><span style="color: black;">败兴</span>，这一想法在<span style="color: black;">非常多</span>民众的脑海中根深蒂固。”</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">据<span style="color: black;">认识</span>，<span style="color: black;">长时间</span>临床实践证明，以止痛治疗为目的，阿片类<span style="color: black;">药品</span>在常规剂量规范化<span style="color: black;">运用</span><span style="color: black;">状况</span>下，<span style="color: black;">病人</span><span style="color: black;">显现</span>成瘾的现象极为罕见，<span style="color: black;">长时间</span><span style="color: black;">吃下</span>吗啡和其他阿片类<span style="color: black;">药品</span>的<span style="color: black;">病人</span>中，成瘾的<span style="color: black;">病人</span>只占0.029%和0.033%。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">“在规范<span style="color: black;">运用</span>的<span style="color: black;">状况</span>下，<span style="color: black;">通常</span>并不会<span style="color: black;">显现</span><span style="color: black;">病人</span>所担心的阿片类<span style="color: black;">药品</span>成瘾现象，<span style="color: black;">况且</span>在<span style="color: black;">实质</span>治疗中，肿瘤<span style="color: black;">大夫</span>始终在与时俱进地学习，<span style="color: black;">提高</span>癌痛管理能力，<span style="color: black;">注意</span><span style="color: black;">病人</span>感受，<span style="color: black;">持续</span>注重<span style="color: black;">恰当</span>用药、合适剂量、稳定<span style="color: black;">运用</span>以及<span style="color: black;">即时</span><span style="color: black;">评定</span>等问题。”张俊指出。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">治疗对象不只是肿瘤，而是一个人</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">“<span style="color: black;">咱们</span><span style="color: black;">大夫</span>常说，治疗的对象不是一个肿瘤，而是一个人。” 张俊对21世纪经济<span style="color: black;">报告</span><span style="color: black;">暗示</span>， 癌症<span style="color: black;">病痛</span>管理的<span style="color: black;">重点</span><span style="color: black;">目的</span>有三个：<span style="color: black;">第1</span><span style="color: black;">期盼</span><span style="color: black;">病人</span>能<span style="color: black;">没</span>痛<span style="color: black;">睡觉</span>；第二<span style="color: black;">期盼</span><span style="color: black;">病人</span>能<span style="color: black;">没</span>痛<span style="color: black;">休憩</span>；第三是<span style="color: black;">期盼</span><span style="color: black;">病人</span>能够<span style="color: black;">没</span>痛活动。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">据《2020中国癌症<span style="color: black;">病人</span><span style="color: black;">存活</span>质量白皮书》，七成以上的受访癌症<span style="color: black;">病人</span>存在<span style="color: black;">睡觉</span><span style="color: black;">阻碍</span>，“难以入睡且易醒”、“<span style="color: black;">夜晚</span>睡过觉，<span style="color: black;">白日</span>依然昏昏欲睡”、“失眠后心情烦闷”是这部分群体<span style="color: black;">平常</span>的三大<span style="color: black;">睡觉</span>问题，分别占28.8%、13.7%、11.1%。近年来，社会各界<span style="color: black;">长时间</span>呼吁将缓解<span style="color: black;">病痛</span><span style="color: black;">做为</span>癌症<span style="color: black;">病人</span><span style="color: black;">不该</span>被<span style="color: black;">忽略</span>的基本健康诉求，癌痛管理<span style="color: black;">亦</span>越来越<span style="color: black;">作为</span>癌症治疗中不可或缺的环节。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">“<span style="color: black;">咱们</span><span style="color: black;">始终</span>倡导对癌症的全病程管理和全症状<span style="color: black;">掌控</span>。”据张俊介绍，<span style="color: black;">病痛</span>管理其实是肿瘤全病程管理的<span style="color: black;">要紧</span>指标，<span style="color: black;">日前</span>上海交通大学医学院<span style="color: black;">附庸</span>瑞金医院肿瘤科已<span style="color: black;">创立</span>了“五个<span style="color: black;">没</span>”的<span style="color: black;">重要</span>临床指标。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">一是<span style="color: black;">没</span>痛，<span style="color: black;">期盼</span><span style="color: black;">病人</span>能够真正做到<span style="color: black;">没</span>痛活动、<span style="color: black;">没</span>痛<span style="color: black;">休憩</span>和<span style="color: black;">没</span>痛<span style="color: black;">睡觉</span>；二是<span style="color: black;">没</span>呕，<span style="color: black;">尽可能</span>预防和降低抗肿瘤<span style="color: black;">药品</span>治疗<span style="color: black;">引起</span>的恶心、呕吐等胃肠道反应；三是<span style="color: black;">没</span>饿，<span style="color: black;">经过</span>完善的营养<span style="color: black;">评定</span>、<span style="color: black;">即时</span>的营养<span style="color: black;">干涉</span>和营养<span style="color: black;">意见</span>，使<span style="color: black;">病人</span>体重维持在较稳定的指标，<span style="color: black;">从而</span>维持免疫力和抵抗力；四是<span style="color: black;">没</span>丑，减少<span style="color: black;">由于</span>接受抗肿瘤<span style="color: black;">药品</span>所<span style="color: black;">引起</span>的皮肤变化，这<span style="color: black;">亦</span>是维持<span style="color: black;">病人</span>自信的<span style="color: black;">重要</span><span style="color: black;">行径</span>；五是<span style="color: black;">没</span>忧，<span style="color: black;">经过</span><span style="color: black;">包含</span>心理辅导在内的一系列<span style="color: black;">干涉</span>，使肿瘤<span style="color: black;">病人</span>尽快回归到家庭角色和社会角色<span style="color: black;">其中</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">张俊向21世纪经济<span style="color: black;">报告</span>介绍，<span style="color: black;">针对</span><span style="color: black;">病人</span>缺少癌痛<span style="color: black;">关联</span>认知的<span style="color: black;">状况</span>，除了加强科学普及，医护对癌痛进行筛查<span style="color: black;">亦</span>已<span style="color: black;">作为</span>肿瘤科的长效常态工作，上海交通大学医学院<span style="color: black;">附庸</span>瑞金医院探索综合性医院肿瘤规范诊疗管理体系构建，已<span style="color: black;">创立</span>起一支癌痛规范化诊疗队伍，对<span style="color: black;">区别</span>的病人进行<span style="color: black;">评定</span>和规范化处理。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">“<span style="color: black;">日前</span><span style="color: black;">咱们</span>在癌痛管理方面有专职的<span style="color: black;">大夫</span>和专业的护理同事，<span style="color: black;">她们</span>会对<span style="color: black;">每一个</span>病人进行个性化<span style="color: black;">评定</span>，<span style="color: black;">针对</span>存在<span style="color: black;">病痛</span>的癌症<span style="color: black;">病人</span><span style="color: black;">即时</span>加以规范化处理和实时记录，之后还会<span style="color: black;">连续</span>跟进和<span style="color: black;">评定</span>，做到以<span style="color: black;">病人</span>为中心的<span style="color: black;">恰当</span>用药。”张俊<span style="color: black;">暗示</span>。</p>
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