癌痛治疗药物的运用办法及注意事项，专家来解答丨直播回顾
<img src="https://mmbiz.qpic.cn/mmbiz_gif/Oic1ISJQh4wGfFSBNxW3OwXRPY9KLOlA3Zxl1zDK6JiczmwAfL12uSwUdo4JojAQVWFRibUmicib8VAlI6zlwsXFWtg/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;"><p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">点击下方关注，抗癌知识不<span style="color: black;">错失</span>~</strong></p><img src="https://mmbiz.qpic.cn/sz_mmbiz_png/dFkdDX0DErEKIHfN61ibsP0NFBbsT2D2icYAIhoJ0Yl7FYhPfibpV0iaiaB3sQMo9mibahPzCPicmQvkojqAqR77bibZZw/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这次</span>由靓超版主，sunflower整理。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">审核：鹰版，陈蒙蒙教授。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">北京清华长庚医院<span style="color: black;">病痛</span>科特聘专家</span></strong><strong style="color: blue;"><span style="color: black;">王昆教授</span></strong>的直播精华内容，<span style="color: black;">帮忙</span><span style="color: black;">大众</span><span style="color: black;">一起</span>战胜癌痛。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">主讲嘉宾介绍</strong></p><img src="https://mmbiz.qpic.cn/sz_mmbiz_png/dFkdDX0DErEKIHfN61ibsP0NFBbsT2D2icymRKMfF2xGwOxicMrqNINnLlvk0raKz4GXQ5eojL5uic893vWm1sicuibA/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">王昆</strong><strong style="color: blue;">教授</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">北京清华长庚医院</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">病痛</span>科特聘专家</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">天津医科大学肿瘤医院<span style="color: black;">病痛</span>科、营养科<span style="color: black;">专家</span>医师</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">中国抗癌协会癌症<span style="color: black;">恢复</span>与姑息治疗专业委员会副<span style="color: black;">专家</span>、难治性癌痛学组组长</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">中国医促会肿瘤舒缓治疗学分会副<span style="color: black;">专家</span>委员</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">中华医学会<span style="color: black;">病痛</span>学分会常员、癌痛学组组长</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">中国抗癌协会<span style="color: black;">麻木</span>与<span style="color: black;">止疼</span>专业委员会常委</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">中国医师协会<span style="color: black;">病痛</span>专业委员会常委</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">中国抗癌协会肿瘤心理学专业委员会常委</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">中国抗癌协会肿瘤营养专业委员会委员</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">观看直播回放，请点击<span style="color: black;">文案</span>最下方<span style="color: black;"><strong style="color: blue;">【阅读原文】</strong></span>观看。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">大部分的癌痛病人和家属觉得癌痛<span style="color: black;">便是</span>肿瘤治疗过程<span style="color: black;">其中</span>的终末<span style="color: black;">周期</span>，这是一个非常大的错误。</strong></span><span style="color: black;">咱们</span>在临床中有一个<span style="color: black;">尤其</span>奇怪的现象：在治疗肿瘤的时候，家属就带病人<span style="color: black;">一块</span>去医院，让<span style="color: black;">大夫</span>赶紧<span style="color: black;">瞧瞧</span>这个病怎么去治，<span style="color: black;">药品</span>怎么抗癌，怎么去化疗手术，怎么接受抗肿瘤治疗。但一到“疼”的时候，家属基本都不让病人去，认为家属说一说就行，<span style="color: black;">大夫</span>直接给病人开个药就<span style="color: black;">能够</span>了。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在临床中经常<span style="color: black;">能够</span>遇到两种病人，<span style="color: black;">第1</span>种认为止痛药很容易上瘾，<span style="color: black;">因此</span>疼的厉害了再吃，<span style="color: black;">尽可能</span>忍着不吃。<span style="color: black;">另一</span>一种<span style="color: black;">便是</span>害怕用了阿片类止痛药之后，以后无药可用了，<span style="color: black;">因此</span><span style="color: black;">始终</span>用初级止痛药勉强维持。<span style="color: black;">另一</span>还有人把癌痛治疗想的过于简单，说到癌痛<span style="color: black;">便是</span>吃药、打针，并且错误的认为打针是最好的止痛方式。<strong style="color: blue;"><span style="color: black;"><span style="color: black;">实质</span>上在临床经历<span style="color: black;">其中</span>，凡是靠打针止痛的病人，不仅止痛效果差，<span style="color: black;">况且</span><span style="color: black;">病人</span>心理<span style="color: black;">亦</span>会受到煎熬，看着表忍着疼等着到时间打针，<span style="color: black;">况且</span>随着用药时间越来越长，<span style="color: black;">药品</span>耐受的<span style="color: black;">显现</span>，针剂的<span style="color: black;">功效</span>时间会越来越短，剂量越来越大，效果越来越差。</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">癌痛的核心，是肿瘤给人体带来的一种<span style="color: black;">损伤</span>的表现。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">慢痛有两个特点，<span style="color: black;">第1</span>点：<span style="color: black;">病痛</span>是有上限的，不会无限度<span style="color: black;">连续</span>加重。第二点：很少的慢痛会<span style="color: black;">导致</span>严重的功能问题。而癌痛恰恰相反，<span style="color: black;">病痛</span>会<span style="color: black;">连续</span>加重，<span style="color: black;">况且</span>随着<span style="color: black;">病痛</span>时间的推移，<span style="color: black;">药品</span>治疗效能越来越差，<span style="color: black;">同期</span>可能<span style="color: black;">出现</span>严重的功能<span style="color: black;">损害</span>，而功能<span style="color: black;">损害</span>是<span style="color: black;">引起</span>病人<span style="color: black;">存活</span>质量变差的核心问题。<span style="color: black;">因此</span>癌痛<span style="color: black;">不仅</span>是<span style="color: black;">病痛</span>问题，而应该<span style="color: black;">做为</span>一个<span style="color: black;">疾患</span>诊治。今天<span style="color: black;">咱们</span><span style="color: black;">重点</span>讨论癌痛的<span style="color: black;">药品</span>治疗，<span style="color: black;">然则</span><span style="color: black;">咱们</span><span style="color: black;">亦</span>应该<span style="color: black;">晓得</span>，<span style="color: black;"><strong style="color: blue;">药物治疗仅仅是癌痛诊治的一个方式，并不是<span style="color: black;">所有</span>的治疗手段</strong></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>曾经做过 100 例的随机性调查，最后<span style="color: black;">发掘</span>有60% 以上的病人的处方执行能力是<span style="color: black;">不足</span>的，大概在家的病人有 70% 以上在忍受<span style="color: black;">病痛</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">那核心问题是什么呢？就在于病人和家属对<span style="color: black;">病痛</span>的态度是跟病人<span style="color: black;">状况</span>不匹配的。换而言之，<span style="color: black;">非常多</span>的<span style="color: black;">病痛</span>治疗效果<span style="color: black;">欠好</span>，不是<span style="color: black;">大夫</span>能力<span style="color: black;">不足</span>，是病人和家属对<span style="color: black;">病痛</span>的错误观念<span style="color: black;">引起</span>了治疗<span style="color: black;">结果</span>的<span style="color: black;">欠好</span>，而一旦<span style="color: black;">显现</span>非常严重的功能问题后，丧失了最佳<span style="color: black;">机会</span>，病人的<span style="color: black;">结果</span>就非常的悲惨。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">因此</span>在<span style="color: black;">全部</span>癌痛治疗<span style="color: black;">其中</span>，<span style="color: black;">咱们</span><span style="color: black;">必要</span>要把癌痛问题<span style="color: black;">做为</span>一个<span style="color: black;">疾患</span>来对待，<span style="color: black;">做为</span>重点的改善病人生活质量的一个<span style="color: black;">目的</span>来对待。要尊重<span style="color: black;">大夫</span>对病人的治疗<span style="color: black;">方法</span>，要执行好<span style="color: black;">方法</span>，有问题<span style="color: black;">即时</span>跟<span style="color: black;">大夫</span>去沟通，<span style="color: black;">即时</span>关注病人内心的痛苦。<span style="color: black;">同期</span>，<span style="color: black;">恰当</span>用药之后必然是能<span style="color: black;">得到</span>很好的治疗效果的。处方的依从性<span style="color: black;">必要</span>要好，<span style="color: black;">必要</span>要按<span style="color: black;">大夫</span>的处方严格的执行，来达成最好的治疗效果。</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">1</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">WHO三阶梯</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">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>(NSAIDs)</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">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>或低剂量的强阿片类<span style="color: black;">药品</span>，并可联合应用非甾体类抗炎<span style="color: black;">药品</span>以及辅助<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)</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">重度<span style="color: black;">病痛</span>：首选强阿片类药，并可合用非甾体类抗炎<span style="color: black;">药品</span>以及辅助<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)</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">实质</span>上，WHO第二阶梯<span style="color: black;">止疼</span><span style="color: black;">药品</span>的<span style="color: black;">运用</span>尚存争议，<span style="color: black;">由于</span>弱阿片类<span style="color: black;">药品</span>存在“天花板效应”，<span style="color: black;">因此呢</span><strong style="color: blue;"><span style="color: black;"><span style="color: black;">针对</span>轻中度<span style="color: black;">病痛</span>，可<span style="color: black;">思虑</span>以低剂量强阿片类<span style="color: black;">药品</span>替代弱阿片类<span style="color: black;">药品</span>与非阿片类<span style="color: black;">药品</span>联合<span style="color: black;">止疼</span></span></strong>。<span style="color: black;">日前</span>在临床实践中，<span style="color: black;">已然</span>有第四阶梯疗法，即三阶梯疗法之上<span style="color: black;">增多</span><span style="color: black;">病痛</span>介入治疗，即<span style="color: black;">重点</span><span style="color: black;">包含</span>区域阻滞技术、PCA泵、神经毁损阻断技术和鞘内<span style="color: black;">药品</span>输注系统等。<span style="color: black;">倘若</span><span style="color: black;">起始</span><span style="color: black;">便是</span>严重的、中重度<span style="color: black;">病痛</span>，<span style="color: black;">咱们</span><span style="color: black;">是不是</span><span style="color: black;">亦</span><span style="color: black;">必须</span>严格<span style="color: black;">根据</span>三阶梯原则，进行“爬”阶梯给药？当然不是，对<span style="color: black;">初始</span><span style="color: black;">便是</span>慢性和中、重度<span style="color: black;">病痛</span>及难治性癌痛，可弱化第二阶梯，直接进入第三和第四阶梯治疗。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">癌痛治疗<span style="color: black;">目的</span>：1. <span style="color: black;">病人</span><span style="color: black;">病痛</span>评分≤3分；2. 24小时<span style="color: black;">病痛</span>频率≤3次；3. 24小时内<span style="color: black;">必须</span>解救<span style="color: black;">药品</span>≤3次；4. 尽可能在24小时之内<span style="color: black;">掌控</span><span style="color: black;">病痛</span>。</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">2</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">癌痛常用<span style="color: black;">药品</span><span style="color: black;">归类</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">癌痛诊疗的常用<span style="color: black;">药品</span>大致<span style="color: black;">能够</span>分三大类：非甾体类抗炎药和对乙酰氨基酚，阿片类<span style="color: black;">药品</span>，以及辅助<span style="color: black;">止疼</span>药物。</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">1</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">非甾体类抗炎药（NSAIDs）</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">特点</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这类药<span style="color: black;">咱们</span>叫解热<span style="color: black;">止疼</span>药，它<span style="color: black;">亦</span>是最初级的<span style="color: black;">止疼</span><span style="color: black;">药品</span>，是<span style="color: black;">咱们</span>平常有牙疼<span style="color: black;">或</span>腰背痛常常吃的药。这类药的核心有两点，<strong style="color: blue;"><span style="color: black;"><span style="color: black;">第1</span>点它的<span style="color: black;">止疼</span>的机制跟阿片是不<span style="color: black;">同样</span>的，它是<span style="color: black;">经过</span>抗炎的形式来减轻<span style="color: black;">病痛</span>。第二点这些<span style="color: black;">药品</span>的<span style="color: black;">运用</span>剂量有上限</span></strong>。<span style="color: black;">咱们</span><span style="color: black;">晓得</span>炎症是<span style="color: black;">病痛</span>的放大器，有<span style="color: black;">非常多</span>骨转移<span style="color: black;">病痛</span>的病人，有时吃非甾体抗炎药<span style="color: black;">乃至</span>比<span style="color: black;">运用</span>阿片类<span style="color: black;">药品</span>效果更好。<span style="color: black;">由于</span>骨转移<span style="color: black;">病痛</span>大部分都会有炎症表达过度的<span style="color: black;">状况</span>，把炎症的问题降下来，病人<span style="color: black;">病痛</span>的层级就下降，<span style="color: black;">病痛</span>就能得到有效的改善。非甾体类抗炎<span style="color: black;">药品</span>和对乙酰氨基酚常用于缓解轻度<span style="color: black;">病痛</span>，或与阿片类<span style="color: black;">药品</span>联合用于缓解轻、中度<span style="color: black;">病痛</span>，常用于癌痛治疗的非甾体类抗炎<span style="color: black;">药品</span><span style="color: black;">表率</span><span style="color: black;">药品</span><span style="color: black;">包含</span>：布洛芬、塞来昔布、对乙酰氨基酚等。<span style="color: black;"><strong style="color: blue;">非甾体类抗炎<span style="color: black;">药品</span>与阿片类<span style="color: black;">药品</span>联用可减少阿片用量及不良反应，<span style="color: black;">亦</span>不存在耐受性和成瘾性的问题，<span style="color: black;">然则</span>缺点在于存在封顶效应，即用药剂量达<span style="color: black;">必定</span>水平后<span style="color: black;">止疼</span><span style="color: black;">功效</span><span style="color: black;">再也不</span>随用药剂量<span style="color: black;">增多</span>而<span style="color: black;">增多</span>，<span style="color: black;">然则</span>副<span style="color: black;">功效</span>会<span style="color: black;">连续</span><span style="color: black;">增多</span>，并且非甾体抗炎药不良反应的<span style="color: black;">出现</span>与用药剂量和<span style="color: black;">连续</span><span style="color: black;">运用</span>时间<span style="color: black;">关联</span>，随剂量<span style="color: black;">增多</span>，<span style="color: black;">药品</span>毒性反应<span style="color: black;">显著</span><span style="color: black;">增多</span>，限制了非甾体抗炎药的<span style="color: black;">运用</span>。</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">归类</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">非甾体抗炎药分为环氧化酶-1的<span style="color: black;">控制</span>剂和环氧化酶-2 的<span style="color: black;">控制</span>剂。<strong style="color: blue;"><span style="color: black;">环氧化酶-1的<span style="color: black;">控制</span>剂<span style="color: black;">重点</span>是芬必得，布洛芬这一类，这种<span style="color: black;">药品</span>最大的<span style="color: black;">危害</span><span style="color: black;">便是</span>消化道不良反应，胃肠道的炎症和<span style="color: black;">流血</span>的问题。环氧化酶-2的<span style="color: black;">控制</span>剂，消化道副<span style="color: black;">功效</span>比较小，<span style="color: black;">然则</span>它<span style="color: black;">长时间</span>应用对心血管<span style="color: black;">危害</span>就<span style="color: black;">增多</span>了，<span style="color: black;">因此</span>，<span style="color: black;">咱们</span><span style="color: black;">此刻</span>更主张轮换用药。</span></strong>对乙酰氨基酚更<span style="color: black;">大都是</span>的联合用药，像氨酚羟考酮、氨酚可待因、氨酚曲马多都是用“氨酚”。<span style="color: black;"><strong style="color: blue;">对乙酰氨基酚对胃肠道的影响比较小，对凝血的影响<span style="color: black;">亦</span>小，<span style="color: black;">因此</span>它相对比较安全。<span style="color: black;">然则</span>它的肝<span style="color: black;">损害</span>会比<span style="color: black;">很强</span>，一旦<span style="color: black;">显现</span>肝<span style="color: black;">损害</span>很难逆转，<span style="color: black;">因此呢</span>在<span style="color: black;">运用</span>的时候<span style="color: black;">必定</span>要密切<span style="color: black;">重视</span>肝功。</strong></span> </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">不良反应</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">消化性溃疡、<span style="color: black;">流血</span>：消化道溃疡病史；合并抗凝血药、糖皮质激素；老年人（60-75岁以上）；联合多种非甾体抗炎药。</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">肝功能<span style="color: black;">损害</span>：对乙酰氨基酚<span style="color: black;">平常</span>的不良反应。</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肾功能<span style="color: black;">损害</span>：60岁以上、体液不足、肾功能不全以及<span style="color: black;">同期</span>合用肾毒性<span style="color: black;">药品</span>的<span style="color: black;">病人</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">心脏毒性：非甾体抗炎药<span style="color: black;">（除阿司匹林）可</span><span style="color: black;">增多</span>心血管事件<span style="color: black;">出现</span><span style="color: black;">危害</span>；<span style="color: black;">吃下</span>小剂量阿司匹林预防心血管事件时，如联合其他非甾体抗炎药，会降低其对心血管事件的预防<span style="color: black;">功效</span>，且胃肠道毒性<span style="color: black;">危害</span><span style="color: black;">增多</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">应用原则</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">不主张两种非甾体类<span style="color: black;">药品</span>联用</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span><span style="color: black;">必须</span><span style="color: black;">长时间</span><span style="color: black;">运用</span>或日用剂量已达到限制性用量时，应<span style="color: black;">思虑</span>更换为单用阿片类<span style="color: black;">药品</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">若联合用药，则只<span style="color: black;">增多</span>阿片类止痛药用药剂量，不得<span style="color: black;">增多</span>非甾体类抗炎<span style="color: black;">药品</span>和对乙酰氨基酚剂量</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">需<span style="color: black;">定时</span>检测血、尿、便常规及血、尿、<span style="color: black;"><strong style="color: blue;">肝肾功能</strong></span>，<span style="color: black;">显现</span><span style="color: black;">反常</span>反应及<span style="color: black;">药品</span>过量应停药并对症治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">5</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">恰当</span>应用</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">非甾体抗炎药<span style="color: black;">（NSAIDs）</span>
</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">可单独<span style="color: black;">运用</span>，<span style="color: black;">亦</span>可联合二阶梯或三阶梯<span style="color: black;">止疼</span>药治疗癌痛。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">基于胃肠道<span style="color: black;">危害</span><span style="color: black;">原因</span><span style="color: black;">思虑</span>癌痛<span style="color: black;">病人</span>NSAIDs的<span style="color: black;">恰当</span>应用。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">基于以前的心血管事件或心血管事件<span style="color: black;">危害</span><span style="color: black;">（低剂量阿司匹林治疗）</span><span style="color: black;">思虑</span>癌痛<span style="color: black;">病人</span>NSAIDs的<span style="color: black;">恰当</span>应用。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">拥有</span>NSAIDs<span style="color: black;">运用</span>禁忌证的<span style="color: black;">病人</span>，直接<span style="color: black;">选取</span>阿片类<span style="color: black;">止疼</span>药。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">NSAIDs<span style="color: black;">运用</span>时，应<span style="color: black;">重视</span>与其他<span style="color: black;">药品</span>的相互<span style="color: black;">功效</span>，如β受体拮抗剂阿替洛尔与NSAIDs合用时可降低NSAIDs的药效；应用抗凝剂时，应避免<span style="color: black;">同期</span><span style="color: black;">吃下</span>乙酰水杨酸类NSAIDs；NSAIDs与洋地黄合用时，应<span style="color: black;">重视</span>防止洋地黄中毒。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">吃下</span>NSAIDs时，需<span style="color: black;">定时</span>监测血压、尿素氮、<span style="color: black;"><strong style="color: blue;">肌酐</strong></span>、血常规和<strong style="color: blue;"><span style="color: black;">便潜血</span></strong>等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">2</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">弱阿片类<span style="color: black;">药品</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">药品</span>特点</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">阿片类<span style="color: black;">药品</span>是癌痛治疗的<span style="color: black;">基本</span>用药，弱阿片类<span style="color: black;">药品</span>属于第二阶梯<span style="color: black;">止疼</span>药，中度<span style="color: black;">病痛</span>时可<span style="color: black;">选择</span>弱阿片类<span style="color: black;">药品</span>治疗。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">弱阿片<span style="color: black;">药品</span>的<span style="color: black;">止疼</span>效能无<span style="color: black;">明显</span><span style="color: black;">优良</span>，容易在30-40天后<span style="color: black;">显现</span>耐药，需更换为强阿片<span style="color: black;">药品</span>，且弱阿片<span style="color: black;">药品</span>剂量存在“天花板效应”，即<span style="color: black;">必定</span>的剂量后，增量<span style="color: black;">不可</span>增效，限制了其临床应用。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">常用<span style="color: black;">药品</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">常用的弱阿片类<span style="color: black;">药品</span>有磷酸可待因、盐酸曲马多等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">磷酸可待因</span></strong>属于天然类生物碱，弱μ和δ类阿片受体激动剂</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">中枢性<span style="color: black;">止疼</span>机制，<span style="color: black;">止疼</span><span style="color: black;">功效</span>较吗啡弱，为吗啡的1/12~1/10，可待因进入<span style="color: black;">身体</span>，经过酶的<span style="color: black;">功效</span>转化成吗啡来起<span style="color: black;">功效</span>。<span style="color: black;">因此</span>相对而言它<span style="color: black;">由于</span>受转化的影响，<span style="color: black;">因此呢</span>效能是有限的。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">磷酸可待因片药代动力学：</p><img src="https://mmbiz.qpic.cn/sz_mmbiz_png/dFkdDX0DErEKIHfN61ibsP0NFBbsT2D2icpRicBNAsiaMYiaia9C08Lf0UobKl5e7aBdMWRr2jTKQ4ZA7koSx9MZs2iaA/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">盐酸曲马多</span></strong>是一种人工合成的弱阿片受体激动剂</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">双重<span style="color: black;">功效</span>机制：弱阿片受体激动<span style="color: black;">功效</span><span style="color: black;">（μ、δ、κ）</span>+<span style="color: black;">控制</span>去甲肾上腺素和5-羟色胺再摄取，用于轻到中度<span style="color: black;">病痛</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">盐酸曲马多缓释片药代动力学：</p><img src="https://mmbiz.qpic.cn/sz_mmbiz_png/dFkdDX0DErEKIHfN61ibsP0NFBbsT2D2icDiaZF9QYj3Tu3dzRJeIiaqZcCib6uXiarq9S4azuaiaVdLObaPXPLhClVCw/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">指南<span style="color: black;">举荐</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">针对</span>轻度到中度<span style="color: black;">病痛</span>，弱类阿片如曲马多、双氢可待因和可待因可与非阿片类<span style="color: black;">止疼</span>剂联合<span style="color: black;">运用</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">低剂量强阿片类<span style="color: black;">药品</span>可<span style="color: black;">做为</span>弱阿片<span style="color: black;">药品</span>的替代<span style="color: black;">选取</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">无证据<span style="color: black;">显示</span>低剂量强阿片代替弱阿片治疗会<span style="color: black;">增多</span>不良反应</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">丁丙诺啡<span style="color: black;">亦</span>是一个中度<span style="color: black;">止疼</span>药，它对脑转移的病人<span style="color: black;">止疼</span>有特异性的<span style="color: black;">优良</span>。<span style="color: black;">因此</span>脑转移痛尤其颅压高的，不适合用阿片类<span style="color: black;">药品</span>，<span style="color: black;">能够</span>尝试用小剂量的布洛芬 ，这是<span style="color: black;">咱们</span>的经验。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">曲马多的<span style="color: black;">止疼</span>效能机制跟可待因是不<span style="color: black;">同样</span>的，它在中枢部分有<span style="color: black;">更加多</span>的<span style="color: black;">止疼</span><span style="color: black;">优良</span>，<span style="color: black;">因此</span>可以跟强阿片类<span style="color: black;">药品</span>联合应用，这一点<span style="color: black;">亦</span>是跟其他弱阿片类<span style="color: black;">药品</span>是不<span style="color: black;">同样</span>的，但弱阿片<span style="color: black;">药品</span>跟强阿片<span style="color: black;">药品</span><span style="color: black;">尽可能</span>别联合用，这是基本的原则。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">3</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">强阿片类<span style="color: black;">药品</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">药品</span>特点</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">针对</span>慢性癌痛治疗，重度<span style="color: black;">病痛</span>首选强阿片类<span style="color: black;">药品</span>，临床常用的强阿片类<span style="color: black;">药品</span><span style="color: black;">包含</span>：吗啡、羟考酮、芬太尼等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">重点</span><span style="color: black;">药品</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">吗啡</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">吗啡属于纯天然阿片类生物碱，是阿片类<span style="color: black;">止疼</span>药的标准<span style="color: black;">药品</span>。<span style="color: black;">同期</span>，其他阿片<span style="color: black;">必须</span>被折算成吗啡<span style="color: black;">才可</span>计算和<span style="color: black;">评定</span>。“吗啡当量”：计算阿片类药的总剂量时，<span style="color: black;">区别</span>种类阿片类药的剂量采用吗啡等效剂量，简<span style="color: black;">叫作</span>吗啡当量。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">盐酸吗啡缓释片药代动力学：</p><img src="https://mmbiz.qpic.cn/sz_mmbiz_png/dFkdDX0DErEKIHfN61ibsP0NFBbsT2D2icqlFAkM7bAfyEFS376IGs2R9COsY7Iuz5xjfQRZJmO5icubCEiaVLsibKw/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">羟考酮</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">羟考酮属于阿片类生物碱的半合成蒂巴因衍生物，μ、κ双受体激动剂。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/sz_mmbiz_png/dFkdDX0DErEKIHfN61ibsP0NFBbsT2D2icsYQLRjMrlDJHvE94jVLtjaTbqfWFmMPicX8rMVoreE5gxYvrsSdMx7Q/640?wx_fmt=png&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;">芬太尼</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">芬太尼属于人工合成的阿片受体激动类<span style="color: black;">止疼</span>药强阿片类μ受体激动剂，药代动力学<span style="color: black;">（芬太尼透皮贴剂）</span>：</p><img src="https://mmbiz.qpic.cn/sz_mmbiz_png/dFkdDX0DErEKIHfN61ibsP0NFBbsT2D2icK9dsI71nwAmAn7RMfR7yiag6AFlUBvTqXkGnHtpoxcpvEm3KG8bpLNA/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">芬太尼<span style="color: black;">药品</span>特点：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">运用</span>芬太尼贴剂前，<span style="color: black;">病痛</span>应<span style="color: black;">经过</span>短效阿片<span style="color: black;">药品</span><span style="color: black;">得到</span>相对较好的<span style="color: black;">掌控</span>。不<span style="color: black;">举荐</span>用于<span style="color: black;">必须</span>频繁<span style="color: black;">调节</span>剂量的不稳定性<span style="color: black;">病痛</span><span style="color: black;">病人</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">发热、局部加热（如<span style="color: black;">运用</span>烤灯、电热毯等）<span style="color: black;">或</span>用力挤压会加速芬太尼透皮贴剂的吸收，是芬太尼透皮贴剂的禁忌症。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">避免芬太尼贴剂<span style="color: black;">运用</span>的部位和周边暴露在热源下。温度<span style="color: black;">上升</span>使芬太尼释放加速，会<span style="color: black;">引起</span>剂量过量和死亡。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">生效</span>浓度不稳定：吸收率降低时血药浓度达不到<span style="color: black;">止疼</span>需求，吸收率<span style="color: black;">上升</span>时易<span style="color: black;">出现</span><span style="color: black;">呼气</span><span style="color: black;">控制</span>或肝肾毒性。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">贴剂转移<span style="color: black;">导致</span>的暴露：非<span style="color: black;">运用</span>者与<span style="color: black;">病人</span>共用床铺和亲密接触可<span style="color: black;">引起</span>贴剂意外转移到非<span style="color: black;">运用</span>者皮肤<span style="color: black;">（尤其时儿童）</span>，从而<span style="color: black;">导致</span>阿片样物质过量。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">阿片类<span style="color: black;">药品</span><span style="color: black;">平常</span>不良反应</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">便秘、恶心、呕吐、瘙痒、谵妄、<span style="color: black;">呼气</span><span style="color: black;">控制</span>、运动认知<span style="color: black;">阻碍</span>、尿潴留、其他。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">谵妄：高活动型谵妄：闹、打人、不认识人，说<span style="color: black;">有些</span>乱七八糟的话，做<span style="color: black;">有些</span>乱七八糟的动作；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">低活动型谵妄：木呆，<span style="color: black;">无</span>任何的表情、<span style="color: black;">无</span>任何反应，跟外界<span style="color: black;">无</span>关系。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在<span style="color: black;">显现</span>谵妄的时候，<span style="color: black;">病人</span>自己并不知情，不是故意为之。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">即释片以盐酸吗啡片为主，<span style="color: black;">尽可能</span>避免<span style="color: black;">运用</span>羟考酮胶囊。</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">5</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">强阿片类<span style="color: black;">药品</span>的<span style="color: black;">运用</span>，<span style="color: black;">必定</span>要以缓释用药为主导药</strong></span>
</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">，而快速<span style="color: black;">生效</span>、即时<span style="color: black;">药品</span>和针剂都是<span style="color: black;">弥补</span>的，起到临时救援<span style="color: black;">功效</span>，绝对<span style="color: black;">不可</span>用于<span style="color: black;">长时间</span>治疗，这一点是核心，<span style="color: black;">亦</span>是基本原则。第二，阿片类止痛药的<span style="color: black;">运用</span><span style="color: black;">必须</span>进行滴定，滴定是能达到有效<span style="color: black;">止疼</span>和不良反应最低的必由之路。第三在<span style="color: black;">全部</span><span style="color: black;">止疼</span>里<span style="color: black;">必定</span>要平衡<span style="color: black;">止疼</span><span style="color: black;">药品</span>的效能和不良反应，这是能<span style="color: black;">连续</span>用药的<span style="color: black;">基本</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">4</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">辅助<span style="color: black;">止疼</span><span style="color: black;">药品</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1、辅助<span style="color: black;">止疼</span><span style="color: black;">药品</span>：能够辅助性<span style="color: black;">加强</span>阿片类<span style="color: black;">药品</span>的止痛效果，或直接产生<span style="color: black;">必定</span>的<span style="color: black;">止疼</span><span style="color: black;">功效</span>；<span style="color: black;">包含</span>抗惊厥类<span style="color: black;">药品</span>、抗抑郁类<span style="color: black;">药品</span>、皮质激素、N-甲基-D-天冬氨酸受体<span style="color: black;">（NMDA）</span>拮抗剂和局部<span style="color: black;">麻木</span>药等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2、辅助<span style="color: black;">止疼</span>药常用于辅助治疗神经病理性<span style="color: black;">病痛</span>、骨痛和内脏痛。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3、常用于神经病理性疼痛的辅助<span style="color: black;">药品</span>：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">抗惊厥类<span style="color: black;">药品</span>：用于神经<span style="color: black;">损害</span><span style="color: black;">导致</span>的撕裂痛、放电样<span style="color: black;">病痛</span>及烧灼痛</strong></span>，如加巴喷丁，普瑞巴林等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">抗抑郁药：用于中枢性或外周神经<span style="color: black;">损害</span><span style="color: black;">导致</span>的麻木样痛、灼痛</strong></span>，该类<span style="color: black;">药品</span><span style="color: black;">亦</span><span style="color: black;">能够</span>改善心情、改善<span style="color: black;">睡觉</span>，如阿米替林、度洛西汀、文拉法辛等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4、<strong style="color: blue;"><span style="color: black;">相对加巴喷丁而言，普瑞巴林效果会更稳定，副<span style="color: black;">功效</span>会相对更少。</span></strong>但这两个药都<span style="color: black;">必须</span>严格的滴定，都<span style="color: black;">必须</span>观察副<span style="color: black;">功效</span>，它们的增量跟副<span style="color: black;">功效</span>之间是<span style="color: black;">相关</span>系的。还有一点它们的计量都有上限，普瑞巴林<span style="color: black;">通常</span>一天<span style="color: black;">不可</span>超过600mg；加巴喷丁在中国可能用到2000多毫克就算计量很大了，在美国最高用到5000多毫克。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">5、抗抑郁药阿米替林的特点跟百忧解、米氮平、奥氮平都是不<span style="color: black;">同样</span>的，<span style="color: black;">功效</span>机制<span style="color: black;">区别</span>，<span style="color: black;">大众</span><span style="color: black;">晓得</span>这些就<span style="color: black;">能够</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">6、在<span style="color: black;">止疼</span>辅助用药里，是以抗惊厥和抗抑郁药为主。<span style="color: black;">然则</span><span style="color: black;">咱们</span><span style="color: black;">亦</span><span style="color: black;">不可</span>忽略，<span style="color: black;">例如</span>说通便<span style="color: black;">药品</span>，它<span style="color: black;">亦</span>算一种辅助药；<span style="color: black;">例如</span>说镇静<span style="color: black;">药品</span>，<span style="color: black;">帮忙</span>病人<span style="color: black;">睡觉</span>的<span style="color: black;">药品</span>；止吐的<span style="color: black;">药品</span>，这些都是<span style="color: black;">止疼</span>里必要的<span style="color: black;">有些</span>辅助用药。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">3</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">阿片类<span style="color: black;">药品</span>的成瘾与<span style="color: black;">病痛</span>的敏化</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>都<span style="color: black;">晓得</span>吗啡是从植物里提取的，它是一个“成瘾”的制剂，<span style="color: black;">咱们</span>都说<span style="color: black;"><strong style="color: blue;">吗啡是个双刃剑，用的好，就<span style="color: black;">能够</span>得到很好的<span style="color: black;">止疼</span>效果，改善肿瘤病人的<span style="color: black;">病痛</span>，但<span style="color: black;">倘若</span>用的<span style="color: black;">欠好</span>，就有可能会<span style="color: black;">诱发</span>成瘾</strong></span>。但处方成瘾在中国<span style="color: black;">出现</span>率比较低，<span style="color: black;">便是</span><span style="color: black;">由于</span>在中国，强阿片<span style="color: black;">止疼</span>药<span style="color: black;">日前</span>只是对癌痛病人开放，对慢痛是没开放的。而美国，<span style="color: black;">由于</span>把强阿片<span style="color: black;">止疼</span>药用在了慢痛病人，<span style="color: black;">因此呢</span>后续<span style="color: black;">诱发</span>了<span style="color: black;">海量</span>阿片<span style="color: black;">药品</span>成瘾的社会问题。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">咱们</span>前面讲到了慢痛跟癌痛的区别。慢痛的<span style="color: black;">病痛</span>有上限的，一旦疼到极端，它就往回走。相对而言，慢痛的<span style="color: black;">病痛</span>的层级<span style="color: black;">亦</span>是中等程度的，<span style="color: black;">因此</span>它不<span style="color: black;">必须</span>太强的<span style="color: black;">止疼</span>药就<span style="color: black;">能够</span>得到有效缓解。<span style="color: black;">况且</span>大部分慢痛<span style="color: black;">能够</span><span style="color: black;">经过</span><span style="color: black;">有些</span>微创治疗，<span style="color: black;">经过</span>去除<span style="color: black;">引起</span><span style="color: black;">病痛</span>的<span style="color: black;">原因</span>，得到<span style="color: black;">长时间</span>有效的<span style="color: black;">掌控</span>，<span style="color: black;">能够</span>改善病人的症状，<span style="color: black;">因此</span>慢痛不适合用吗啡来<span style="color: black;">掌控</span>，这是<span style="color: black;">咱们</span>经过这么<span style="color: black;">数年</span>得到一个客观的结论。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">而癌痛是<span style="color: black;">因为</span>肿瘤在<span style="color: black;">发展</span>，对组织<span style="color: black;">损害</span><span style="color: black;">亦</span>在逐步的加重，<span style="color: black;">倘若</span>肿瘤对神经组织<span style="color: black;">损害</span>的越严重，<span style="color: black;">乃至</span><span style="color: black;">损害</span>的结构破坏越严重，<span style="color: black;">损伤</span>感受<span style="color: black;">亦</span>就越重，<span style="color: black;">必须</span>更强的<span style="color: black;">药品</span>，<span style="color: black;">便是</span>阿片类<span style="color: black;">药品</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在阿片类<span style="color: black;">药品</span><span style="color: black;">运用</span>过程中，有两个<span style="color: black;">没法</span>避免的问题，<span style="color: black;">第1</span>个问题<span style="color: black;">便是</span>阿片类<span style="color: black;">药品</span>的耐受，在之前的直播中<span style="color: black;">咱们</span>有<span style="color: black;">仔细</span>讲到。<span style="color: black;">另一</span>一个问题，<span style="color: black;">便是</span><span style="color: black;">病痛</span>的敏化，<span style="color: black;">咱们</span><span style="color: black;">亦</span><span style="color: black;">叫作</span>其为中枢的敏化和外周的敏化，<span style="color: black;">亦</span><span style="color: black;">便是</span>说，<span style="color: black;">非常多</span>病人在<span style="color: black;">长期</span><span style="color: black;">病痛</span>未能得到有效<span style="color: black;">掌控</span>的<span style="color: black;">状况</span>下，<span style="color: black;">病痛</span>会从轻度转为重度，<span style="color: black;">病人</span>对<span style="color: black;">病痛</span>的感受会变得<span style="color: black;">非常</span><span style="color: black;">敏锐</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">那样</span><span style="color: black;">咱们</span>怎么<span style="color: black;">能够</span>避免<span style="color: black;">病痛</span>的敏化，怎么使阿片类<span style="color: black;">药品</span>的耐受减少呢？核心的问题<span style="color: black;">便是</span>要及早的、<span style="color: black;">即时</span>的让<span style="color: black;">病痛</span>得到有限<span style="color: black;">掌控</span>，<span style="color: black;">即时</span>的<span style="color: black;">止疼</span><span style="color: black;">便是</span>减少<span style="color: black;">病痛</span>敏化的核心关键点，而规范的按时<span style="color: black;">运用</span>长效<span style="color: black;">止疼</span><span style="color: black;">药品</span>，<span style="color: black;">便是</span>减少止痛<span style="color: black;">药品</span>耐受的核心。</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">无</span>哪一种<span style="color: black;">药品</span>是<span style="color: black;">能够</span>完美地将所有<span style="color: black;">病痛</span>都<span style="color: black;">掌控</span>好的，<span style="color: black;">咱们</span><span style="color: black;">必须</span><span style="color: black;">按照</span><span style="color: black;">病人</span><span style="color: black;">疾患</span><span style="color: black;">损害</span>的机制和<span style="color: black;">损害</span>的结果，运用多种技术和<span style="color: black;">方法</span>个体化处理。一个病人在<span style="color: black;">区别</span><span style="color: black;">周期</span>的治疗方式，<span style="color: black;">包含</span><span style="color: black;">药品</span><span style="color: black;">方法</span>，介入<span style="color: black;">方法</span>都是不<span style="color: black;">同样</span>的。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">因此</span><span style="color: black;">第1</span><span style="color: black;">咱们</span>在阿片<span style="color: black;">药品</span><span style="color: black;">运用</span>，<span style="color: black;">包含</span>联合用药的时候<span style="color: black;">必定</span>要严格按处方用药。第二点，<span style="color: black;">针对</span><span style="color: black;">病人</span><span style="color: black;">病痛</span>的<span style="color: black;">掌控</span>，<span style="color: black;">必定</span>要做到及早<span style="color: black;">止疼</span>，<span style="color: black;">即时</span><span style="color: black;">止疼</span>，要把<span style="color: black;">病痛</span><span style="color: black;">掌控</span>好，<span style="color: black;">不可</span>只是<span style="color: black;">掌控</span>一部分，让病人能忍着就行了，这个观点会<span style="color: black;">引起</span>病人快速耐药，<span style="color: black;">由于</span><span style="color: black;">连续</span><span style="color: black;">掌控</span><span style="color: black;">欠好</span>的<span style="color: black;">病痛</span>会<span style="color: black;">引起</span>病人敏化的<span style="color: black;">显现</span>、<span style="color: black;">止疼</span>效能会相对不足，就<span style="color: black;">必须</span>增量，增量过程<span style="color: black;">太多</span>过快，就容易<span style="color: black;">导致</span>耐受。</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">从另一方面来讲，<span style="color: black;">咱们</span>还有一个<span style="color: black;">方法</span>，<span style="color: black;">便是</span><span style="color: black;">所说</span>第三类<span style="color: black;">药品</span>，<span style="color: black;">便是</span>辅助用药。辅助用药<span style="color: black;">包含</span><span style="color: black;">帮忙</span><span style="color: black;">止疼</span>的<span style="color: black;">药品</span>，<span style="color: black;">例如</span>说抗惊厥<span style="color: black;">药品</span>，治疗神经病性<span style="color: black;">病痛</span>，像加巴喷丁和普瑞巴林。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">还有治疗内脏痛<span style="color: black;">药品</span>，像抗抑郁<span style="color: black;">药品</span>.抗抑郁<span style="color: black;">药品</span>还具备一个重要的<span style="color: black;">功效</span>，<span style="color: black;">便是</span>改善病人的心境，减少病人的焦虑和抑郁。从这一点来讲，会<span style="color: black;">提高</span>病人对<span style="color: black;">止疼</span>的感受。<span style="color: black;">因此</span>一个好的联合医药既达到一个有效的<span style="color: black;">止疼</span>，又<span style="color: black;">提高</span>了病人对<span style="color: black;">止疼</span>的一个改善，心境的改善，<span style="color: black;">提高</span>了<span style="color: black;">止疼</span>效能自我的感受，这一点<span style="color: black;">亦</span>是非常重要的。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">在<span style="color: black;">病人</span>止痛过程中，<span style="color: black;">咱们</span>既<span style="color: black;">必须</span>关注止痛的效果，还<span style="color: black;">必须</span><span style="color: black;">思虑</span><span style="color: black;">药品</span>给<span style="color: black;">病人</span>可能带来的副<span style="color: black;">功效</span></span></strong>，<span style="color: black;">包含</span>非甾体<span style="color: black;">药品</span>副<span style="color: black;">功效</span>的管控、阿片类<span style="color: black;">药品</span>副<span style="color: black;">功效</span>的处理等，而在<span style="color: black;">病人</span>真正遇到<span style="color: black;">病痛</span>问题时，<span style="color: black;">咱们</span><span style="color: black;">意见</span><span style="color: black;">病人</span><span style="color: black;">尽可能</span>找到<span style="color: black;">病痛</span>科专科<span style="color: black;">大夫</span>进行咨询和处理，<span style="color: black;">经过</span><span style="color: black;">评定</span>和滴定制定对<span style="color: black;">病人</span>个性化的<span style="color: black;">运用</span>剂量，此处的滴定，既<span style="color: black;">包含</span>对阿片类<span style="color: black;">药品</span><span style="color: black;">运用</span>剂量的滴定，<span style="color: black;">亦</span><span style="color: black;">包含</span>对抗惊厥<span style="color: black;">药品</span>、抗抑郁类<span style="color: black;">药品</span>的<span style="color: black;">选取</span>与滴定，而对癌痛临床用药的<span style="color: black;">运用</span>，专业的癌痛<span style="color: black;">大夫</span><span style="color: black;">由于</span>受过系统的培训，以及<span style="color: black;">数年</span>对临床病人的观察和处置经验，<span style="color: black;">因此呢</span>会比肿瘤科<span style="color: black;">大夫</span><span style="color: black;">或</span>慢痛科<span style="color: black;">大夫</span>更适合<span style="color: black;">有些</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">4</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">癌痛的社会心理支持</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在癌痛治疗<span style="color: black;">其中</span>有一个观念，<span style="color: black;">便是</span>总<span style="color: black;">病痛</span>的观念，<span style="color: black;">由于</span>疼是一种不舒服的感受，<span style="color: black;">倘若</span>病人有<span style="color: black;">有些</span>跟肿瘤<span style="color: black;">关联</span>的心理问题，<span style="color: black;">例如</span>说他工作的丢失，<span style="color: black;">由于</span><span style="color: black;">疾患</span>他自己制定的<span style="color: black;">有些</span><span style="color: black;">目的</span><span style="color: black;">不可</span>达成，病人<span style="color: black;">由于</span>治疗产生的<span style="color: black;">有些</span>支出超出了自己的支付能力，病人的家属给他<span style="color: black;">供给</span>的服务和支撑<span style="color: black;">不足</span>等等<span style="color: black;">有些</span>问题都会<span style="color: black;">引起</span>病人心理的创伤，而<span style="color: black;"><strong style="color: blue;">心理的创伤<span style="color: black;">便是</span>痛苦。</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">而痛苦<span style="color: black;">无</span>方式能表达的时候，<span style="color: black;">亦</span>会用疼来表达</strong></span>。<span style="color: black;">因此</span><span style="color: black;">咱们</span>在癌痛<span style="color: black;">其中</span>就有一个总<span style="color: black;">病痛</span>的概念。有些在临床上急性<span style="color: black;">病痛</span>，会有疼的大汗淋漓、痛不欲生的时候。<span style="color: black;">然则</span>癌痛，病人说我疼的受不了，我都疼的不想活，但表情很淡漠，这是癌痛和急性<span style="color: black;">病痛</span>的一个最大的区别。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">急性<span style="color: black;">病痛</span><span style="color: black;">能够</span>用生理的<span style="color: black;">有些</span>反应来表达<span style="color: black;">病痛</span>的成因，<span style="color: black;">例如</span>心动过速、血压过高、大汗淋漓、痛苦面容、濒死的面容等等。但癌痛是不存在的，他说的我很疼，心率很<span style="color: black;">安稳</span>，血压一点都不高，<span style="color: black;">乃至</span>还低。<span style="color: black;">为何</span>？<span style="color: black;">由于</span>掺杂<span style="color: black;">有些</span>心理<span style="color: black;">原因</span>，掺杂<span style="color: black;">有些</span>社会<span style="color: black;">包袱</span>、社会的压力等等给内心带来的痛苦，这是癌痛最难的一面。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">为何</span>癌痛难治？疼都<span style="color: black;">掌控</span>住了，<span style="color: black;">不该</span>该疼了，但病人说还疼。<span style="color: black;">为何</span>？可能是病人家属的支持<span style="color: black;">不足</span>，<span style="color: black;">大夫</span>护士对<span style="color: black;">病人</span>的关注<span style="color: black;">不足</span>。<span style="color: black;">因此</span>在<span style="color: black;">全部</span>过程<span style="color: black;">其中</span><span style="color: black;">咱们</span><span style="color: black;">必定</span>要<span style="color: black;">晓得</span>病人的需求是多元的，他的表达的方式是单一的，<span style="color: black;">咱们</span>治疗的时候<span style="color: black;">必定</span>要甄别这些问题，给予多方面的支持，<span style="color: black;">才可</span>真正的达到对病人痛苦的<span style="color: black;">掌控</span>、<span style="color: black;">病痛</span>的<span style="color: black;">掌控</span>，<span style="color: black;">最后</span><span style="color: black;">得到</span>一个很好的治疗结果。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">5</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">癌痛的诊治<span style="color: black;">目的</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在癌痛的诊疗过程中，<span style="color: black;">药品</span>治疗只是一个<span style="color: black;">基本</span>，三阶梯是<span style="color: black;">药品</span>治疗一个基本的原则，<span style="color: black;">必要</span>要给予病人逐步递升的<span style="color: black;">止疼</span>过程。<span style="color: black;">止疼</span>过程<span style="color: black;">首要</span><span style="color: black;">必定</span>要滴定，不管是快速滴定<span style="color: black;">亦</span>好，还是<span style="color: black;">每日</span>去给予调药滴定<span style="color: black;">亦</span>好，换句话说，给完药之后<span style="color: black;">必定</span>要看<span style="color: black;">止疼</span>效果好或<span style="color: black;">欠好</span>，病人和家属<span style="color: black;">亦</span>要<span style="color: black;">晓得</span>我吃完这药<span style="color: black;">欠好</span>怎么办？要<span style="color: black;">即时</span>跟<span style="color: black;">大夫</span>去沟通，这点非常重要。三阶梯的模式只是一个参考。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">此刻</span>有个四阶梯，我特别反对四阶梯，<span style="color: black;">由于</span><span style="color: black;"><strong style="color: blue;">四阶梯的概念说在止痛药<span style="color: black;">已然</span>不起<span style="color: black;">功效</span>了，再用四阶梯，这种观点是不可取的，会使<span style="color: black;">非常多</span>病人丧失了有效治疗的机会</strong></span>。<span style="color: black;">例如</span>骨转移痛，病人躺着不疼，<span style="color: black;">然则</span>一翻身坐起来就疼，他算<span style="color: black;">药品</span>治疗有效没效呢？算不算难治性癌痛呢？<span style="color: black;">非常多</span>人认为不算，<span style="color: black;">由于</span>都不<span style="color: black;">必须</span>用药，<span style="color: black;">然则</span>一坐起来就疼的不行，<span style="color: black;">病人</span><span style="color: black;">不可</span>动，他有生活质量吗？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因此</span>我认为这种就属于难治性癌痛。<span style="color: black;"><strong style="color: blue;">难治性癌痛一是<span style="color: black;">药品</span>效果<span style="color: black;">欠好</span>，二是有功能<span style="color: black;">损害</span>。</strong></span>像这种病人就有功能<span style="color: black;">损害</span>，这种病人<span style="color: black;">不可</span>说等<span style="color: black;">药品</span>都不行了，就让病人等着，最后疼的不行再用介入，这是不<span style="color: black;">能够</span>。像<span style="color: black;">这般</span>病人要及早给予介入治疗，及早打骨水泥，<span style="color: black;">这般</span>病人<span style="color: black;">才可</span>动，这是核心。从这一点来讲，<span style="color: black;">咱们</span>应该<span style="color: black;">按照</span>病人的<span style="color: black;">实质</span><span style="color: black;">状况</span>来<span style="color: black;">选取</span>治疗<span style="color: black;">方法</span>，这是核心。<span style="color: black;">针对</span>癌痛的<span style="color: black;">掌控</span>，过去推崇以口服药为主，<span style="color: black;">然则</span>比方<span style="color: black;">病人</span><span style="color: black;">已然</span>有肠梗阻，怎么办？给打针止痛吗？<span style="color: black;">亦</span>不对，<span style="color: black;">因此</span><span style="color: black;">运用</span>芬太尼透皮贴类经皮止痛<span style="color: black;">亦</span>是<span style="color: black;">能够</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">因此</span>，不管是<span style="color: black;">运用</span>哪种<span style="color: black;">止疼</span>方式，关键是<span style="color: black;">必须</span><span style="color: black;">思虑</span>病人到底<span style="color: black;">必须</span>什么，这是<span style="color: black;">第1</span>点。第二要按阶梯给药，用药计量要滴定，要逐步<span style="color: black;">增多</span><span style="color: black;">止疼</span><span style="color: black;">药品</span>的种类和剂量。第三，要按时给药，而不是按需给药。</strong></span>按需给药是疼了再给，病人的感受就<span style="color: black;">欠好</span>，<span style="color: black;">药品</span>有效，但病人总是有疼，<span style="color: black;">这般</span>话对病人<span style="color: black;">亦</span>是一种<span style="color: black;">损伤</span>。<span style="color: black;">因此</span>按时给药的特点是<span style="color: black;">按照</span>药代动力学，最低血药浓度达到无缝<span style="color: black;">止疼</span>。<span style="color: black;">咱们</span>治疗<span style="color: black;">目的</span>是优化<span style="color: black;">止疼</span>，要活动，要有生活质量，要把副<span style="color: black;">功效</span>降到最低，还要避免<span style="color: black;">药品</span>的<span style="color: black;">乱用</span>、对<span style="color: black;">病人</span>的心理和<span style="color: black;">心情</span>予以关注和支持。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">6</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">答疑：</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题一</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">病人</span>男，肺鳞癌晚期，有胸椎转移，3月10号做过原发灶冷冻消融术，<span style="color: black;">此刻</span>吃奥施康定早晚各一次，每次60mg。</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;">由于</span>冷冻消融术影响到右手神经，<span style="color: black;">因此</span>右手神经<span style="color: black;">始终</span><span style="color: black;">病痛</span>，手臂一按压就很<span style="color: black;">病痛</span>，<span style="color: black;">况且</span>手臂<span style="color: black;">无</span>力气，<span style="color: black;">没法</span>抬手。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">背部<span style="color: black;">白日</span>偶尔<span style="color: black;">病痛</span>，约4分，<span style="color: black;">然则</span>一到<span style="color: black;">夜晚</span>就会<span style="color: black;">病痛</span>加剧，是一阵阵的，非<span style="color: black;">连续</span>性，<span style="color: black;">忽然</span>来一阵很痛很痛，过一会缓解，<span style="color: black;">病痛</span>6分。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">想请教王教授：<span style="color: black;">病人</span><span style="color: black;">已然</span><span style="color: black;">吃下</span>奥施康定2年时间，<span style="color: black;">是不是</span>是<span style="color: black;">由于</span><span style="color: black;">显现</span>耐药<span style="color: black;">引起</span><span style="color: black;">此刻</span>止痛药效果不是很<span style="color: black;">显著</span>？<span style="color: black;">另一</span>在这种<span style="color: black;">状况</span>下，有<span style="color: black;">无</span>其他的止痛药<span style="color: black;">方法</span><span style="color: black;">或</span>联药<span style="color: black;">方法</span>适合<span style="color: black;">病人</span>的？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">王教授解答：</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">冷冻消融术有个缺点，冷冻过程<span style="color: black;">其中</span>对神经的<span style="color: black;">损害</span>是非常彻底的。<span style="color: black;">非常多</span>病人冷冻之后，神经功能和运动功能会受<span style="color: black;">损害</span>，<span style="color: black;">乃至</span>软瘫，<span style="color: black;">因此</span>我不太<span style="color: black;">意见</span>用冷冻的<span style="color: black;">办法</span>治疗癌痛，<span style="color: black;">由于</span>它对神经的<span style="color: black;">损害</span>会<span style="color: black;">导致</span>功能的<span style="color: black;">阻碍</span>，但<span style="color: black;">倘若</span>胸壁的，不<span style="color: black;">触及</span>运动神经的<span style="color: black;">亦</span><span style="color: black;">能够</span>去<span style="color: black;">运用</span>，<span style="color: black;"><strong style="color: blue;"><span style="color: black;">倘若</span>跟肢体功能<span style="color: black;">相关</span>的，<span style="color: black;">意见</span>不要用冷冻的<span style="color: black;">办法</span></strong></span>。这个病人可能是为治疗肿瘤，对肿瘤进行消融，像这种病人<span style="color: black;">咱们</span><span style="color: black;">更加多</span><span style="color: black;">意见</span>用粒子<span style="color: black;">移植</span>，既<span style="color: black;">能够</span>把肿瘤缩小，又<span style="color: black;">能够</span>改善功能，<span style="color: black;">掌控</span><span style="color: black;">病痛</span>效果又很好，这是两者<span style="color: black;">区别</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">针对</span><span style="color: black;">日前</span>这位<span style="color: black;">病人</span>的<span style="color: black;">病痛</span>，<span style="color: black;">首要</span><span style="color: black;">咱们</span>要<span style="color: black;">评定</span><span style="color: black;">病痛</span>部位，看<span style="color: black;">是不是</span><span style="color: black;">能够</span>做神经阻断，这个要寻找专业<span style="color: black;">病痛</span>科<span style="color: black;">大夫</span><span style="color: black;">评定</span>处理，处理过程中应当<span style="color: black;">尽可能</span>避免对<span style="color: black;">病人</span>运动神经的<span style="color: black;">损害</span>。<span style="color: black;">另一</span><span style="color: black;">意见</span><span style="color: black;">病人</span>联合用药，看描述这位<span style="color: black;">病人</span>大概率有炎性的问题，<span style="color: black;">因此</span>联合非甾体药，<span style="color: black;">另一</span><span style="color: black;">日前</span>的<span style="color: black;">病痛</span>是与神经<span style="color: black;">关联</span>的，<span style="color: black;">因此</span><span style="color: black;">亦</span>要联合抗惊厥药，<span style="color: black;">便是</span>治疗神经病理性<span style="color: black;">病痛</span>的药。<span style="color: black;">日前</span><span style="color: black;">病人</span>不存在奥施康定耐药的问题，不<span style="color: black;">必须</span>更换<span style="color: black;">药品</span>，在联合用药后，大概率<span style="color: black;">病痛</span>会缓解，后续<span style="color: black;">倘若</span><span style="color: black;">病痛</span>未能缓解，<span style="color: black;">能够</span><span style="color: black;">思虑</span>奥施康定加量处理。</p>
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