9q13nh 发表于 2024-6-8 01:50:23

癌症病人全身病痛还在硬扛？教你怎么样选取适合的止痛药

阅读前请点击“关注”，<span style="color: black;">咱们</span>会发送健康的<span style="color: black;">关联</span><span style="color: black;">文案</span>，让觅健陪您<span style="color: black;">一块</span>关爱健康<span style="color: black;">新闻</span>～<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">当胃癌进入到晚期，部分<span style="color: black;">病人</span>会<span style="color: black;">显现</span>全身<span style="color: black;">病痛</span>的现象，这种<span style="color: black;">病痛</span>到底有多痛呢。<span style="color: black;">非常多</span><span style="color: black;">女性</span>都说生<span style="color: black;">孩儿</span>痛，而胃癌晚期比生<span style="color: black;">孩儿</span>还要痛，<span style="color: black;">倘若</span>说生<span style="color: black;">孩儿</span>最<span style="color: black;">病痛</span>时属于8级<span style="color: black;">病痛</span>，<span style="color: black;">那样</span>胃癌晚期的癌痛完全达到10级（0级是<span style="color: black;">没</span>痛，7级以后属于重度<span style="color: black;">病痛</span>）。</p>
    <div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-b5816b8c67d2fa7d674b25cd6fe7d861_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>《NCCN成人癌痛指南》<span style="color: black;">病痛</span>强度评级<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">从左向右，每一张脸<span style="color: black;">暗示</span><span style="color: black;">病痛</span>越来越严重。</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;">针对</span>癌症<span style="color: black;">病人</span>的治疗<span style="color: black;">重点</span>依据是世界卫生组织（WHO）提出的《癌痛三阶梯止痛治疗指南》原则，需按<span style="color: black;">病痛</span>程度<span style="color: black;">选择</span>不同强度的<span style="color: black;">止疼</span><span style="color: black;">药品</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">轻度<span style="color: black;">病痛</span>（数字评分法 NRS ≤ 3 分）</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">大多<span style="color: black;">病人</span><span style="color: black;">能够</span>忍受，<span style="color: black;">亦</span>不会影响正常生活。首选非甾体类抗炎药（NSAIDs），<span style="color: black;">表率</span><span style="color: black;">药品</span>有：阿司匹林、对乙酰氨基酚等。若有非甾体类抗炎药禁忌证，<span style="color: black;">亦</span>可<span style="color: black;">思虑</span><span style="color: black;">运用</span>低剂量阿片类<span style="color: black;">药品</span>；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">中度<span style="color: black;">病痛</span>（3 分&lt;NRS&lt;7 分）</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">病人</span>会感知<span style="color: black;">病痛</span>（较为<span style="color: black;">显著</span>），此时会影响到<span style="color: black;">睡觉</span>质量。可<span style="color: black;">运用</span>弱阿片类<span style="color: black;">药品</span>，<span style="color: black;">亦</span>可<span style="color: black;">运用</span>低剂量强阿片类<span style="color: black;">药品</span>，并可联用非甾体类抗炎药及辅助<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）；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">重度<span style="color: black;">病痛</span>（NRS ≥ 7 分）</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">比较剧烈，<span style="color: black;">病人</span>难以忍受，<span style="color: black;">乃至</span>会<span style="color: black;">显现</span>痛哭/呻吟、精神<span style="color: black;">错乱</span>、抑郁<span style="color: black;">或</span>大发脾气等现象，家属<span style="color: black;">必定</span>要给予安慰，理解。首选强阿片类<span style="color: black;">药品</span>，并可合用非甾体类抗炎药及辅助<span style="color: black;">止疼</span><span style="color: black;">药品</span>。</p>
    <div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic1.zhimg.com/80/v2-454a4c4d1a401d4fe4130f2ae3756708_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这儿</span><span style="color: black;">说到</span>的非甾体类抗炎药和阿片类<span style="color: black;">止疼</span><span style="color: black;">药品</span><span style="color: black;">便是</span>临床中常用的两类<span style="color: black;">止疼</span><span style="color: black;">药品</span>，<span style="color: black;">病人</span>在<span style="color: black;">运用</span>时<span style="color: black;">必须</span>注意什么，下面科普君就带<span style="color: black;">大众</span><span style="color: black;">一块</span>来看一看。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">非甾体类抗炎药（NSAIDs）</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;">指的是</span>一类不含皮质激素而<span style="color: black;">拥有</span>抗炎、<span style="color: black;">止疼</span>和解热<span style="color: black;">功效</span>的<span style="color: black;">药品</span>。有人说这类药叫“抗炎药”<span style="color: black;">为何</span>还<span style="color: black;">能够</span>止痛？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">机体产生炎症的过程，环氧化酶（COX）是一个<span style="color: black;">重要</span>的酶，能够把花生四烯酸代谢产物转化为前列腺素（PG）等致炎和致痛物质，从而产生炎症。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">非甾体类<span style="color: black;">药品</span>，正是<span style="color: black;">经过</span><span style="color: black;">控制</span>COX，从而<span style="color: black;">控制</span>前列腺素的产生而起到抗炎的<span style="color: black;">功效</span>。而在<span style="color: black;">掌控</span>炎症的<span style="color: black;">同期</span>，起到了止痛、<span style="color: black;">止疼</span>的<span style="color: black;">功效</span>。</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>非甾体抗炎药并非单纯的止痛，与吗啡、可待因、曲马多等止痛药完全不同，不会产生依赖和成瘾性。</p>
    <div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-6c829d5c0c866b4f4632c2f09f934d25_720w.webp" style="width: 50%; margin-bottom: 20px;"></div><span style="color: black;">照片</span><span style="color: black;">源自</span>：摄图网 <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">根据</span><span style="color: black;">药品</span>的<span style="color: black;">功效</span>机制来分，<span style="color: black;">能够</span>分为非<span style="color: black;">选取</span>性NSAIDs与<span style="color: black;">选取</span>性COX-2<span style="color: black;">控制</span>剂。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">非<span style="color: black;">选取</span>性NSAIDs的<span style="color: black;">表率</span><span style="color: black;">药品</span>有：阿司匹林、布洛芬、吲哚美辛、双氯芬酸钠、洛索洛芬。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">选取</span>性COX-2<span style="color: black;">控制</span>剂的<span style="color: black;">表率</span><span style="color: black;">药品</span>有：美洛昔康、塞来昔布、依托考昔、帕瑞昔布。</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;">平常</span>不良反应<span style="color: black;">包含</span>胃肠道、肾脏、肝脏、心血管毒性(<span style="color: black;">尤其</span><span style="color: black;">重视</span>心肌梗死、脑卒中)和过敏反应等。临床<span style="color: black;">运用</span>非甾体抗炎药时，应遵守以下几条原则。</p>正确诊断，严格<span style="color: black;">把握</span>NSAIDs的适应证，防止<span style="color: black;">乱用</span>。<span style="color: black;">不可</span>联合用药，只能<span style="color: black;">运用</span>一种，<span style="color: black;">以避免</span>副<span style="color: black;">功效</span>累积<span style="color: black;">出现</span>。避免大剂量<span style="color: black;">长时间</span><span style="color: black;">运用</span>。非甾体类抗炎药之间不良发应的类型和程度不同，如对乙酰氨基酚大剂量<span style="color: black;">长时间</span><span style="color: black;">运用</span>可<span style="color: black;">引起</span>急性重型肝炎，布洛芬和双氯芬酸钠的胃肠反应较少，阿司匹林肠溶片对胃肠道刺激<span style="color: black;">亦</span>相对较小。<span style="color: black;">按照</span><span style="color: black;">每一个</span>病人的个体<span style="color: black;">状况</span>来区别用药，在用药过程中<span style="color: black;">持续</span><span style="color: black;">调节</span>，以求达到最好的治疗效果，最小影响的毒副<span style="color: black;">功效</span>。<span style="color: black;">重视</span>并发症对用药的影响，低血容量、低白蛋白血症等可能<span style="color: black;">增多</span>非甾体类抗炎药的肾毒性和耳毒性。老年人慎用。<span style="color: black;">必要</span><span style="color: black;">仔细</span><span style="color: black;">认识</span>老年人的病史及用药史，以便制定<span style="color: black;">恰当</span>的用药<span style="color: black;">方法</span>。<span style="color: black;">通常</span>应从小剂量<span style="color: black;">起始</span>，避免用药过频，<span style="color: black;">以避免</span>因<span style="color: black;">运用</span>NSAIDs而出汗<span style="color: black;">太多</span>、体温骤降而致虚脱<span style="color: black;">乃至</span>休克，<span style="color: black;">同期</span>应<span style="color: black;">重视</span>对胃黏膜的<span style="color: black;">守护</span>。<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">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;">阿片类<span style="color: black;">药品</span>是轻、中、重度癌痛中都<span style="color: black;">能够</span><span style="color: black;">选取</span>的治疗<span style="color: black;">药品</span>，其中强阿片类<span style="color: black;">药品</span>是中、重度癌痛治疗的首选<span style="color: black;">药品</span>。阿片类<span style="color: black;">止疼</span>药的<span style="color: black;">功效</span>机制是<span style="color: black;">经过</span>存在于中枢神经系统和消化系统的阿片类受体起<span style="color: black;">功效</span>。</p>弱效阿片类<span style="color: black;">药品</span>（如：可待因、曲马多）<span style="color: black;">仅有</span>在中度<span style="color: black;">病痛</span>时<span style="color: black;">运用</span>，<span style="color: black;">由于</span>这类<span style="color: black;">药品</span>有<span style="color: black;">意见</span>的最大剂量；超过最大剂量后，该类<span style="color: black;">药品</span>不良影响的<span style="color: black;">增多</span>将超过其止痛效用的<span style="color: black;">增多</span>。强效阿片类<span style="color: black;">药品</span>（ 如：吗啡，羟考酮，氢吗啡酮，芬太奴以及美沙酮）与弱效阿片类<span style="color: black;">药品</span>相比，用量范围更广。<span style="color: black;">倘若</span><span style="color: black;">病痛</span>对阿片类<span style="color: black;">药品</span><span style="color: black;">敏锐</span>（即能用阿片类<span style="color: black;">药品</span>来缓解），就<span style="color: black;">能够</span><span style="color: black;">经过</span><span style="color: black;">增多</span>药量来达到更<span style="color: black;">显著</span>的疗效。长效阿片类<span style="color: black;">药品</span>(控释或缓释类的)：用来治疗稳定或基线<span style="color: black;">病痛</span>。<span style="color: black;">通常</span>是口服，一日两次。快速或短效阿片类<span style="color: black;">药品</span>：当必要时用于突破性或偶发性<span style="color: black;">病痛</span>（<span style="color: black;">经过</span>口服，粘膜吸收或吸入途径<span style="color: black;">吃下</span>）。<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">吃下</span>阿片类<span style="color: black;">药品</span>的<span style="color: black;">平常</span>不良反应<span style="color: black;">包含</span>恶心和呕吐，瞳孔缩小，口干和便秘。其他不良反应有荨麻疹，低体温症，姿态性低血压，头昏，头疼，尿潴留，肌跃症等。<span style="color: black;">呼气</span><span style="color: black;">控制</span>是阿片类<span style="color: black;">止疼</span><span style="color: black;">药品</span>最严重的不良反应。</p>
    <div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-f2f329086ee18f2df195d4a9fb476fd1_720w.webp" style="width: 50%; margin-bottom: 20px;"></div><span style="color: black;">照片</span><span style="color: black;">源自</span>：摄图网 <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">由于</span>阿片类<span style="color: black;">止疼</span>药中含有吗啡，<span style="color: black;">始终</span><span style="color: black;">败兴</span><span style="color: black;">针对</span>阿片类<span style="color: black;">药品</span>“成瘾”的说法<span style="color: black;">作为</span>不少<span style="color: black;">病人</span>的心结。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">中日友好医院<span style="color: black;">病痛</span>科<span style="color: black;">专家</span>、全国<span style="color: black;">病痛</span>诊疗<span style="color: black;">科研</span>中心<span style="color: black;">专家</span>樊碧发教授曾在采访中<span style="color: black;">说到</span>，“医学用途的阿片类<span style="color: black;">药品</span>治疗，<span style="color: black;">药品</span>成瘾是非常罕见的。<span style="color: black;">大夫</span>科学、规范、<span style="color: black;">恰当</span>的<span style="color: black;">指点</span>下，阿片类<span style="color: black;">药品</span>非常安全，完全<span style="color: black;">不消</span><span style="color: black;">思虑</span>成瘾问题。<span style="color: black;">倘若</span><span style="color: black;">经过</span>良好的治疗，<span style="color: black;">病人</span>的<span style="color: black;">病痛</span>得以有效地<span style="color: black;">掌控</span>，阿片类<span style="color: black;">药品</span>是<span style="color: black;">能够</span><span style="color: black;">减少</span><span style="color: black;">乃至</span>停用的，<span style="color: black;">因此</span>阿片类<span style="color: black;">药品</span>不<span style="color: black;">必须</span>终生<span style="color: black;">吃下</span>。”</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>癌症<span style="color: black;">病人</span><span style="color: black;">不该</span>惧怕<span style="color: black;">运用</span>阿片类<span style="color: black;">止疼</span>药，<span style="color: black;">同期</span>应在遵医嘱的<span style="color: black;">状况</span>下规范<span style="color: black;">运用</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">除了上面<span style="color: black;">说到</span>的两类<span style="color: black;">止疼</span><span style="color: black;">药品</span>之外，<span style="color: black;">针对</span>胃癌骨转移的<span style="color: black;">病人</span>，双膦酸盐类<span style="color: black;">药品</span>则是<span style="color: black;">她们</span>的<span style="color: black;">首要</span><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;">双膦酸盐类药</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">骨是胃癌转移<span style="color: black;">平常</span>好发部位。而骨转移一旦<span style="color: black;">出现</span>，就会很高几率<span style="color: black;">显现</span>骨<span style="color: black;">关联</span>事件（SREs），<span style="color: black;">导致</span>诸如<span style="color: black;">病痛</span>、高钙血症、病理性骨折、脊柱压迫等严重后果。</p>
    <div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic1.zhimg.com/80/v2-a2d16f3f48f82b6aaf7be484f1ae1828_720w.webp" style="width: 50%; margin-bottom: 20px;"></div><span style="color: black;">照片</span><span style="color: black;">源自</span>：摄图网 <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">唑来膦酸是第三代双膦酸盐类<span style="color: black;">药品</span>，<span style="color: black;">因为</span>和骨有高度的亲和力，能够比癌细胞优先到达骨代谢的部位，到达骨转移部位后，会和破骨细胞结合，<span style="color: black;">控制</span>破骨细胞的活性，<span style="color: black;">最后</span><span style="color: black;">控制</span>破骨细胞介导的骨质重吸收过程，<span style="color: black;">从而</span>阻止肿瘤转移<span style="color: black;">导致</span>的溶骨型病变，减少骨吸收、减轻骨痛，可用于骨质疏松症、骨转移性癌痛及由骨转移<span style="color: black;">导致</span>的高钙血症及其他骨<span style="color: black;">关联</span>事件（SREs）。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因为</span>唑来膦酸<span style="color: black;">功效</span>于破骨细胞，降低破骨细胞的活性，会<span style="color: black;">引起</span>血液中的钙浓度下降，<span style="color: black;">因此呢</span>在使用唑来膦酸之前，应该<span style="color: black;">重视</span>以下4点：</p>有牙科<span style="color: black;">疾患</span>，以及近期内做过牙科手术的<span style="color: black;">病人</span>不宜<span style="color: black;">运用</span>，这些<span style="color: black;">状况</span>可能<span style="color: black;">引起</span>颌骨坏死的<span style="color: black;">出现</span>；肾功能不全和对阿司匹林过敏的<span style="color: black;">病人</span>不宜<span style="color: black;">运用</span>唑来膦酸；与氨基糖甙类<span style="color: black;">药品</span>（如庆大霉素、链霉素、丁胺卡那霉素等）和利尿剂（如甘露醇、呋塞米、螺内酯等）<span style="color: black;">药品</span><span style="color: black;">同期</span><span style="color: black;">运用</span>时，应该遵循<span style="color: black;">大夫</span>的意见，<span style="color: black;">由于</span>这些<span style="color: black;">药品</span>均能降低血钙；与影响肾功能的<span style="color: black;">药品</span><span style="color: black;">同期</span><span style="color: black;">运用</span>时，应该<span style="color: black;">谨慎</span>，如治疗多发性骨髓瘤时，与沙利度胺<span style="color: black;">同期</span><span style="color: black;">运用</span>可能<span style="color: black;">增多</span>肾功能损害<span style="color: black;">出现</span>的<span style="color: black;">危害</span>。<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">樊碧发教授曾<span style="color: black;">暗示</span>科学的癌症治疗<span style="color: black;">方法</span>，加上良好、规范的<span style="color: black;">病痛</span>治疗，远比只治癌不治痛效果好。对<span style="color: black;">病人</span><span style="color: black;">来讲</span>，不仅生命质量<span style="color: black;">能够</span><span style="color: black;">加强</span>，<span style="color: black;">况且</span><span style="color: black;">存活</span>期会延长<span style="color: black;">非常多</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">......</span>胃癌<span style="color: black;">恢复</span>君</p>




nykek5i 发表于 2024-10-27 19:02:58

楼主果然英明！不得不赞美你一下！

4zhvml8 发表于 4 天前

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