癌症病痛管理药学专家共识
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">癌症<span style="color: black;">病痛</span>管理药学专家共识</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">北京市<span style="color: black;">病痛</span>治疗质量<span style="color: black;">掌控</span>和改进中心</span></p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1、</span>概述</p>
</span><span style="color: black;"><span style="color: black;">病痛</span>会给癌症病人<span style="color: black;">导致</span><span style="color: black;">极重</span>的身心痛苦，是导</span><span style="color: black;">致抑郁和死亡等不良<span style="color: black;">结果</span>的高<span style="color: black;">危害</span><span style="color: black;">原因</span>。</span><span style="color: black;"><span style="color: black;">因此呢</span>，癌</span><span style="color: black;">症<span style="color: black;">病痛</span>（以下简<span style="color: black;">叫作</span>“癌痛”）的治疗是癌症综合治</span><span style="color: black;">疗中的核心环节之一。</span><span style="color: black;"><span style="color: black;">药品</span>治疗是癌痛治疗最为重</span><span style="color: black;">要和常用的<span style="color: black;">办法</span>，规范、有效的<span style="color: black;">药品</span>治疗能够缓解</span><span style="color: black;">80%～90% 癌症病人的<span style="color: black;">病痛</span>症状。</span><span style="color: black;"><span style="color: black;">因此呢</span>，<span style="color: black;">按照</span>癌症</span><span style="color: black;">病人<span style="color: black;">病痛</span>的性质、程度等<span style="color: black;">状况</span>，<span style="color: black;">恰当</span><span style="color: black;">选取</span><span style="color: black;">药品</span>种类，</span><span style="color: black;">个体化<span style="color: black;">调节</span><span style="color: black;">药品</span>剂量，有助于<span style="color: black;">得到</span>最佳的<span style="color: black;">止疼</span>效果。</span><span style="color: black;">癌痛发病机制<span style="color: black;">繁杂</span>，临床表现多样，治疗效果</span><span style="color: black;">的影响<span style="color: black;">原因</span>众多，组建多学科<span style="color: black;">病痛</span>管理团队已<span style="color: black;">作为</span></span><span style="color: black;">广泛共识。</span><span style="color: black;">药学<span style="color: black;">分部</span>在癌痛治疗<span style="color: black;">药品</span>规范<span style="color: black;">运用</span>与管</span><span style="color: black;">理中占有非常<span style="color: black;">要紧</span>的地位，其工作内容<span style="color: black;">触及</span>药事管</span><span style="color: black;">理和药学服务中的各个环节。</span><span style="color: black;">为充分发挥药学专业</span><span style="color: black;">技术人员在癌痛<span style="color: black;">药品</span>治疗过程中的<span style="color: black;">功效</span>，结合我国</span><span style="color: black;">癌痛治疗<span style="color: black;">状况</span>，特制定本共识，以期为推进癌痛规</span><span style="color: black;">范化管理的药学服务实践<span style="color: black;">供给</span>指引。</span><span style="color: black;"><span style="color: black;">2、</span></span><span style="color: black;">癌痛<span style="color: black;">药品</span>治疗的原则及<span style="color: black;">方法</span></span><span style="color: black;">（一）WHO 癌痛三阶梯<span style="color: black;">止疼</span>原则及<span style="color: black;">发展</span></span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">按照</span>世界卫生组织 (WHO) “癌痛三阶梯<span style="color: black;">止疼</span></span><span style="color: black;">治疗”原则，应<span style="color: black;">按照</span>病人的<span style="color: black;">病痛</span>程度，有针对性地</span><span style="color: black;"><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>。</span><span style="color: black;">采用数字评分法(</span><span style="color: black;">NRS) 评分，<span style="color: black;">针对</span>轻度<span style="color: black;">病痛</span>（NRS≤ 3</span><span style="color: black;">分）可<span style="color: black;">选择</span>非甾体消炎<span style="color: black;">止疼</span><span style="color: black;">药品</span>，<span style="color: black;">倘若</span>存在<span style="color: black;">运用</span>非</span><span style="color: black;">甾体消炎<span style="color: black;">止疼</span><span style="color: black;">药品</span>的禁忌证，<span style="color: black;">亦</span>可<span style="color: black;">思虑</span><span style="color: black;">运用</span>低剂量</span><span style="color: black;">阿片类<span style="color: black;">药品</span>；</span><span style="color: black;">中度<span style="color: black;">病痛</span>（3 分< NRS < 7 分）可使</span><span style="color: black;">用弱阿片类<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>，</span><span style="color: black;">并可联合应用非甾体消炎<span style="color: black;">止疼</span><span style="color: black;">药品</span>以及辅助<span style="color: black;">止疼</span>药</span><span style="color: black;">物（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）；</span><span style="color: black;">重度<span style="color: black;">病痛</span> （NRS ≥ 7 分） 首选强阿片类药，并可</span><span style="color: black;">合用非甾体消炎<span style="color: black;">止疼</span><span style="color: black;">药品</span>及辅助<span style="color: black;">止疼</span><span style="color: black;">药品</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">近年来的<span style="color: black;">科研</span><span style="color: black;">显示</span>，弱阿片类<span style="color: black;">药品</span>与非甾体消</span><span style="color: black;">炎<span style="color: black;">止疼</span>药在治疗癌痛的疗效方面<span style="color: black;">没</span><span style="color: black;">明显</span>差异，低剂</span><span style="color: black;">量强阿片类<span style="color: black;">药品</span>对中度癌痛的<span style="color: black;">止疼</span>效果<span style="color: black;">明显</span>优于弱</span><span style="color: black;">阿片类药物，且弱阿片类<span style="color: black;">药品</span>的<span style="color: black;">止疼</span>效果存在天花</span><span style="color: black;">板效应，<span style="color: black;">因此呢</span>，<span style="color: black;">举荐</span>中度<span style="color: black;">病痛</span>病人<span style="color: black;">亦</span>可<span style="color: black;">运用</span>低剂量</span><span style="color: black;">强阿片类<span style="color: black;">药品</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（二）癌痛<span style="color: black;">药品</span>治疗的五项基本原则及<span style="color: black;">诠释</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1. 口服给药：</span><span style="color: black;">口服给药简单方便，为癌痛治疗</span><span style="color: black;">的首选给药途径。</span><span style="color: black;">对不宜口服的病人可<span style="color: black;">选择</span>其他给</span><span style="color: black;">药途径。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2. 按阶梯给药：</span><span style="color: black;">应<span style="color: black;">按照</span>病人的<span style="color: black;">病痛</span>程度，有针</span><span style="color: black;">对性地<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>（参照上文“WHO</span><span style="color: black;">三阶梯<span style="color: black;">止疼</span>治疗原则及<span style="color: black;">发展</span>”）。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3. 按时给药：</span><span style="color: black;">应以缓释阿片类<span style="color: black;">药品</span><span style="color: black;">做为</span><span style="color: black;">基本</span>维</span><span style="color: black;">持用药，按规<span style="color: black;">按时</span>间间隔规律性给予<span style="color: black;">止疼</span>药。</span><span style="color: black;">按时</span><span style="color: black;">给药有助于维持稳定、有效的血药浓度。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4. 个体化用药： </span><span style="color: black;"><span style="color: black;">按照</span>病人个体差异制订个体化</span><span style="color: black;">用药<span style="color: black;">方法</span>。</span><span style="color: black;">晚期癌症病人<span style="color: black;">长时间</span><span style="color: black;">运用</span>阿片类<span style="color: black;">止疼</span>药（如</span><span style="color: black;">吗啡），<span style="color: black;">没</span>极量限制，即应<span style="color: black;">按照</span>个体对吗啡等阿片</span><span style="color: black;">类<span style="color: black;">止疼</span>药的耐受程度决定用药剂量，但应严密<span style="color: black;">重视</span></span><span style="color: black;">监控不良反应。</span><span style="color: black;"><span style="color: black;">同期</span>，还应鉴别<span style="color: black;">是不是</span>存在神经病理</span><span style="color: black;">性<span style="color: black;">病痛</span>，<span style="color: black;">思虑</span>联合<span style="color: black;">运用</span>三环类抗抑郁<span style="color: black;">药品</span>或抗惊厥</span><span style="color: black;">类<span style="color: black;">药品</span>等；</span><span style="color: black;"><span style="color: black;">倘若</span>存在肿瘤骨转移<span style="color: black;">导致</span>的<span style="color: black;">病痛</span>，应联</span><span style="color: black;">合<span style="color: black;">运用</span>双膦酸盐类<span style="color: black;">药品</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">5. <span style="color: black;">重视</span><span style="color: black;">详细</span>细节：</span><span style="color: black;">对<span style="color: black;">运用</span><span style="color: black;">止疼</span><span style="color: black;">药品</span>的病人，要</span><span style="color: black;">密切观察<span style="color: black;">病痛</span>缓解程度和机体反应<span style="color: black;">状况</span>，<span style="color: black;">重视</span><span style="color: black;">药品</span></span><span style="color: black;">联合应用的相互<span style="color: black;">功效</span>，并<span style="color: black;">即时</span>采取必要<span style="color: black;">办法</span>以尽可</span><span style="color: black;">能减少<span style="color: black;">药品</span>的不良反应，<span style="color: black;">加强</span>病人的生活质量。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（三）阿片类<span style="color: black;">药品</span>滴定原则</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1. 滴定<span style="color: black;">目的</span>：</span><span style="color: black;">阿片类<span style="color: black;">药品</span>滴定的目的是为了迅</span><span style="color: black;">速获知病人每日<span style="color: black;">止疼</span>所需阿片类<span style="color: black;">药品</span>剂量，缓解中、</span><span style="color: black;">重度<span style="color: black;">病痛</span>，达到<span style="color: black;">病痛</span>缓解与不良反应之间的平衡。</span><span style="color: black;">3 天内<span style="color: black;">病痛</span>评分未降至3 分以下，应请专科会诊。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2. 滴定<span style="color: black;">药品</span>：</span><span style="color: black;"><span style="color: black;">通常</span><span style="color: black;">运用</span>即释阿片类<span style="color: black;">药品</span>进行滴</span><span style="color: black;">定，<span style="color: black;">亦</span><span style="color: black;">能够</span><span style="color: black;">思虑</span>给予小剂量缓释阿片类<span style="color: black;">药品</span><span style="color: black;">做为</span></span><span style="color: black;">背景用药，联合即释阿片类<span style="color: black;">药品</span>处理爆发痛的方式</span><span style="color: black;">进行滴定。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3. 滴定<span style="color: black;">方法</span> 参照《癌症<span style="color: black;">病痛</span>诊疗规范》（2018</span><span style="color: black;">年版）。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（四）阿片类<span style="color: black;">药品</span>轮换原则</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1. 阿片类<span style="color: black;">药品</span>轮换的定义和目的：</span><span style="color: black;">阿片类药</span><span style="color: black;">物轮换<span style="color: black;">指的是</span>用一种阿片类<span style="color: black;">药品</span>替代另一种阿片类药</span><span style="color: black;">物，<span style="color: black;">或</span>是同一阿片类<span style="color: black;">药品</span>不同剂型之间的转换，</span><span style="color: black;">以寻求<span style="color: black;">病痛</span><span style="color: black;">掌控</span>和不良反应之间的平衡。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2. 轮换<span style="color: black;">方法</span>：</span><span style="color: black;">阿片类<span style="color: black;">药品</span>之间的轮换可<span style="color: black;">根据</span>下述</span><span style="color: black;"><span style="color: black;">过程</span>操作：</span><span style="color: black;">①计算病人前24 h 的原阿片类<span style="color: black;">药品</span>总剂</span><span style="color: black;">量；</span><span style="color: black;">②将原阿片类<span style="color: black;">药品</span>总剂量转换为口服吗啡等效剂</span><span style="color: black;">量（见表1）；</span><span style="color: black;">③将口服吗啡等效剂量转换为<span style="color: black;">目的</span>阿</span><span style="color: black;">片类<span style="color: black;">药品</span>24 h 总剂量（见表1）。</span><span style="color: black;"><span style="color: black;">思虑</span>到不同阿片类</span><span style="color: black;"><span style="color: black;">药品</span>之间的不完全性交叉耐药，<span style="color: black;">倘若</span><span style="color: black;">病痛</span>得到有效控</span><span style="color: black;">制，可<span style="color: black;">减少</span>25% ～ 50%；</span><span style="color: black;"><span style="color: black;">倘若</span>之前的剂量<span style="color: black;">没</span>效，可</span><span style="color: black;">给予100% ～ 125% 的等效<span style="color: black;">止疼</span>剂量；</span><span style="color: black;">④将<span style="color: black;">目的</span>阿片</span><span style="color: black;">类<span style="color: black;">药品</span>24 h 总剂量<span style="color: black;">根据</span>按时给药原则分次给药。</span></p><span style="color: black;"><span style="color: black;">3、</span><span style="color: black;">癌痛治疗<span style="color: black;">药品</span>的药事管理</span></span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（一）癌痛治疗<span style="color: black;">药品</span>配备及<span style="color: black;">需求</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">应当<span style="color: black;">按照</span>癌症病人<span style="color: black;">病痛</span>的程度、性质等<span style="color: black;">状况</span>，</span><span style="color: black;"><span style="color: black;">恰当</span>配备<span style="color: black;">止疼</span><span style="color: black;">药品</span>和辅助<span style="color: black;">止疼</span><span style="color: black;">药品</span>。</span><span style="color: black;">常用<span style="color: black;">药品</span><span style="color: black;">包括</span>：</span><span style="color: black;">非甾体消炎<span style="color: black;">止疼</span>药和对乙酰氨基酚、强阿片类<span style="color: black;">止疼</span></span><span style="color: black;">药和辅助<span style="color: black;">止疼</span>药等。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1. 非甾体消炎<span style="color: black;">止疼</span>药和对乙酰氨基酚：</span><span style="color: black;">非甾</span><span style="color: black;">体消炎<span style="color: black;">止疼</span>药和对乙酰氨基酚是癌痛治疗的常用药</span><span style="color: black;">物，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</span><span style="color: black;">于缓解中、重度<span style="color: black;">病痛</span>，可减少阿片类<span style="color: black;">药品</span>的用量。</span><span style="color: black;"><span style="color: black;">根据</span><span style="color: black;">功效</span>机制的不同，非甾体消炎<span style="color: black;">止疼</span>药可分为非</span><span style="color: black;"><span style="color: black;">选取</span>性环氧酶(COX) <span style="color: black;">控制</span>剂和<span style="color: black;">选取</span>性COX-2 <span style="color: black;">控制</span></span><span style="color: black;">剂。</span><span style="color: black;">常用的非甾体消炎<span style="color: black;">止疼</span>药和对乙酰氨基酚的药</span><span style="color: black;">代动力学参数和用法用量（见表2）。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2. 强阿片类<span style="color: black;">止疼</span>药：</span><span style="color: black;">强阿片类<span style="color: black;">止疼</span>药是中、重</span><span style="color: black;">度癌痛治疗的首选<span style="color: black;">药品</span>。</span><span style="color: black;"><span style="color: black;">根据</span>WHO <span style="color: black;">止疼</span>原则, 为满</span><span style="color: black;">足癌痛病人的<span style="color: black;">止疼</span>需求，医疗<span style="color: black;">公司</span>应<span style="color: black;">供给</span><span style="color: black;">最少</span>3 个</span><span style="color: black;">品种以上的强阿片类<span style="color: black;">止疼</span><span style="color: black;">药品</span>，规格、剂型配备齐全，</span><span style="color: black;">口服即释剂型和缓释剂型备齐，并<span style="color: black;">根据</span><span style="color: black;">麻木</span><span style="color: black;">药物</span>管理</span><span style="color: black;">（参见下文“<span style="color: black;">麻木</span><span style="color: black;">药物</span>管理”部分）。</span><span style="color: black;">常用强阿片类</span><span style="color: black;"><span style="color: black;">止疼</span>药的药代动学参数和<span style="color: black;">重视</span>事项见表3。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3. 辅助<span style="color: black;">止疼</span>药：</span><span style="color: black;">辅助<span style="color: black;">止疼</span>药能够辅助性<span style="color: black;">加强</span>阿</span><span style="color: black;">片类<span style="color: black;">药品</span>的<span style="color: black;">止疼</span>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><span style="color: black;">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</span><span style="color: black;">和内脏痛。</span><span style="color: black;">用药的种类<span style="color: black;">选取</span>和剂量<span style="color: black;">调节</span><span style="color: black;">亦</span><span style="color: black;">必须</span>个体</span><span style="color: black;">化对待，尤其是肾功能不全病人应<span style="color: black;">重视</span><span style="color: black;">减少</span>。</span><span style="color: black;">常用</span><span style="color: black;">辅助<span style="color: black;">止疼</span>药的用法用量和不良反应见表4。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4. 阿片类<span style="color: black;">药品</span>中毒解救<span style="color: black;">药品</span>：</span><span style="color: black;">医疗<span style="color: black;">公司</span>应<span style="color: black;">供给</span></span><span style="color: black;">纳洛酮等阿片类<span style="color: black;">药品</span>中毒解救<span style="color: black;">药品</span>，用于阿片类药</span><span style="color: black;">物过量，以逆转阿片类<span style="color: black;">药品</span><span style="color: black;">导致</span>的<span style="color: black;">呼气</span><span style="color: black;">控制</span>等症状。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（二）<span style="color: black;">麻木</span><span style="color: black;">药物</span>管理</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">为保证临床治疗<span style="color: black;">必须</span>，规范<span style="color: black;">麻木</span><span style="color: black;">药物</span>管理，医</span><span style="color: black;">疗<span style="color: black;">公司</span>应<span style="color: black;">根据</span>《<span style="color: black;">麻木</span><span style="color: black;">药物</span>和精神<span style="color: black;">药物</span>管理条例》（国</span><span style="color: black;">务院令【2005】442 号，2016 修订）、《处方管理办法》</span><span style="color: black;">（卫生部令 第53 号）、《医疗<span style="color: black;">公司</span>药事管理规定》</span><span style="color: black;">（卫医政发【2011】11 号）、《三级综合医院评审</span><span style="color: black;">标准实施细则（2011 年版）》（卫办医管发【2011】</span><span style="color: black;">148 号）、《<span style="color: black;">麻木</span><span style="color: black;">药物</span>临床应用<span style="color: black;">指点</span>原则》（卫医发</span><span style="color: black;">【2007】38 号）、《癌症<span style="color: black;">病痛</span>诊疗规范（2018 年版）》</span><span style="color: black;">等文件<span style="color: black;">需求</span>，切实做好<span style="color: black;">麻木</span><span style="color: black;">药物</span>的药事管理工作。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1. 三级管理：</span><span style="color: black;">医疗<span style="color: black;">公司</span>应实行严格的三级管理</span><span style="color: black;">制度，药库、<span style="color: black;">药店</span>和病区分别承担相应的<span style="color: black;">麻木</span><span style="color: black;">药物</span></span><span style="color: black;">管理责任。</span><span style="color: black;">药库负责<span style="color: black;">麻木</span><span style="color: black;">药物</span>的入库验收、储存和</span><span style="color: black;">出入库管理；</span><span style="color: black;"><span style="color: black;">药店</span>与药库<span style="color: black;">创立</span>基数，经药学<span style="color: black;">分部</span><span style="color: black;">准许</span>，</span><span style="color: black;">至药库请领<span style="color: black;">药物</span>，负责<span style="color: black;">药物</span>保管和发放；</span><span style="color: black;">病区<span style="color: black;">按照</span></span><span style="color: black;">临床<span style="color: black;">实质</span><span style="color: black;">运用</span><span style="color: black;">状况</span>与<span style="color: black;">药店</span><span style="color: black;">创立</span>基数，经<span style="color: black;">关联</span><span style="color: black;">分部</span>批</span><span style="color: black;">准，至<span style="color: black;">药店</span>请领<span style="color: black;">药物</span>，负责<span style="color: black;">药物</span>保管和<span style="color: black;">运用</span>登记。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2. “五专”管理：</span><span style="color: black;"><span style="color: black;">麻木</span><span style="color: black;">药物</span>应实行“五专”管</span><span style="color: black;">理，即专人负责、专柜加锁、专用账册、专用处方、</span><span style="color: black;">专册登记。</span><span style="color: black;">医疗<span style="color: black;">公司</span>应配备符合<span style="color: black;">需求</span>的专业技术人</span><span style="color: black;">员（相对固定），负责<span style="color: black;">麻木</span><span style="color: black;">药物</span>的采购、储存保管、</span><span style="color: black;">调配<span style="color: black;">运用</span>及管理工作，并<span style="color: black;">运用</span>专库（柜）储存，对</span><span style="color: black;">进出专库（柜）的<span style="color: black;">麻木</span><span style="color: black;">药物</span>进行逐笔登记。</span><span style="color: black;">开具麻</span><span style="color: black;">醉<span style="color: black;">药物</span>应<span style="color: black;">运用</span>专用处方，并对处方进行专册登记。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3. 批号管理：</span><span style="color: black;"><span style="color: black;">麻木</span><span style="color: black;">药物</span>实行批号管理。</span><span style="color: black;"><span style="color: black;">麻木</span>药</span><span style="color: black;">品在购入、储存、发放、调配、<span style="color: black;">运用</span>和回收等过程</span><span style="color: black;">中应登记和核对批号，做到帐、物、批号相符。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4. 处方管理：</span><span style="color: black;">医疗<span style="color: black;">公司</span>为门（急）诊、住院癌</span><span style="color: black;">痛</span><span style="color: black;">病人开具<span style="color: black;">麻木</span><span style="color: black;">药物</span>，应<span style="color: black;">根据</span>《处方管理办法》有</span><span style="color: black;">关规定执行，满足<span style="color: black;">病痛</span>治疗需求。</span><span style="color: black;">医疗<span style="color: black;">公司</span>医务部</span><span style="color: black;">门和药学<span style="color: black;">分部</span>应<span style="color: black;">定时</span>组织对<span style="color: black;">麻木</span><span style="color: black;">药物</span>处方进行专项</span><span style="color: black;">点评，<span style="color: black;">保准</span><span style="color: black;">麻木</span><span style="color: black;">药物</span>的<span style="color: black;">恰当</span>应用。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">5. <span style="color: black;">麻木</span><span style="color: black;">药物</span>保管<span style="color: black;">办法</span>：</span><span style="color: black;">①安全<span style="color: black;">设备</span>：</span><span style="color: black;">药库设置有</span><span style="color: black;">“</span><span style="color: black;"><span style="color: black;">麻木</span><span style="color: black;">药物</span>”专用库（柜），门窗有防盗<span style="color: black;">设备</span>，配有</span><span style="color: black;">安全监控及自动报警<span style="color: black;">设备</span>；</span><span style="color: black;"><span style="color: black;">药店</span>和各病房（区）、</span><span style="color: black;">手术室等有专用保险柜或带保险的智能药柜，有防盗</span><span style="color: black;"><span style="color: black;">设备</span>；</span><span style="color: black;">②验收<span style="color: black;">办法</span>：</span><span style="color: black;"><span style="color: black;">麻木</span><span style="color: black;">药物</span>入库验收<span style="color: black;">必要</span>货到即验，</span><span style="color: black;"><span style="color: black;">最少</span>双人开箱验收，清点验收到最小包装，验收记录</span><span style="color: black;">双人签字；</span><span style="color: black;">③病区基数药<span style="color: black;">检测</span>规定：</span><span style="color: black;">药学<span style="color: black;">分部</span>应<span style="color: black;">定时</span></span><span style="color: black;">对病区<span style="color: black;">麻木</span><span style="color: black;">药物</span>基数药进行<span style="color: black;">检测</span>，<span style="color: black;">检测</span>内容<span style="color: black;">包含</span><span style="color: black;">麻木</span></span><span style="color: black;"><span style="color: black;">药物</span>的<span style="color: black;">运用</span>记录、<span style="color: black;">药物</span>批号和数量、保管<span style="color: black;">办法</span>等，至</span><span style="color: black;">少每季度<span style="color: black;">检测</span>1 次，并做记录（见表5）。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">4、</span><span style="color: black;">癌痛治疗<span style="color: black;">药品</span>的药学监护</span></span></p><span style="color: black;">临床药师直接参与癌痛病人临床用药实践，为癌痛治疗用药<span style="color: black;">供给</span>药学服务，对改善癌痛病人的生</span><span style="color: black;">活质量、<span style="color: black;">加强</span>医疗<span style="color: black;">公司</span><span style="color: black;">病痛</span>诊疗水平、<span style="color: black;">保准</span>医疗质</span><span style="color: black;">量和安全<span style="color: black;">拥有</span><span style="color: black;">要紧</span><span style="color: black;">道理</span>。</span><span style="color: black;">（一）临床药师在癌痛治疗中的工作内容</span><span style="color: black;">1. 指定人员参与癌痛治疗小组：</span><span style="color: black;">药学<span style="color: black;">分部</span>应<span style="color: black;">协同</span></span><span style="color: black;">癌痛治疗工作，并派出临床药师负责癌痛<span style="color: black;">药品</span>用药指</span><span style="color: black;">导。</span><span style="color: black;">三级医院应配备专职的<span style="color: black;">病痛</span>专科或肿瘤专科临床</span><span style="color: black;">药师，有1 年以上临床药师工作经验。</span><span style="color: black;">二级及以下医</span><span style="color: black;">院应有指定临床药师为癌痛治疗<span style="color: black;">供给</span>临床药学服务。</span><span style="color: black;">2. <span style="color: black;">麻木</span><span style="color: black;">药物</span>临床应用分析与管理：</span><span style="color: black;">临床药师</span><span style="color: black;">应<span style="color: black;">定时</span>对癌痛治疗<span style="color: black;">药品</span><span style="color: black;">运用</span><span style="color: black;">状况</span>进行动态分析，每</span><span style="color: black;">年≥ 2 次，为临床<span style="color: black;">恰当</span>用药<span style="color: black;">供给</span><span style="color: black;">指点</span>。</span><span style="color: black;">分析内容包</span><span style="color: black;">括癌痛治疗<span style="color: black;">药品</span>用量的种类分布和科室分布，以及</span><span style="color: black;">不<span style="color: black;">同期</span>间段的变化<span style="color: black;">状况</span>。</span><span style="color: black;">临床药师应<span style="color: black;">即时</span>向药事管</span><span style="color: black;">理<span style="color: black;">分部</span><span style="color: black;">报告</span>超常规用药病人的案例总结，与<span style="color: black;">关联</span>科</span><span style="color: black;">室沟通<span style="color: black;">处理</span>，并留存记录。</span><span style="color: black;">3. 开展药学服务工作：</span><span style="color: black;">临床药师应<span style="color: black;">把握</span>癌痛治</span><span style="color: black;">疗<span style="color: black;">关联</span><span style="color: black;">药品</span>治疗<span style="color: black;">方法</span>设计与<span style="color: black;">评定</span>、<span style="color: black;">药物</span><span style="color: black;">危害</span><span style="color: black;">评定</span>和</span><span style="color: black;">药学监护等临床药师专业知识与技能，参与临床药</span><span style="color: black;">物治疗，为病人<span style="color: black;">供给</span>用药教育与咨询服务。</span><span style="color: black;">临床药</span><span style="color: black;">师开展的药学服务工作应<span style="color: black;">包含</span>：</span><span style="color: black;">药学查房、医嘱审</span><span style="color: black;">核与处方点评、<span style="color: black;">药品</span>治疗<span style="color: black;">方法</span>重整、不良反应上报</span><span style="color: black;">与处理、用药教育与<span style="color: black;">指点</span>、<span style="color: black;">药品</span>咨询、<span style="color: black;">麻木</span><span style="color: black;">药物</span>合</span><span style="color: black;">理应用培训与宣教等，见表6 ～ 8。</span><span style="color: black;">（二）药学监护要点及策略</span><span style="color: black;">1. <span style="color: black;">病痛</span><span style="color: black;">评定</span>：</span><span style="color: black;">应<span style="color: black;">按照</span>病人的理解能力、认知<span style="color: black;">状况</span></span><span style="color: black;">和<span style="color: black;">评定</span>目的<span style="color: black;">选取</span>合适的<span style="color: black;">病痛</span><span style="color: black;">评定</span><span style="color: black;">工具</span>。</span><span style="color: black;"><span style="color: black;">日前</span>临床应用</span><span style="color: black;">的<span style="color: black;">病痛</span><span style="color: black;">评定</span><span style="color: black;">工具</span>大致可分为两类：</span><span style="color: black;">单维度<span style="color: black;">病痛</span><span style="color: black;">评定</span>量</span><span style="color: black;">表和多维度<span style="color: black;">病痛</span><span style="color: black;">评定</span><span style="color: black;">工具</span>。</span><span style="color: black;">常用的单维度<span style="color: black;">病痛</span><span style="color: black;">评定</span>量</span><span style="color: black;">表<span style="color: black;">包含</span>视觉模拟<span style="color: black;">病痛</span><span style="color: black;">评定</span>表、数字<span style="color: black;">病痛</span>强度<span style="color: black;">评定</span>表、</span><span style="color: black;">Wong-Baker <span style="color: black;">病痛</span>影响面容表、面部表情<span style="color: black;">病痛</span><span style="color: black;">评定</span>表、</span><span style="color: black;">主诉<span style="color: black;">病痛</span>程度分级法，用于量化<span style="color: black;">病痛</span>强度，为临床选</span><span style="color: black;">择<span style="color: black;">止疼</span>药和<span style="color: black;">调节</span>剂量<span style="color: black;">供给</span>依据。</span><span style="color: black;">多维度<span style="color: black;">病痛</span><span style="color: black;">评定</span>量表</span><span style="color: black;"><span style="color: black;">包含</span>简化McGiII <span style="color: black;">病痛</span>问卷-2 和简明<span style="color: black;">病痛</span><span style="color: black;">评定</span>量表，</span><span style="color: black;">用于<span style="color: black;">测绘</span><span style="color: black;">病痛</span>体验的多个方面，整合病人的<span style="color: black;">病痛</span>强度、</span><span style="color: black;"><span style="color: black;">病痛</span>的加重<span style="color: black;">原因</span>、<span style="color: black;">病痛</span>对功能的影响及其他与<span style="color: black;">病痛</span>相</span><span style="color: black;">关的问题，用于对<span style="color: black;">病痛</span>进行全面<span style="color: black;">评定</span>。</span><span style="color: black;"><span style="color: black;">按照</span>病人的<span style="color: black;">疾患</span><span style="color: black;">周期</span>和临床治疗需求决定<span style="color: black;">病痛</span></span><span style="color: black;"><span style="color: black;">评定</span>的频率，初次就诊、<span style="color: black;">病痛</span><span style="color: black;">出现</span>变化及<span style="color: black;">病痛</span>治疗</span><span style="color: black;">计划<span style="color: black;">出现</span>改变时均应进行全面<span style="color: black;">评定</span>。</span><span style="color: black;">2. 用药依从性<span style="color: black;">评估</span>：</span><span style="color: black;">癌痛病人用药依从性是一</span><span style="color: black;">个非常<span style="color: black;">要紧</span>的问题。</span><span style="color: black;"><span style="color: black;">加强</span>病人用药依从性可<span style="color: black;">加强</span>药</span><span style="color: black;">物治疗效果，减少不良反应<span style="color: black;">出现</span><span style="color: black;">危害</span>，<span style="color: black;">加强</span>病人生</span><span style="color: black;">活质量。</span><span style="color: black;">3. 参与个体化治疗<span style="color: black;">方法</span>的制订与<span style="color: black;">调节</span>：</span><span style="color: black;">应<span style="color: black;">按照</span></span><span style="color: black;">病人的病情、<span style="color: black;">病痛</span>的程度和病人的<span style="color: black;">止疼</span>需求，<span style="color: black;">根据</span></span><span style="color: black;">癌痛的三阶梯<span style="color: black;">止疼</span>原则与医师<span style="color: black;">一起</span>制订个体化治疗</span><span style="color: black;"><span style="color: black;">方法</span>。</span><span style="color: black;">在制订个体化治疗<span style="color: black;">方法</span>时，应<span style="color: black;">思虑</span>病人的病</span><span style="color: black;">理生理状态、<span style="color: black;">药品</span>相互<span style="color: black;">功效</span>等<span style="color: black;">原因</span>，积极处理爆发</span><span style="color: black;">痛和不良反应。</span><span style="color: black;">（1）肝肾功能不全时常用<span style="color: black;">止疼</span><span style="color: black;">药品</span>的<span style="color: black;">调节</span><span style="color: black;">方法</span>：</span><span style="color: black;">肝肾功能不全可影响<span style="color: black;">药品</span>在<span style="color: black;">身体</span>的代谢和排泄等过</span><span style="color: black;">程，<span style="color: black;">因此呢</span>，<span style="color: black;">必须</span>个体化<span style="color: black;">调节</span>相应<span style="color: black;">药品</span>的用法用量。</span><span style="color: black;"><span style="color: black;">针对</span><span style="color: black;">必须</span><span style="color: black;">长时间</span><span style="color: black;">运用</span><span style="color: black;">止疼</span><span style="color: black;">药品</span>的肝肾功能不全的癌痛</span><span style="color: black;">病人，需密切监护<span style="color: black;">药品</span>的<span style="color: black;">止疼</span>效果和可能<span style="color: black;">显现</span>的不</span><span style="color: black;">良反应，<span style="color: black;">小心</span><span style="color: black;">调节</span>剂量和用药频次（见表9、10）。</span><span style="color: black;">（2）<span style="color: black;">评定</span><span style="color: black;">药品</span>相互<span style="color: black;">功效</span>：</span><span style="color: black;"><span style="color: black;">药品</span>相互<span style="color: black;">功效</span>可影响</span><span style="color: black;"><span style="color: black;">药品</span>疗效，<span style="color: black;">增多</span><span style="color: black;">药品</span>不良反应。</span><span style="color: black;">应<span style="color: black;">尤其</span><span style="color: black;">警觉</span>阿片类</span><span style="color: black;"><span style="color: black;">药品</span>与苯二氮䓬类<span style="color: black;">药品</span></span><span style="color: black;">合用<span style="color: black;">导致</span>过度镇静、与5- 羟</span><span style="color: black;">色胺能<span style="color: black;">药品</span><span style="color: black;">导致</span>5- 羟色胺<span style="color: black;">综合症</span>的相互<span style="color: black;">功效</span>。</span><span style="color: black;">常用</span><span style="color: black;">的苯二氮䓬类<span style="color: black;">药品</span><span style="color: black;">包含</span>艾司唑仑、地西泮、劳拉西</span><span style="color: black;">泮等，常用的5- 羟色胺能<span style="color: black;">药品</span><span style="color: black;">包含</span>阿片类<span style="color: black;">止疼</span>药、</span><span style="color: black;"><span style="color: black;">选取</span>性5- 羟色胺再摄取<span style="color: black;">控制</span>剂、5- 羟色胺和去甲肾</span><span style="color: black;">上腺素再摄取<span style="color: black;">控制</span>剂、三环类抗抑郁药、5- 羟色胺</span><span style="color: black;">受体拮抗剂、部分抗惊厥<span style="color: black;">药品</span>和单胺氧化酶<span style="color: black;">控制</span>剂</span><span style="color: black;">等。</span><span style="color: black;">其他潜在相互<span style="color: black;">功效</span>见表11。</span><span style="color: black;">（3）爆发痛处理<span style="color: black;">方法</span>：</span><span style="color: black;">参见《癌症<span style="color: black;">病痛</span>诊疗规</span><span style="color: black;">范》（2018 年版）。</span><span style="color: black;">4. <span style="color: black;">药品</span>治疗效果的<span style="color: black;">评定</span>：</span><span style="color: black;">癌痛治疗过程中应定</span><span style="color: black;">期<span style="color: black;">评定</span>病人<span style="color: black;">是不是</span><span style="color: black;">得到</span>满意的<span style="color: black;">止疼</span>效果，<span style="color: black;">知道</span><span style="color: black;">病痛</span>是</span><span style="color: black;">否<span style="color: black;">连续</span>改善或加重，<span style="color: black;">评定</span>当前治疗<span style="color: black;">药品</span>剂量<span style="color: black;">是不是</span>需</span><span style="color: black;">要<span style="color: black;">调节</span>以及<span style="color: black;">是不是</span><span style="color: black;">必须</span>加用其他<span style="color: black;">病痛</span>治疗<span style="color: black;">药品</span>。</span><span style="color: black;"><span style="color: black;">按照</span></span><span style="color: black;">病人的临床治疗需求和治疗<span style="color: black;">周期</span>决定疗效<span style="color: black;">评定</span>的频</span><span style="color: black;">率，当病人的<span style="color: black;">病痛</span><span style="color: black;">状况</span>或治疗<span style="color: black;">方法</span><span style="color: black;">出现</span>变化时，应</span><span style="color: black;">进行全面<span style="color: black;">评定</span>。</span><span style="color: black;">5. <span style="color: black;">药物</span>不良反应的监测：</span><span style="color: black;">在癌痛治疗过程中，</span><span style="color: black;">临床药师应<span style="color: black;">即时</span>关注<span style="color: black;">药物</span>不良反应。</span><span style="color: black;">一旦<span style="color: black;">出现</span>，及</span><span style="color: black;">时采取适当的<span style="color: black;">办法</span>进行处理。</span><span style="color: black;">（1）非甾体消炎<span style="color: black;">止疼</span>药：</span><span style="color: black;">最<span style="color: black;">平常</span>胃肠道<span style="color: black;">流血</span>、溃</span><span style="color: black;">疡和穿孔等胃肠道反应，<span style="color: black;">针对</span>既往有胃肠道病史的病</span><span style="color: black;">人应<span style="color: black;">小心</span><span style="color: black;">运用</span>。</span><span style="color: black;">非甾体消炎<span style="color: black;">止疼</span>药还可能<span style="color: black;">引起</span>严重的</span><span style="color: black;">心血管不良反应，有心血管病史的病人应慎用，若使</span><span style="color: black;">用应密切监测血压等指标。</span><span style="color: black;"><span style="color: black;">同期</span>应<span style="color: black;">重视</span>含非甾体消炎</span><span style="color: black;"><span style="color: black;">止疼</span><span style="color: black;">药品</span>的复方制剂<span style="color: black;">出现</span>相互<span style="color: black;">功效</span>和不良反应的潜在</span><span style="color: black;"><span style="color: black;">危害</span>。</span><span style="color: black;">（2）阿片类<span style="color: black;">药品</span>：</span><span style="color: black;">不良反应<span style="color: black;">重点</span><span style="color: black;">包含</span>便秘、</span><span style="color: black;">恶心、呕吐、嗜睡、瘙痒、<span style="color: black;">头昏</span>、尿潴留、谵妄、</span><span style="color: black;">认知<span style="color: black;">阻碍</span>、<span style="color: black;">呼气</span><span style="color: black;">控制</span>等。</span><span style="color: black;">除了便秘外，<span style="color: black;">都数</span>不良反</span><span style="color: black;">应是短暂且<span style="color: black;">能够</span>耐受的。</span><span style="color: black;">在临床上<span style="color: black;">发掘</span>最多的不良</span><span style="color: black;">反应是便秘，在<span style="color: black;">起步</span>阿片类<span style="color: black;">药品</span>治疗时应<span style="color: black;">同期</span>预防</span><span style="color: black;">性<span style="color: black;">运用</span>通便类<span style="color: black;">药品</span>，如番泻叶、麻仁丸、酚酞片、</span><span style="color: black;">乳果糖、聚乙二醇电解质散等；</span><span style="color: black;">用药<span style="color: black;">时期</span>应多喝水，</span><span style="color: black;">多吃含纤维的<span style="color: black;">食品</span>。</span><span style="color: black;"><span style="color: black;">呼气</span><span style="color: black;">控制</span>是阿片类<span style="color: black;">药品</span>最严重</span><span style="color: black;">的不良反应，阿片类<span style="color: black;">药品</span>过量或与镇静药联合<span style="color: black;">运用</span></span><span style="color: black;"><span style="color: black;">亦</span>可能<span style="color: black;">显现</span><span style="color: black;">呼气</span><span style="color: black;">控制</span>。</span><span style="color: black;">（3）辅助<span style="color: black;">止疼</span>药：</span><span style="color: black;">加巴喷丁和普瑞巴林的<span style="color: black;">重点</span></span><span style="color: black;">不良反应<span style="color: black;">包含</span><span style="color: black;">头昏</span>、嗜睡和<span style="color: black;">周边</span>性水肿等，度洛西</span><span style="color: black;">汀的<span style="color: black;">重点</span>不良反应为恶心，<span style="color: black;">通常</span>可<span style="color: black;">经过</span>缓慢<span style="color: black;">增多</span>剂</span><span style="color: black;">量等方式耐受。</span><span style="color: black;">在<span style="color: black;">运用</span>辅助<span style="color: black;">止疼</span>药时，需<span style="color: black;">按照</span>肾功</span><span style="color: black;">能<span style="color: black;">调节</span>加巴喷丁、普瑞巴林、度洛西汀等<span style="color: black;">药品</span>的剂</span><span style="color: black;">量，<span style="color: black;">警觉</span>双膦酸盐致下颌骨坏死的<span style="color: black;">危害</span>，<span style="color: black;">重视</span><span style="color: black;">药品</span></span><span style="color: black;">间相互<span style="color: black;">功效</span>。</span><span style="color: black;">6. 病人用药教育与咨询：</span><span style="color: black;">临床药师<span style="color: black;">做为</span><span style="color: black;">病痛</span>管</span><span style="color: black;">理的<span style="color: black;">要紧</span>成员，应参与病人用药教育与咨询。</span><span style="color: black;">临床</span><span style="color: black;">药师对病人教育应围绕治疗<span style="color: black;">药品</span>展开，<span style="color: black;">包含</span>教育病</span><span style="color: black;">人及家属正确认识<span style="color: black;">病痛</span>和<span style="color: black;">病痛</span>治疗<span style="color: black;">药品</span>、<span style="color: black;">评定</span><span style="color: black;">药品</span></span><span style="color: black;">疗效和不良反应、<span style="color: black;">把握</span><span style="color: black;">药品</span>的用法用量、<span style="color: black;">加强</span>用药</span><span style="color: black;">依从性等。</span><span style="color: black;"><span style="color: black;">针对</span>过度恐惧不良反应的病人，应与病</span><span style="color: black;">人积极沟通，解释成瘾性、依赖性与耐受性的关系，</span><span style="color: black;">消除病人及其家属对阿片类<span style="color: black;">止疼</span>药的恐惧。</span><span style="color: black;">病人用</span><span style="color: black;">药教育的<span style="color: black;">重要</span>要点还<span style="color: black;">包含</span>：</span><span style="color: black;">缓释制剂应按时<span style="color: black;">吃下</span>，</span><span style="color: black;">即释制剂按需<span style="color: black;">吃下</span>；</span><span style="color: black;">缓释制剂应整片吞服，<span style="color: black;">不该</span>嚼</span><span style="color: black;">碎、掰开或研磨；</span><span style="color: black;">芬太尼透皮贴剂的<span style="color: black;">运用</span><span style="color: black;">办法</span>；</span><span style="color: black;">阿</span><span style="color: black;">片类的不良反应；</span><span style="color: black;">阿片类<span style="color: black;">药品</span>的成瘾性；</span><span style="color: black;">对乙酰氨</span><span style="color: black;">基酚的剂量限制等。</span><span style="color: black;">7. 用药随访：</span><span style="color: black;">癌痛病人出院后的用药随访是促</span><span style="color: black;">进安全<span style="color: black;">恰当</span>用药的<span style="color: black;">要紧</span>环节，有助于<span style="color: black;">加强</span>癌痛治疗</span><span style="color: black;">效果，降低不良事件<span style="color: black;">出现</span><span style="color: black;">危害</span>。</span><span style="color: black;">其内容应<span style="color: black;">包含</span>：</span><span style="color: black;">疼</span><span style="color: black;">痛缓解<span style="color: black;">状况</span>、用药<span style="color: black;">指点</span>、<span style="color: black;">药物</span>不良反应的鉴别与防</span><span style="color: black;">范等。</span><span style="color: black;">（三）临床药师参与癌痛管理的工作路径（见</span><span style="color: black;">图1）。</span><span style="color: black;">参考文献（略）</span>
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<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/olMDHtXgmVsoffP57WOCQJPibtEv4qJOyR7iaDuS5SkPEC9f1Y5HVeDj7Y69olVuFxBo266TRMkBx0bYLOwTshXA/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;"><img src="https://mmbiz.qpic.cn/sz_mmbiz_png/olMDHtXgmVsoffP57WOCQJPibtEv4qJOymibwy0LkBVdKlJ4tWqs7RzL366WuicTf7ficiac8aDeISRR80ZrlydIy4w/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;"><img src="https://mmbiz.qpic.cn/sz_mmbiz_png/olMDHtXgmVsoffP57WOCQJPibtEv4qJOy2UxEVFYlhNDOtiacT9KvnWxuZQhNC0FcsJ058KiaMEzeVkibAHz8A30LQ/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;"><strong style="color: blue;">《癌症<span style="color: black;">病痛</span>管理药学专家共识》编写组名单（按姓氏笔画排序）:</strong></span><span style="color: black;">概<span style="color: black;">1、</span></span><span style="color: black;">王薇（北京大学肿瘤医院中西医结合暨老年肿瘤科）、王丽霞（中国中医科学院广安门医院药剂科）、王昆（天津医科大学肿瘤医院<span style="color: black;">病痛</span>科）、王晨（天津医科大学肿瘤医院药学部）、艾超（清华大学<span style="color: black;">附庸</span>北京清华长庚医院药剂科）、付桂英（解放军总医院第五医学中心药学部）、冯婉玉（北京大学人民医院药剂科）、冯智英（浙江大学医学院<span style="color: black;">附庸</span><span style="color: black;">第1</span>医院<span style="color: black;">病痛</span>科）、古今（北京大学首钢医院药剂科）、华国栋（北京中医药大学东方医院药学部）、刘丽宏（首都医科大学<span style="color: black;">附庸</span>北京朝阳医院药学部）、刘维（北京大学第三医院药剂科）、任夏洋（中国医学科学院北京协和医学院肿瘤医院药剂科）、许瑞（首都医科大学<span style="color: black;">附庸</span>北京胸科医院药学部）、李国辉（中国医学科学院北京协和医学院肿瘤医院药剂科）、李朋梅（中日友好医院药学部）、李萍萍（北京大学肿瘤医院中西医结合暨老年肿瘤科）、李然（北京大学肿瘤医院药剂科）、李占东（北京大学肿瘤医院中西医结合暨老年肿瘤科）、陆进（中日友好医院药学部）、杨青（中日友好医院<span style="color: black;">病痛</span>科）、杨阳（中日友好医院<span style="color: black;">病痛</span>科）、张艳华（北京大学肿瘤医院药剂科）、张弋（天津市<span style="color: black;">第1</span>中心医院药学部）、张洁（天津医科大学肿瘤医院药学部）、沈素（首都医科大学<span style="color: black;">附庸</span>友谊医院药学部）、吴涛（中国人民解放军总医院药学部）、金毅（中国人民解放军东部战区总医院<span style="color: black;">病痛</span>科）、郝志英（山西省肿瘤医院药学部）、赵荣生（北京大学第三医院药剂科）、段京莉（北京大学国际医院药剂科）、郭桂明（首都医科大学<span style="color: black;">附庸</span>北京中医医院药学部）、郭振勇（首都医科大学<span style="color: black;">附庸</span>北京胸科医院药学部）、高宁（天津医科大学肿瘤医院药学部）、梅丹（中国医学科学院北京协和医学院北京协和医院药剂科）、葛卫红（南京鼓楼医院药学部）、覃旺军（中日友好医院药学部）、董梅（哈尔滨医科大学<span style="color: black;">附庸</span>肿瘤医院药学部）、鄢丹（首都医科大学<span style="color: black;">附庸</span>北京世纪坛医院药剂科）、谭玲（北京医院药学部）、翟所迪（北京大学第三医院药剂科）、樊碧发（中日友好医院<span style="color: black;">病痛</span>科）、戴媛媛（中国医学科学院北京协和医学院肿瘤医院药剂科）</span><strong style="color: blue;"><span style="color: black;">执笔人</span></strong><span style="color: black;">：覃旺军、任夏洋、李然、谭玲、李国辉、张艳华</span><strong style="color: blue;"><span style="color: black;">△ 通讯作者</span></strong><span style="color: black;">：李朋梅lipengmei@yeah.net；</span><span style="color: black;">樊碧发 fbf1616@yeah.net</span><span style="color: black;"><strong style="color: blue;"><span style="color: black;">文案</span><span style="color: black;">源自</span></strong><span style="color: black;">：《中国<span style="color: black;">病痛</span>医学杂志》2019年第25卷第12期，指南与规范栏目《癌症<span style="color: black;">病痛</span>管理药学专家共识》第801-807页。</span></span>
外链发布社区 http://www.fok120.com/ 你的见解独到，让我受益匪浅，非常感谢。 楼主果然英明！不得不赞美你一下！ 说得好啊！我在外链论坛打滚这么多年，所谓阅人无数，就算没有见过猪走路，也总明白猪肉是啥味道的。 说得好啊！我在外链论坛打滚这么多年，所谓阅人无数，就算没有见过猪走路，也总明白猪肉是啥味道的。
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