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1、Standardized treatment of cancer pain,癌症疼痛的规范化治疗,医学目的 Medical purposes,1.治愈(Cure) 2.延长生命 (Prolong life) 3.提高生活质量 (Improve the quality of life),重新定医疗方向 Re-scheduled medical direction,治愈-控制疾病 ( Cure- Controlling the disease ) 照顾-末期照顾 症狀控制 ( Care-Terminal Care Symptom Control ),治愈性治疗 Curative Treatment
2、 支持性治疗 Supportive Treatment 缓和性治疗 Palliative Treatment,WHO palliative care principles WHO姑息治疗的原则,Palliative care as soon as possible for early tumor, chemotherapy combined with radiotherapy; 姑息治疗应尽早地用于肿瘤的早期,与放疗、化疗相结合; The basis and prerequisite of palliative care: to ease the pain and suffering caus
3、ed symptoms 姑息治疗的基础和前提：缓解疼痛及其造成的痛苦症状; Correct attitude toward death affirmation of life and death as a normal process; the death neither extend nor promote 正确对待死亡肯定生命,并把死亡看成一个正常的过程;对死亡既不延长也不促进; Care of patients with heart and soul, the patients as active life as possible; 对患者全身心照顾,使患者尽可能主动生活; Medica
4、l services are extended to the families, to provide a support system to the families, to take care of patients properly, correctly handle the funeral smooth through the mourning period. 医疗服务延伸至家属，给家属提供一个支持系统,妥善地照顾患者,正确处理后事，平稳度过居丧期。,What is pain？什么是疼痛？,Pain is a subjective feeling 疼痛是一种主观感觉 PainIs an
5、 unpleasant feeling and emotional feelings associated with substantial or potential tissue damage 是一种令人不快的感觉和情绪上的感受，伴有实质上的或潜在的组织损伤,Animal protection organizations动物保护组织,Food industry, standardized treatment食品行业，规范处理,Calling for legislation to protect animals呼吁立法，保护动物,Human enough attention to their
6、own pain人类对自身疼痛的足够重视,The previous world analgesic Day theme 历届世界镇痛日主题 2004: removal of pain, it is the basic right of patients 2004年：免除疼痛，是患者的基本权利 2005: Exempt from pain-The basic rights of patients The sacred duty of the doctor 2005年：免除疼痛患者的基本权利 医生的神圣职责 2006: Concerned about the elderly pain 2006年：
7、关注老年疼痛 2007: attention to womens pain 2007年：关注女性疼痛 2008: The fight against cancer pain 2008年：对抗癌痛,一、癌症疼痛（Cancer Pain）,Pain Why valued?癌痛为什么受重视？,癌痛（Cancer Pain）的定义(definition) ： The pain caused due to the cancer itself and cancer treatment process 由于癌症本身及癌症诊疗过程中所引起的疼痛 About 60% of the incidence of ca
8、ncer pain 癌症疼痛的发生率为60%左右 40% mild pain, 30% moderate pain, 30% moderate to severe pain 40%轻度疼痛，30%中度疼痛，30%重度疼痛 Pain is the most feared symptoms 癌痛是最令人畏惧的症状 Cancer at the time of diagnosis, and 50% have symptoms of pain 癌症在诊断时，50%的有疼痛症状 In the treatment process, 30% of pain 在治疗过程中，30%的有疼痛症状 In end-st
9、age cancer, 90% experienced pain 在癌症终末期，90%的经历过疼痛,Tumor development is a direct violation of cause (70% -80%)肿瘤发展直接侵犯引起（70%80%） Associated with tumors, but not the direct cause (10%) 与肿瘤相关但非直接引起（10%） Caused by the diagnosis and treatment of tumors (10% -20%)由肿瘤的诊断和治疗引起（10%20%） Has nothing to do with
10、 tumor or treatment of pain (10%) 与肿瘤或治疗无关的疼痛（10%）,Pain reasons 癌痛的原因（WHO）,Cancer pain cause - a direct violation of tumor 癌痛的原因肿瘤直接侵犯,Bone infringement 骨侵犯 Mucosal ulceration or invasion 粘膜溃疡或受侵 Pressure on nerve tissue or invasion 神经组织受压或受侵 Obstruction or invasion of the vascular system 血管系统阻塞或受侵
11、Hollow organs obstruction 空腔脏器梗阻 Solid organ pipe system obstruction 实体器官管道系统梗阻 Treatment: anti-tumor, drainage, pain主要处理：抗肿瘤、引流、止痛,Cancer pain causes - tumor-related syndrome 癌痛的原因肿瘤相关综合征,Paraneoplastic syndrome 副癌综合征 Due to the pain caused by movement disorder 由于活动障碍引起的疼痛 Decubitus 褥疮 Constipation
12、 便秘 Rectum or bladder spasm 直肠或膀胱痉挛 Other: illusory limb pain 其它：如幻肢痛 Mainly deal with: anti-tumor, symptomatic treatment, pain,Reason for cancer pain - diagnosis and treatment癌痛的原因诊断和治疗,Method of diagnosis and staging: Guchuan, lumbar puncture, biopsy 诊断及分期方法：骨穿、腰穿、活检等 Pain after surgery 手术后的疼痛 Rad
13、iotherapy 放疗 Mucositis, enteritis, neurotoxic, non-infectious necrosis粘膜炎、肠炎、神经毒性、无感染性坏死 Chemotherapy 化疗 Mucositis, neurotoxicity, phlebitis 粘膜炎、神经毒性、静脉炎 Mainly deal with: the pain, the symptomatic treatment主要处理：止痛、对症处理,Reasons - nothing to do with tumor and treatment of cancer pain 癌痛的原因与肿瘤及治疗无关,My
14、ocardial infarction 心肌梗死 Ischemic diseases 缺血性疾病 Arthritis, rheumatism, gout 关节炎、风湿、痛风 Other 其他 Mainly deal with: the pain, the symptomatic treatment 主要处理：止痛、对症处理,Characteristics of cancer pain 癌痛的特征,Pain is a mechanism that is unique and complex chronic pain 癌痛是一种机制独特而复杂的慢性疼痛 Patients often engende
15、red hyperalgesia or allodynia 患者常常表现为痛觉过敏或痛觉超敏 External stimuli may lead to a “breakthrough pain“ 在外界刺激下可能引发“爆发痛”,二、The standardization of the treatment of cancer pain 癌痛治疗的规范化,癌疼治疗规范化的依据 （Good Pain Management，GPM）,Recommended by the authority recognized principles and methods of pain management, pa
16、in treatment 按照权威机构推荐的公认的疼痛处理原则及方法，进行癌痛治疗 WHO U.S. NCCN Adult Cancer Pain Clinical Practice Guidelines 美国NCCN成人癌痛临床实践指南 European the ESMO Cancer Pain Therapy Clinical Practice Guidelines 欧洲ESMO癌痛治疗临床实践指南,The purpose of standardized pain treatment,Out of the misunderstanding of pain treatment 走出癌痛治疗的误区 Early, sustained, effective and optimal pain control 早期、持续、有效、最优化地控制疼痛 Minimize treatment side effects, adverse reactions, as well as costs 将治
