某社區醫院安寧病房癌末病人轉入前疼痛控制處方的適當性_

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題名：	某社區醫院安寧病房癌末病人轉入前疼痛控制處方的適當性
書刊名：	安寧療護
作者：	許瀞分／陳正裕
作者(外文)：	Hsu, Ching-fen／Chen, Cheng-yu
出版日期：	2014
卷期：	19:3
頁次：	頁247-257
主題關鍵詞：	生命末期；癌症疼痛；疼痛控制；適當性；End-of-life；Cancer pain；Pain control；Appropriateness
原始連結：	連回原系統網址
相關次數：	被引用次數:期刊(1) 博士論文(0) 專書(0) 專書論文(0) 排除自我引用:1 共同引用:0 點閱:1

目的：疼痛是癌症病人最常見的症狀之一。世界衛生組織（WHO）提出疼痛控制的原則，包括口服給藥、規律按時服藥、三階段調整止痛藥強度、個別化的給藥以及注意細節。我們依據WHO癌症疼痛控制的原則，歸納出臨床上常見的不適當疼痛控制模式。本篇研究希望藉由了解某社區醫院癌末病人在非安寧病房的疼痛控制的情況，來做為未來改善癌末病人疼痛控制的方針。方法：我們收集從2009年10月1日至2011年9月30日，在安寧病房住院的病人，檢視病人的病歷，記錄下基本資料、回顧在非安寧病房時的疼痛控制處方；包括止痛藥物使用目的、止痛藥物種類、給予的途徑、劑量調整的方式，以及是否為規則給藥。結果：收案期間在安寧病房住院的病人共有545人；男性有288人，女性有257人。平均年齡是69歲。符合是由非安寧病房轉入並使用鴉片類藥物做為癌症末期止痛的人有124人，當中有31人使用meperidine 作為慢性疼痛處控制。其中使用單一途徑規則給藥的有46人（37%），使用二種以上的給藥途徑的有81人（65%），同時使用到三種途徑的有24人（19%）。沒有人使用皮下注射的方式。有25人（20%）的疼痛控制模式為沒有規則定時使用止痛藥。有28人（23%）沒有依照WHO止痛階梯原則，同時使用強效和弱效的鴉片類藥物。結論：本篇研究發現末期癌症病人疼痛控制仍有許多比例未遵循世界衛生組織（WHO）提出疼痛控制的原則，未來可以藉由加強教育醫護人員疼痛控制的原則和知識，讓更多癌末病人可以得到最適當的疼痛控制。

以文找文

Purpose: Pain is one of the most common symptom in patients with cancer. World Health Organization (WHO) has promoted the principles of cancer pain relief including by the mouth, by the clock, by the ladder, for the individual and attention to detail. Morphine is recommended as the first choice for moderate to severe cancer pain. Therefore, this study was aimed to assess the appropriateness of pain control for terminal cancer patients in non-palliative care unit. Method: This was a retrospective survey. We surveyed the medical record of patients referred from the ordinary ward to our palliative care ward in the same hospital from October 1, 2009 to September 30, 2011. We included the terminally ill cancer patients using opioid for cancer pain control during hospitalization. Results: Total 124 patients were included in this study. We found 65% used more than two routes of administration for pain control. 20% only used as needs pain control management without at fixed interval of time. Besides, 23% in this study used weak opioids and strong opioids in the same time for cancer pain control and most of them used regular oral ultracet combined with injective morphine as needed. Although meperidine was not suitable for cancer pain control, 25% still using meperidine but all of them were as needed not regular. Conculsion: We can find some barrier in cancer pain control without following WHO principles. There is much work to be done such as educate physicians to provide better pain control for cancer patients.

以文找文

期刊論文
1.	Klepstad, P.、Kaasa, S.、Cherny, N.、Hanks, G.、de Conno, F.(2005)。Research Steering Committee of the EAPC: Pain and pain treatments in European palliative care units. A cross sectional survey from the European Association for Palliative Care Research Network。Palliat Med，19，477-484。
2.	邱泰源(1997)。癌症病人的疼痛控制。台灣醫學，1，198-208。延伸查詢
3.	Gordon, D. B.、Pellino, T. A.、Miaskowski, C.(2002)。A 10-year review of quality improvement monitoring in pain management: Recommendations for standardized outcome measures。Pain Manage Nurs，3，116-130。
4.	Yun, Y. H.、Heo, D. S.、Lee, I. G.(2003)。Multicenter study of pain and its management in patients with advanced cancer in Korea。J Pain Symptom Manage，25，430-437。
5.	Russell, K.、Portenoy, Pauline Lesage(1999)。Management of cancer pain。Lancet，353(9165)，1695-1700。
6.	McCarberg, Bill H.、Barkin, Robert L.(2001)。Long-acting opioids for chronic pain: pharmacotherapeutic opportunities to enhance compliance, quality of life, and analgesia。Am J Ther，8，181-186。
7.	Colson, James、Koyyalagunta, Dhanalakshmi、Falco, Frank J.E.、Manchikanti, Laxmaiah(2011)。A Systematic Review of Observational Studies on the Effectiveness of Opioid Therapy for Cancer Pain。Pain Physician，14，85-102。
8.	Levy, Michael H.(1996)。Pharmacologic Treatment of Cancer Pain。N Engl J Med，335，1124-113。
9.	Vadalouca, A.、Moka, E.、Argyra, E.、Sikioti, P.、Siafaka, I.(2008)。Opioid rotation in patients with cancer: a review of the literature。J Opioid Manag，4(4)，213-250。
10.	Szeto, H. H.、Inturrisi, C. E.、Houde, R.(1977)。Accumulation of normeperidine, an active metabolite of meperidine, in patients with renal failure of cancer。Ann Intern Med，86，738-741。
11.	Hoyer, Kyle-Anne(2002)。Administering Meperidine to Patients With Cancer.。Clinical journal of oncology nursing，6，1092-1095。
12.	Ventafridda, V.、Caraceni, A.、Gamba, A.(1990)。Field-testing of the WHO guidelines for cancer pain relief: summary report of demonstration projects。Advances in Pain Research and Therapy，16，451-464。
13.	Grond, S.、Zech, D.、Schug, S. A.(1991)。Validation or World Health Organization guidelines for cancer pain relief during the last days and hours of life。J Pain Symptom Manage，6，411-422。
14.	Eisner F.、Radbruch, L.、Loick, G.、Gartner, J.、Sabatowski, R.(2005)。Intravenous versus Subcutaneous Morphine Titration in Patients with Persisting Exacerbation of Cancer Pain。J. Palliat. Med，8，743-750。
15.	Vargas-Schaffer, Grisell(2010)。Is the WHO analgesic ladder still valid? Twenty-four years of experience。Can Fam Physician，56，202-205。
16.	Jadad, A. R.、Browman, G. P.(1995)。The WHO analgesic ladder for cancer pain management. Stepping up the quality of its evaluation。JAMA，274，1870-1873。
17.	Moulin, D. E.、Kreeft, J. H.、Murray-Parsons, N.、Bouquillon, A. I.(1991)。Comparison of continuous subcutaneous and intravenous hydromorphone infusions for management of cancer pain。Lancet，337，465-468。
18.	Twycross, R. G.(1998)。The therapeutic equivalence of oral and subcutaneous / intramuscular Morphine sulphate in cancer patients。J Palliat Care，4，67-68。
19.	Hanks, G. W.、de Conno, F.、Cherny, N.(2001)。Morphine and alternative opioids in cancer pain: the EAPC recommendations。British Journal of Cancer，84(5)，587-593。
20.	Ventafridda, V.、Tamburini, M.、Caraceni, A.、De Conno, F.、Naldi, F.(1987)。A validation study of the WHO method for cancer pain relief。Cancer，59，850-856。

圖書
1.	World Health Organization(1996)。Organization. Cancer Pain Relief。Albany, NY：WHO Publications Center。
2.	National Health Service (NHS) Greater Glasgow Primary Care Palliative Care Team(2010)。Guidelines for the use of subcutaneous medications in palliative care for adults-primary care and hospices。Glasgow：NHS。
3.	王英偉(2009)。安寧緩和醫療臨床工作指引。台北：財團法人中華民國台灣安寧療護基金會。延伸查詢
4.	World Health Organization(1986)。Organization. Cancer Pain Relief。Albany, NY：WHO Publications Center。

其他
1.	Wiffen, P. J.，McQuay, H. J.(2007)。Oral Morphine for cancer pain。

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