原名「台灣學術線上」
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1
題名:台灣非安寧照顧下末期癌症疼痛處置的適當性    
Appropriateness of Cancer Pain Management for Non-Hospice Terminally Ill Cancer Patients in Taiwan
著者:陳貞秀(Chen-Hsiu Chen) ;劉滄梧(Tsang-Wu Liu) ;蔡來蔭(Lai-Yin Tsai) ;劉憶萍(I-Ping Liu) ;徐翠霞(Tsui-Hsia Hsu) ;唐秀治(Siew-Tzuh Tang)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:癌症疼痛 ; 癌症疼痛處置 ; 疼痛處置適當性 ; 末期癌症病人 ; 臨終照顧 ; Cancer pain ; cancer pain management ; appropriateness of pain management ; terminally ill cancer patients ; end-of-life care
刊名:中華民國癌症醫學會雜誌
頁碼:1-29
語言:繁體中文
摘要: 中文摘要PDF ; 英文摘要PDF

疼痛是末期癌症病人最常經歷的症狀,世界各國研究指出60%~90%的末期癌症病患於臨終階段中曾經歷疼痛。妥善的疼痛處置不僅可使病人免受不必要的痛苦、促進身體的功能、更可提昇病人臨終的生活品質。本研究以橫斷性描述性研究,採方便性取樣收案,自92年2月至93年11月30日大規模全面性的調查包括臺灣北、中、南、東地區二十三家提供癌症病患主要照顧的醫療院所,以訪談及病歷查核,調查於非安寧照顧下之經歷疼痛的末期癌症病患其疼痛控制現況、止痛藥物使用情形、使用方式、及給藥途徑等,以探討疼痛處置的適當性及成效,期進一步作為未來疼痛處置改善的方向。本研究共收案2,185位末期癌症病人,其中1,364位(62.4%)病人於訪談時表示正承受著不同程度的疼痛;疼痛的末期癌症病患中,30.2%病人表示「通常」或「一直」承受著疼痛;39.7%病人表示其疼痛強度為「相當強烈」、「非常強烈」或「無法忍受」。大部份疼痛病患(84.2%)皆接受止痛藥治療,其中,89.3%的病人接受麻醉性止痛藥治療其疼痛,但卻僅有41.6%之病人使用非麻醉性止痛藥以治療其疼痛。止痛藥之給予以口服(78.4%)作為主要的止痛藥給藥途徑,並依按時給藥(66.3%)及持續給藥(22.0%)為最常見止痛劑使用的方式。此外,癌症病人不當的使用Meperidine (Demerol) (4.4%)、不當的接受肌肉注射為給藥途徑(5.0%)、及以「需要時給藥」(11.7%)之比例較目前文獻中探討癌症疼痛的相關研究低。但約四分之一經歷疼痛的末期癌症病患,有別於WHO癌症疼痛處置指引,使用多重麻醉性止痛藥、或以多重給藥途徑接受麻醉性止痛藥,以治療其疼痛,其適當性值得進一步探討。 整體而言,臺灣非安寧照顧下,經歷疼痛之末期癌症病人其疼痛控制處置之「使用最簡單容易給藥途徑」、「以按時給藥及持續給藥」大多遵守WHO及American Pain Society所建立的三階段癌症疼痛處置指引,然而,麻醉性止痛藥之使用種類、給藥途徑仍應再審慎考慮。本研究提供臺灣地區非安寧照顧下,經歷疼痛之末期癌症病人其疼痛控制處置現況基礎值,由此資料已可區辨出目前癌症疼痛控制不足或過量處置之處,提供了未來提昇末期癌症病患疼痛控制品質改善方向,期待癌症照顧醫護人員未來進一步配合病人對疼痛緩解程度之期望,以適當疼痛處置模式,達到有效緩解疼痛、促進末期癌症病患最高生活品質的目標。
Pain remains one of the most common and detrimental symptoms suffered by cancer patients, especially for patients at their end of life. Research indicated that 60-90% terminally ill cancer patients suffered from unrelieved pain. Adequate and appropriate pain management can avoid unnecessary suffering, enhance physical functioning, and improve quality of life at the end of life. From February 2003 to November 30, 2004, a cross-sectional survey was conducted across 23 hospitals throughout Taiwan to investigate the current status of cancer pain management in Taiwan. Subjects were recruited by a convenience sampling strategy and data were collected by face-to-face interviews and charts auditing. Among the 2185 terminally ill cancer patients studied, 1364(62.4%)study participants suffered from pain at the time of data collection interview. The frequency of pain was reported as "usually" or "almost constantly" for 30.2% of the study participants and 39.7% of the cancer patients with pain indicated that the pain was "fairly intense", "very intense" or "almost unbearable". Approximately 84.2% of the cancer patients with pain received pain medication. Narcotics were administrated to 89.3% of the patients who received analgesics, while only 41.6% of the patients who received pain medication were treated by non-narcotic analgesics. Pain medication was most frequently administrated by oral route (78.4%) and around the clock (66.3%) or continually (22.0%). The inappropriate traditional practices of cancer pain management such as the regular use of intramuscular injections, Meperidine (Demerol), and sole reliance on "as-needed" analgesic administration was found as 5.0%, 4.4%, and 11.7%, respectively, which were all lower than the figures documented in the literature. However, approximately one-fourth of terminally ill cancer patients with pain received multiple narcotics or multiple routes for administration of narcotics. The appropriateness of such practices is questionable for at least half of them. Current pain management for non-hospice terminally ill cancer patients in Taiwan is generally in accordance with the standards proposed by the WHO and the American Pain Society in using the simplest and the least invasive pain management modalities and scheduling doses on a regular base. By taking the patient’s pain intensity and expectations of pain relief into consideration, appropriately selecting analgesics and the route and the frequency of analgesic administration, cancer pain may be adequately relieved. Therefore, unnecessary side effects and resources consumption may be avoided and quality of life may be improved for cancer patients at their end of life.




本卷期目次
中華民國癌症醫學會雜誌
台灣非安寧照顧下末期癌症疼痛處置的適當性/ 陳貞秀劉滄梧蔡來蔭劉憶萍徐翠霞唐秀治
Yolk Sac Tumor in the Anterior Mediastinum with the Presentation of Superior Vena Cava Syndrome/ Shang-Hung ChenChien-Feng LiChing-Nan LinWei-Shiou Hwang
 
   
 
   

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