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

Appropriateness of Pain Control Medication of Terminal Cancer Patients Pre-Admitted to Palliative Care Ward in A Community Hospital

許瀞分(Ching-Fen Hsu) ； 陳正裕(Cheng-Yu Chen)

《安寧療護雜誌》 19卷3期 (2014/11) Pp. 247-257

https://doi.org/10.6537/TJHPC.2014.19(3).2

摘要

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。

關鍵字

生命末期 ； 癌症疼痛 ； 疼痛控制 ； 適當性

並列摘要

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.

並列關鍵字

end-of-life ； cancer pain ； pain control ； appropriateness