瀕死病患之疼痛治療

要成功控制末期病患接近臨終期的疼痛，首先仍然要作正確的疼痛評估，找到疼痛的原因及疼痛的種類，才能正確地使用止痛方法及藥物作治療。一般治療之原則仍然是依據聯合國世界衛生組織所建議的癌病疼痛治療三階梯之模式，再輔以相關的治療技術及方法，並強調身心靈『整體痛』必須同時處理，才可達到完美的效果。對接近臨終（瀕死）病患疼痛最難處理的問題，包括有神經病變性疼痛、突發痛、難治性疼痛及吞嚥困難等問題，可經由調整止痛樂物之劑量、加入輔助藥物、轉換止痛藥物、改變給藥途徑及使用末期鎮靜等方法達到止痛目的。而病患的社會性、心理性及靈性的不適，可透過安寧緩和醫療團隊各專業人員的合作，使病人及家屬的痛苦降至最低。經由團隊的住院與居家的整合照顧，讓瀕死病患在家可接受如住院類似的醫療，可增加病人與家屬的親情，並減少醫療資源的浪費。

關鍵字

緩和醫療照顧；疼痛治療；瀕死

並列摘要

Effective Pain management in the terminally ill patient requires an understanding of pain control strategies. Appropriate pain assessment and determining the causes/ the kinds of pain can provide suitable methods and medications for the management of pain. Basic principles for the pain management at the end of life should be followed the World Health Organization’s three-step analgesic ladder accomplished with adjuvant procedures and therapies. Treatment of the “ Total pain” will achieve a successful pain relief. Difficulties in managing pain in the dying patients are included the neuropathic pain, the breakthrough pain, the refractory pain and the difficulty swallowing; which can usually be controlled by the aggressive titration of pain medication, the use of adjuvant agents, changing the medication or route of administration, opioid rotation and the use of terminal sedation. The physical, psychological, social and spiritual needs of dying patients are best managed with a team approach to minimizing their suffering. Home care and visits can provide comfort and facilitate the doctor-patient-family relationship at the end of life.

並列關鍵字

palliative care ； pain management ； end of life

國際替代計量

瀕死病患之疼痛治療

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