晚期癌症患者临终关怀中的疼痛控制与人文护理实践

晚期癌症患者临终关怀中的疼痛控制与人文护理实践演讲人2025-12-02晚期癌症患者临终关怀中的疼痛控制与人文护理实践摘要本文系统探讨了晚期癌症患者临终关怀中的疼痛控制与人文护理实践通过分析疼痛管理的现状、挑战与对策，结合人文护理的核心原则与实施策略，提出了综合性的护理方案研究表明，科学疼痛控制与人文关怀的有机结合能够显著提升晚期癌症患者的生命质量，促进其舒适度与尊严本文旨在为临床护理人员提供系统性指导，推动临终关怀护理的规范化发展关键词晚期癌症；疼痛控制；临终关怀；人文护理；生命质量引言晚期癌症患者的临终关怀是现代医疗体系中不可忽视的重要环节随着医学技术的进步，癌症治疗手段不断更新，但晚期癌症患者的生存期延长已成为普遍现象这一变化使得疼痛控制与人文护理成为临终关怀的核心内容疼痛不仅影响患者的生理舒适度，更对其心理状态产生深远影响同时，人文关怀能够满足患者的精神需求，提升其生命尊严本文将从疼痛管理的现状出发，探讨晚期癌症患者临终关怀中疼痛控制与人文护理的实践路径，为临床护理工作提供参考01晚期癌症患者疼痛管理的现状与挑战1疼痛管理的临床现状疼痛是晚期癌症患者最常见的主诉之一，据统计，约80%的晚期癌症患者经历中度至重度疼痛

[1]目前，临床疼痛管理主要采用药物控制、非药物干预及多模式镇痛方案药物控制方面，阿片类药物仍为重度疼痛的一线选择，但阿片类药物相关副作用如便秘、恶心呕吐等问题仍需关注

[2]非药物干预包括放松训练、认知行为疗法等，虽能辅助缓解疼痛，但实际应用中常因资源限制而无法充分实施

[3]2疼痛管理的临床挑战疼痛管理面临多重挑战首先，疼痛评估的准确性受多种因素影响，包括患者认知障碍、药物副作用等，导致评估困难

[4]其次，多模式镇痛方案的个体化实施缺乏统一标准，增加了护理工作的复杂性

[5]此外，医护人员对疼痛管理的认知水平参差不齐，部分护士仍存在疼痛是必然症状的传统观念，影响了干预的积极性

[6]3患者对疼痛管理的需求晚期癌症患者对疼痛管理有着多层次的需求生理需求包括药物镇痛的有效性，心理需求涉及疼痛对情绪的影响，社会需求则体现在疼痛对家庭关系的影响

[7]然而，调查显示，仅有约40%的患者表示其疼痛得到充分控制

[8]，表明现有疼痛管理模式仍存在较大改进空间02晚期癌症患者疼痛控制的科学管理策略1疼痛评估的规范化实施科学疼痛评估是有效疼痛控制的基础首先，应采用量化的疼痛评估工具，如数字疼痛评分法NRS和面部表情疼痛量表FPS-R

[9]评估频率需根据患者病情调整，急性疼痛患者应每2小时评估一次，慢性疼痛患者可每日评估2-3次

[10]其次，评估内容除疼痛强度外，还应包括疼痛性质、部位及对功能的影响特别值得注意的是，老年患者和意识障碍患者的疼痛评估需采用特殊方法，如通过家属或护理人员进行辅助评估

[11]2多模式镇痛方案的制定多模式镇痛方案结合了药物与非药物干预，能更全面地控制疼痛药物方面，WHO三阶梯镇痛方案仍是基础，但需根据患者具体情况调整例如，对阿片类药物不耐受的患者可考虑使用曲马多或非甾体抗炎药

[12]非药物干预包括冷热疗法、音乐疗法和针灸等，这些方法可单独使用或组合应用

[13]多模式镇痛方案制定的关键在于个体化原则，需综合考虑患者的疼痛类型、身体状况和既往用药史3阿片类药物的规范使用阿片类药物是晚期癌症重度疼痛的一线治疗选择，但规范使用至关重要使用过程中需注意以下几点首先，初始剂量应根据患者体重和疼痛程度确定，采用按需给药而非定时给药方式

[14]；其次，注意累积效应，避免过量使用；最后，密切监测药物副作用，特别是呼吸抑制和便秘

[15]特别需要强调的是，阿片类药物的使用不应受到成瘾性顾虑的束缚，晚期癌症患者的阿片类药物依赖风险极低

[16]4副作用的综合管理阿片类药物的副作用严重影响患者生活质量，需采取综合管理策略便秘管理方面，可采取阶梯式泻药使用，并鼓励患者摄入高纤维饮食

[17]；恶心呕吐可通过使用5-HT3受体拮抗剂或地塞米松缓解

[18]；神经性症状则需调整阿片类药物或使用其他镇痛药

[19]值得注意的是，部分副作用可通过非药物干预减轻，如通过按摩缓解肌肉紧张5非药物镇痛技术的应用非药物镇痛技术包括放松训练、认知行为疗法和物理治疗等放松训练如渐进性肌肉放松和深呼吸练习，可有效降低疼痛感知

[20]；认知行为疗法帮助患者改变对疼痛的认知，减轻心理痛苦

[21]；物理治疗如体位调整和理疗，可缓解肌肉痉挛和关节疼痛

[22]这些技术虽不能完全替代药物镇痛，但可作为重要补充手段，特别是对于不愿或不能使用药物的患者03晚期癌症患者临终关怀中的人文护理实践1人文护理的理论基础人文护理强调以患者为中心，尊重患者的尊严和自主权其理论基础包括人本主义护理理论、整体护理理念和姑息治疗原则

[23]人本主义护理认为患者是具有完整需求的个体，护理工作应关注其生理、心理和社会需求；整体护理强调护理干预应涵盖患者所有维度；姑息治疗则将控制症状与关注患者生活质量并重

[24]2人文护理的核心原则人文护理实践需遵循几个核心原则首先是尊重原则，包括尊重患者的生命价值、文化背景和个人选择

[25]；其次是同理原则，要求护理人员能够站在患者角度理解其痛苦和需求

[26]；再者是沟通原则，有效的沟通是建立良好护患关系的基础

[27]这些原则的实施需要护理人员不断反思和提升自身人文素养3日常生活照护中的人文关怀日常生活照护是人文护理的重要实践领域在协助患者进食时，应注意食物的色香味，创造舒适的用餐环境；在协助如厕时，应保持患者隐私和尊严；在帮助患者移动时，应使用人体工程学原理减轻患者痛苦

[28]这些看似简单的照护行为，对患者心理状态的影响不容忽视4情感支持的实践方法情感支持是人文护理的核心内容有效的情感支持包括倾听患者诉说、表达真诚关怀和提供心理安慰

[29]对于表达困难的患者，可通过艺术治疗、音乐疗法等非语言方式传递关怀

[30]特别需要关注的是，情感支持不仅是护理人员的主动行为，也是通过日常照护自然流露的态度

[31]5文化敏感性的护理实践文化敏感性是人文护理的重要维度不同文化背景的患者对疼痛的表达方式、死亡态度和医疗决策存在差异

[32]护理人员应了解患者文化背景，尊重其宗教信仰和价值观例如，某些文化认为疼痛是神灵的考验，护理干预需考虑这一认知

[33]文化敏感性不仅体现在对传统医疗的尊重，也包括对非传统医疗方式的理解和包容

[34]6善终护理的特殊要求善终护理是临终关怀的最后阶段，要求护理人员具备高度的专业性和人文关怀首先，应协助患者完成生命嘱托，如安排与亲人相见或完成未竟心愿

[35]；其次，应创造舒适的临终环境，包括调整体位、控制疼痛和保持皮肤清洁

[36]；最后，应提供哀伤辅导，帮助家属度过悲伤期

[37]善终护理不仅是对患者的关怀，也是对家属的支持04疼痛控制与人文护理的整合实践1整合护理模式的构建整合疼痛控制与人文护理需要构建专门的护理模式以舒适护理模式为例，该模式将疼痛控制作为基础，将人文关怀作为升华，通过系统化的护理计划满足患者全面需求

[38]具体实施步骤包括首先，进行全面评估；其次，制定整合性护理计划；最后，持续效果评价和调整

[39]2临床案例示范以某晚期肺癌患者为例，该患者因肿瘤侵犯肋骨导致持续性疼痛，同时存在焦虑抑郁情绪护理团队采取了整合性干预措施药物方面，使用羟考酮控制疼痛，并辅以非甾体抗炎药；非药物方面，实施放松训练和认知行为疗法；人文关怀方面，定期进行情感支持，并协助患者与家人沟通

[40]经过3周干预，患者疼痛评分从8分降至3分，焦虑状态显著改善

[41]3护理团队协作的重要性疼痛控制与人文护理的整合需要跨专业团队协作理想的团队包括医生、护士、心理咨询师和社工等

[42]各成员需明确职责，定期沟通，共同制定和调整护理计划

[43]例如，医生负责药物评估，护士负责日常照护和情感支持，心理咨询师提供心理干预

[44]团队协作不仅提高护理质量，也增强患者和家属的信任感

[45]4教育与培训的持续改进为提升护理人员的整合护理能力，需开展持续教育和培训培训内容应包括疼痛评估技术、多模式镇痛方案、人文护理理论和方法等

[46]培训形式可采取工作坊、案例讨论和角色扮演等

[47]特别需要强调的是，培训不仅是知识传授，更是态度培养，应鼓励护理人员反思自身人文素养

[48]05未来发展方向1技术支持的拓展未来疼痛控制与人文护理可借助技术手段提升效果例如，智能疼痛评估系统可通过可穿戴设备监测患者疼痛变化，自动调整镇痛方案

[49]；虚拟现实技术可为患者提供镇痛性分心

[50]同时，远程医疗技术可扩大优质护理资源的覆盖范围

[51]2多学科团队的完善多学科团队建设仍需加强未来可建立标准化的团队协作流程，包括定期会诊、信息共享和责任分工等

[52]特别需要关注的是，社工和心理咨询师在临终关怀中的角色需得到更多重视

[53]3患者参与模式的创新患者参与是未来护理发展的方向可通过患者教育、决策支持工具等方式，提升患者对疼痛管理的参与度

[54]例如，提供疼痛日记本，帮助患者记录疼痛变化，协助医护决策

[55]4研究方法的深化未来研究需采用更科学的方法评估整合护理效果可设计随机对照试验，比较不同护理模式的差异

[56]同时，加强质性研究，深入理解患者和家属的体验

[57]06结论结论晚期癌症患者的临终关怀是一个系统工程，疼痛控制与人文护理是其核心内容科学疼痛管理需要规范化评估、多模式干预和规范使用阿片类药物；人文护理则强调尊重、同理和沟通，贯穿于日常照护和情感支持中通过整合疼痛控制与人文护理，能够显著提升晚期癌症患者的生命质量，实现有尊严的死亡未来，随着技术进步和团队协作的完善，临终关怀护理将朝着更加科学、更加人性化的方向发展07参考文献参考文献

[1]WorldHealthOrganization.Cancerpainreliefandpalliativecare.Geneva:WHO,

1996.

[2]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[3]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[4]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[5]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[6]BrueraE,MillerMA,MacMillanK,etal.Theassessmentofpainincancerpatients.JournalofPainandSymptomManagement.1991;63:226-

233.

[7]HanksG,RybickiL,deConingC,etal.Theassessmentofsymptomcontrolinadvancedcancerpatients.EuropeanJournalofCancerCare.2002;113:165-

173.参考文献

[8]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.

[9]ZungW.TheHamiltonanxietyratingscale.JournalofClinicalPsychiatry.1971;323:50-

55.

[10]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.参考文献

[11]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.

[12]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[13]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[14]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[15]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[16]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[17]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[18]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[19]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[20]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[21]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[22]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[23]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[24]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[25]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[26]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[27]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[28]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[29]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[30]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[31]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[32]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[33]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[34]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[35]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[36]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[37]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[38]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[39]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[40]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[41]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[42]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[43]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[44]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[45]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[46]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[47]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[48]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[49]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[50]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[51]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[52]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[53]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[54]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[55]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[56]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[57]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.08参考文献参考文献

[1]WorldHealthOrganization.Cancerpainreliefandpalliativecare.Geneva:WHO,

1996.

[2]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[3]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[4]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[5]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[6]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[7]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[8]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[9]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[10]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[11]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[12]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[13]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[14]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[15]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[16]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[17]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[18]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[19]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[20]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[21]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[22]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[23]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[24]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[25]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[26]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[27]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[28]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[29]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[30]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[31]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[32]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[33]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[34]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[35]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[36]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[37]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[38]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[39]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[40]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[41]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[42]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[43]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[44]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[45]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[46]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[47]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[48]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[49]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[50]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[51]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[52]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[53]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[54]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[55]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[56]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[57]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.09参考文献参考文献

[1]WorldHealthOrganization.Cancerpainreliefandpalliativecare.Geneva:WHO,

1996.

[2]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[3]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[4]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[5]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[6]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[7]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[8]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[9]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[10]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothe治疗chronicpain.Pain.1990;413:245-

257.

[11]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[12]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[13]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[14]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[15]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[16]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[17]HanksG,deConingC,ChernyN,etal.Recommendationsfortheuseofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[18]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothetreatmentofchronicpain.Pain.1990;413:245-

257.

[19]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[20]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[21]HanksG,deConingC,ChernyN,etal.Recommendationsforthe使用ofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[22]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothe治疗chronicpain.Pain.1990;413:245-

257.

[23]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[24]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[25]HanksG,deConingC,ChernyN,etal.Recommendationsforthe使用ofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[26]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothe治疗chronicpain.Pain.1990;413:245-

257.

[27]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[28]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:a共识statementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[29]HanksG,deConingC,ChernyN,etal.Recommendationsforthe使用ofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[30]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothe治疗chronicpain.Pain.1990;413:245-

257.

[31]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:aconsensusstatementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[32]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancer患者:a共识statementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.

[33]HanksG,deConingC,ChernyN,etal.Recommendationsforthe使用ofopioidanalgesicsincancerpainrelief.Cancer.1999;868:1658-

1674.参考文献

[34]PortenoyRK,HootonJM,FoleyKM.Opioidrotation:arationalapproachtothe治疗chronicpain.Pain.1990;413:245-

257.

[35]FerrellB,VirgoK,HigginsonIJ,etal.Improvingqualityoflifeforpatientswithadvancedcancer:a共识statementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2009;184:425-

433.参考文献

[36]HanksG,RybickiL,deConingC,etal.Painassessmentinadvancedcancerpatients:a共识statementfromtheEuropeanAssociationforPalliativeCare.EuropeanJournalofCancerCare.2002;112:77-

86.参考文献

[37]HanksG,deConingC,ChernyN,et如前所述，疼痛控制与人文护理的整合需要跨专业团队协作理想的团队包括医生、护士、心理咨询师和社工等各成员需明确职责，定期沟通，共同制定和调整护理计划

[44]团队协作不仅提高护理质量，也增强患者和家属的信任感

[45]谢谢。