摘要
目的:了解三阶梯止痛方案在医疗机构中的执行情况,评价上海地区癌症患者疼痛诊断和治疗的规范性。方法:抽取上海市22家二、三级医院的210份具有疼痛症状并经止痛治疗的癌症患者的住院病史,采用专家评审的方法,以三阶梯止痛原则为标准,对患者疼痛诊断和治疗符合标准的程度进行评估。结果:癌症疼痛诊疗完全符合三阶梯止痛原则的病史占5.7%,基本符合者占33.3%,不符合者占30.0%,无法评价者占31.0%,总符合率为39.0%。三级医院总符合率高于二级医院(P<0.01),郊区二级医院总符合率高于市区二级医院(P=0.012)。疼痛描述不规范是不符合和无法评价的最主要原因。结论:被调查的上海医院对癌症疼痛处理的规范性仍不理想,目前癌症疼痛诊断和治疗中突出的问题由原来的用药转变为疼痛评估。癌症疼痛控制应得到临床医护人员的重视,除进一步加强培训和教育外,还应加强临床规范诊治的监督检查力度,以提高癌症疼痛处理的规范率。
Objective To evaluate the compliance to WHO cancer pain relief guideline （3-ladder treatment strategy） by reviewing the cancer patients medical histories in Shanghai area. Methods The medical history achieves of 210 cases were selected from 22 hospitals in Shanghai. The eligible cases were hospitalized cancer patients with pain, and received pain relief treatment. Experts were invited to review the medical history achieves and made judgments aecording to the principals of the WHO cancer pain relief guideline. Results The cases whose pain diagnosis and treatment were in full compliance with the principals of the guideline accounted for 5.7%, partially compliant accounted for 33.3%, not compliant accounted for 30.0%, and unable to evaluate with the medical records accounted for 31.0%. The overall （full and partial） compliance rate was 39.0%. The overall compliance rate was higher in municipal tertiary hospitals than that in district hospitals （P〈0.01）, and was higher in rural area secondary hospitals than that in urban area secondary hospitals （P=0.012）. The major reason of incompliance and unable to evaluate was improper description of pain. Conclusions Cancer pain management is not ideal in the hospitals investigated. The major problem in cancer pain management has turned to the poor evaluation of pain instead of the improper drug treatment in the past. Pain relief should be paid more attention by the clinicians and nurses. The management of cancer pain should be improved by enforcing the supervision and surveillance of the implementation of WHO cancer pain relief guideline, along with professional training and public education.
出处
《诊断学理论与实践》
2009年第1期59-62,共4页
Journal of Diagnostics Concepts & Practice
关键词
癌症
疼痛
诊断
治疗
评估
Cancer
Pain
Diagnosis
Treatment
Evaluation
