对2016年版美国《术后疼痛管理指南》的药学解读

发布时间：2018-03-18 01:26

本文选题：围术期　切入点：术后疼痛　出处：《中国药房》2017年35期 　论文类型：期刊论文

【摘要】：目的:为临床术后合理选择镇痛药物及优化镇痛方案提供参考。方法:从临床药师的角度,对2016年美国《术后疼痛管理指南》(简称《指南》)第6～22章涉及术后疼痛治疗药物的内容进行解读。结果:《指南》涉及术后疼痛治疗药物的内容包括围术期治疗药物与给药途径的选择、多模式镇痛给药方案、个体化药物治疗方案,以及患者的用药监护、用药教育、术后疼痛管理方案等。《指南》不推荐在术前给予患者阿片类药物或非选择性非甾体抗炎药,因为不能获益;对于术后可口服给药的患者,若给予阿片类药物应优先选择口服制剂,避免采用肌内注射方式给药。《指南》强推荐采用多模式镇痛治疗方案与非药物性干预相结合的手段治疗患者术后疼痛,并根据患者的具体病情选择个体化治疗方案;临床医师应重点监护术后患者的镇静程度、呼吸状态及不良反应发生情况,并应向患者及其家属讲解术后疼痛管理流程及出院后镇痛药物的减量方法。结论:《指南》对围术期患者镇痛给药方案的规定,可为临床医师选择合适的个体化药物镇痛方案提供参考。
[Abstract]:Objective: to provide a reference for the rational selection of analgesic drugs and the optimization of analgesic scheme after operation. Methods: from the point of view of clinical pharmacists, In 2016, the American guidelines for postoperative pain Management (hereinafter referred to as "the guidelines") Chapter 622 related to postoperative pain treatment drugs were interpreted. Results: the contents of the guidelines related to postoperative pain treatment drugs, including perioperative treatment drugs. And the choice of drug delivery route, Multimode analgesic regimen, individualized drug therapy, patient monitoring, drug education, postoperative pain management program, etc. The guidelines do not recommend that patients be given opioids or non-selective non-steroidal anti-inflammatory drugs before operation. Because there is no benefit; for patients who can be administered orally after surgery, opioids should be given priority to oral preparations, Avoid intramuscular injection. The guidelines strongly recommend the use of multi-mode analgesic therapy combined with non-drug intervention in the treatment of postoperative pain, and according to the specific condition of patients to choose individualized treatment; Clinicians should focus on monitoring the sedation, respiratory status and adverse reactions of the patients after surgery. The procedure of postoperative pain management and the method of reducing analgesic drugs after discharge should be explained to the patients and their families. It can provide reference for clinicians to select appropriate individual analgesic regimen.
【作者单位】：绍兴市柯桥区中医医院药剂科;浙江大学附属第一医院药学部;
【基金】：浙江省自然科学基金资助项目(No.LY17H310002)
【分类号】：R619

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