癌症病人使用鴉片類藥物導致便秘之實證護理

Evidence-Based Nursing Care for Cancer Patients With Opioid-induced Constipation

10.6224/JN.57.4.100

游千代(Chien-Tai Yu)；柯乃熒(Nai-Ying Ko)

實證護理 ； 鴉片類藥物 ； 便秘 ； 癌症病人 ； evidence-based nursing ； opioid drugs ； constipation ； cancer patients

護理雜誌

57卷4期（2010 / 08 / 01）

100 - 105

繁體中文

約三分之一的癌症病人在使用鴉片藥物治療疼痛後出現便秘症狀，臨床醫療人員處理便秘的方式常採取專家意見，缺乏實證的基礎，以至於癌症病人的便秘問題常常不能有效解決。本文以美國2009年最新癌症緩和照護網路指引為基礎，並以實證護理研究文獻修改內容。當癌症病人使用鴉片藥物治療疼痛時，需先執行詳細的便秘評估，在病人尚未發生便秘之前，就需提供預防措施，藥物為Sennoside加上Docusate，非藥物則為運動、高纖維的飲食及腹部按摩預防便秘。如果已發生便秘，一開始先使用Bisacodyl(Ducolax)，如果仍持續便秘，則改變為Lactulose加上Sennoside，在措施進行中，如果有糞便嵌塞的問題，先予指診再給予甘油灌腸。護理人員在癌症病人開始使用鴉片藥物之時，應建議醫師提早使用預防措施，每日評估病人便秘症狀及衛教病人採取非藥物的方法降低便秘症狀，進而提高癌症病人的生活品質。

About one-third of cancer patients who receive opioid drugs to control pain experience constipation. While clinical healthcare personnel often deal with constipation problems by adopting professional suggestions, effective evidence-based solutions remain lacking. Thus, cancer patient constipation problems are often not effectively solved. In this article, 2009 American National Comprehensive Cancer Network guidelines for palliative care in cancer were modified as the basis of evidence-based nursing research. Constipation assessments should first be conducted before the initiation of opioid drug treatment to relieve pain in cancer patients. Before the patient develops opioid-induced constipation, preventive action should be conducted, such as using drug combinations (e.g., sennoside and docusate). Non-pharmaceutical interventions include exercising, maintaining a high-fiber diet, conducting abdominal massage and having correct bowel habits. If the patient is already experiencing constipation, bisacodyl (ducolax) may be used. However, if no improvement is observed, pharmaceutical treatments (e.g., a lactulose-sennoside combination) may be administered. If stool impaction occurs during the testing process, digital and glycerine should be implemented to remove stool impaction. Eliminating stool impaction enhances medication effectiveness. Nurses should advise doctors regarding preventive measures related to commencing treatment with opioid drugs. Further, nurses must evaluate degree of constipation and educate patients on following non-pharmaceutical strategies to alleviate constipation to improve quality of life.