肝腎衰竭安寧癌末病人的疼痛控制

Pain Control in Liver and Renal Failure Hospice Patients

10.6537/TJHPC.2017.22(1).6

王律凱(Lu-Kai Wang)；黃雅文(Ya-Wen Huang)；林益卿(I-Chin Lin)；蔡佩渝(Pei-Yu Tsai)

安寧療護 ； 緩和醫療 ； 疼痛控制 ； 肝衰竭 ； 腎衰竭 ； Hospice ； Palliative Care ； Pain Control ； Liver Failure ； Renal Failure

安寧療護雜誌

22卷1期（2017 / 03 / 01）

75 - 84

繁體中文

疼痛對於癌症末期的安寧療護病人是很常見的症狀，而這些病人合併有肝腎衰竭的疼痛控制也是需要特別考量的，本文整理近期發表的相關文獻，希望能給臨床照顧患者的醫師提供一些建議。根據有限的文獻整理，WHO的疼痛階梯(analgesic ladder)是最主要的依循原則；此外，對於腎衰竭的安寧療護病人，鴉片類藥物最好使用tramadol、fentanyl、methadone（或是其他鴉片類藥物但減低劑量）；對於肝衰竭的安寧療護病人，鴉片類藥物最好使用morphine、fentanyl（或是其他鴉片類藥物但減低劑量）；疼痛控制不僅僅是藥物上的治療而已，還需注意到非藥物的部分，諸如病人心理、靈性上的支持是否完好，整體痛（total pain）的觀念不能被忽視。

Pain is common in hospice patients with advanced malignant diseases. Patients with renal or liver impairment need specicfic consideration, as most anlgesics rely on either or both for their metabolism and excretion. We reviewed the recent articles and give some adivices to clinicians. The principles of the WHO (World Health Organization) analgesic ladder are commonly endorse as a structured approach to the management of pain. For patients with significant renal impairment, tramadol, fentanyl and methadone are the preferred opioid options (or other opioids at reduced doses) . For patients with significant liver impairment, morphine and fentanyl are potentially the preferable opioids (or other opioids at reduced doses). The concept of total pain and the use of non-pharmacological approaches to pain management should not be overlooked in the approach to the patient with pain in advanced disease.

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