姑息关怀中皮肤治疗看护管理.pptVIP

姑息关怀中的皮肤护理Skin care in palliative care ;皮肤护理 Skin care;某些因素可加剧放疗后皮肤反应，包括： There are some things that can make the skin reactions to radiotherapy more severe. These include:;化疗期间的皮肤护理Skin care during radiotherapy;为了缓解症状病人能做些什么？ What can patient do to relieve symptoms?;;瘙 痒 症 Pruritus = itch ;瘙痒症的分类 Classification of Itch;癌症相关的瘙痒症状Pruritic syndromes associated with cancer;瘙痒是全身性癌病罕见而重要的症状Pruritus, an uncommon but important symptom of systemic carcinomaCormia FE. Arch Dermatol 1965;92:36-39.;一名72岁的老年女性乳腺癌患者，7年前曾接受过乳癌手术治疗。现因肿瘤皮内扩散，而饱受极度疼痛和瘙痒的折磨。 Woman, 72 years of age, intracutaneous spread of breast cancer. Originally treated with surgery 7 years earlier. She experienced extreme pain and pruritus.;恶性肿瘤引起的神经源性瘙痒(1) Neurogenic pruritus in malignancy (i);恶性肿瘤引起的神经源性瘙痒(2) Neurogenic pruritus in malignancy (ii);造血系统疾病Hematopoietic disorders; 疼痛 Pain;疼痛 Pain ;疼痛 Pain; 椎管内注射阿片类药物： Spinaopioids 节段性或全身性； segmental or generalised; 机理 ： mechanisms: 局部兴奋（5-HT）或激活?2受体 local excitation (5-HT) or stimulation of ?2receptors PGE ? 治疗 ： treatment: 5-HT3 拮抗剂 5-HT3 antagonists 异丙酚 Propofol ?2受体拮抗剂 ?2 antagonism ?双氯芬酸 diclofenac ;瘙痒的潜在化学介质（1）Potential chemical mediators of pruritus (i);瘙痒的潜在化学介质（2） Potential chemical mediators of pruritus (ii);润滑剂 Emolients;帕罗西汀治疗瘙痒症Paroxetine for pruritus;帕罗西汀治疗瘙痒症的临床证据（1） Clinical evidence on paroxetine (i) ;帕罗西汀治疗瘙痒症的临床证据（2） Clinical evidence on paroxetine (ii);瘙痒症治疗中的一般处理General measures in pruritus;尿毒症性瘙痒的治疗Uraemic pruritus;胆汁???积性瘙痒的治疗Pruritus of cholestasis;何杰金病所致瘙痒的治疗Hodgkin lymphoma;真性红细胞增多症所致瘙痒的治疗Polycythaemia vera;椎管内注射阿片类药物所致瘙痒的治疗Spinal opioid-induced pruritus;全身性阿片类药物应用所致瘙痒的治疗 Systemic opioid-induced pruritus;副癌性瘙痒的治疗Paraneoplastic pruritus;痛性伤口的治疗Painful wounds;C型纤维上可能存在阿片类受体C-fibres may contain opioid receptors;一位82岁的老年患者，因动脉血供不足，导致多处皮损，出现局部缺