课件：zdl神经系统障碍年制.ppt

* 疼痛的双重性： 常是许多疾病的先兆信号； 不利的是它给病人造成痛苦，可掩盖原发病的体征，易造成误诊或延诊。 * * * * 伤害性刺激引起的化学物质释放可激活或敏化伤害性感受器 伤害性刺激或组织损伤可引起缓激肽、前列腺素、5-HT、组织胺、K+等化学物质的释放。这些物质作用于伤害性感受器，使其释放P物质和降钙素基因相关肽（CGRP），P物质和CGRP作用于邻近感觉终末的肥大细胞和外周血管，引起组织胺和缓激肽的进一步释放，并激活伤害性感受器，如此形成正反馈循环，导致伤害性感受器的敏化。 * 躯体组织与患病内脏的传入纤维进入脊髓的同一水平，会聚到同一后角神经元 ，患病内脏传来的冲动可提高邻近的躯体感觉神经元的兴奋性，从而对体表传入冲动产生易化作用 疼痛往往放射到与疼痛原发内脏具有相同胚胎来源节段和皮节的体表部位 * * Pain is not perceived until pain signals reach the somatosensory cortex of the brain If pain signals are prevented from reaching the cortex, pain is not “felt” “闸门”是抑制中间神经元的激活： * * * * 循环系统 抑制交感神经，阻断儿茶酚胺对心血管兴奋作用。 呼吸系统 使病人敢于深呼吸和用力咳嗽，从而使通气量和功能残气量得到改善。 消化系统 促进肠 蠕动、消除平滑肌痉挛 * * Assessments of Pain Source – Client 1. Pain History 2. Subjective (OLDCART or OPQRST) a. Location b. Intensity – pain scale, face scale c. Quality – describe d. Pattern (onset, duration, consistency) e. Precipitation/contributing stressors f. Alleviating means 面部表情量表包括一系列进行性痛苦的面部表情,大多为评估儿童疼痛强度而设计,受试者选择代表其疼痛强度的面部表情,具有较好的信度与效度 * * 该法比较灵敏，有可比性。具体做法是：在纸上面划一条10 cm的横线，横线的一端为0，表示无痛；另一端为10，表示剧痛；中间部分表示不同程度的疼痛。让病人根据自我感觉在横线上划一记号，表示疼痛的程度。轻度疼痛平均值为2.57±1.04；中度疼痛平均值为5.18±1.41；重度疼痛平均值为8.41±1.35〔1〕。 Subjective tools such as the Visual Analog Scale (VAS) and the Faces Scale are used to assess pain. The VAS is a straight horizontal 100 mm line anchored with no pain on the left end and worst possible pain or pain as bad as it could possibly be on the right. Clients are asked to choose a position on the line that represents their pain. The Faces Scale depicts facial expression on a scale of 0-6, with 0=smile, and 6=crying grimace. Clients should choose a face that represents how the pain makes them feel. The VAS is particularly useful for children, elderly and the cognitively impaired. * The African-American version of the Oucher was developed and copyrighted by Mary J. Denyes, PhD, RN, Wayne State University School of Nursing, and Antonia M. Villarruel, PhD, RN, currently of the University of Pennsylvania * 疼痛治疗包括病因治疗和对症治疗两个方面，有的疼痛即