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Jingdong book

麻醉药品和精神药品规范化临床应用与管理

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麻醉药品和精神药品规范化临床应用与管理

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麻醉药品和精神药品是疼痛治疗及精神病症治疗必不可少的基本药品。然而,由于嘛醉药品和精神药品都是具有依赖性潜力的药品,滥用或不合理使用易产生身体依赖性和精神依赖性。因此,为保证患者正常医疗需求,一方面需要保障麻醉药品和精神药品的供给及处方,另一方面还要加强医疗机构对麻醉药品和精神药品处方管理。编写《麻醉药品和精神药品规范化临床应用与管理》一书,用于麻醉药品和精神药品处方资格培训教材,将促进麻醉药品和精神药品的合理应用与规范化管理。
精神药品包括对中枢神经系统具有抑制作用的镇静催眠药和具有兴奋作用的中枢兴奋药物。中枢兴奋药临床使用较少,镇静催眠药物临床应用则十分广泛。许多镇静催眠药和中枢兴奋药物具有潜在的依赖性,长期使用可产生耐受性,以及躯体和心理依赖性。本书精神药品应用与管理章节重点讨论镇静催眠药的规范化临床使用。
疼痛是发病率高,严重影响生理功能和生活质量的病症。据欧盟10个国家的一项调查显示,人群中患有慢性疼痛者达22%,而得到满意治疗者仅17%~60%。急性疼痛常导致循环、呼吸、消化、内分泌、免疫和代谢改变,慢性疼痛则常引起心理和精神改变。严重疼痛尤其是慢性疼痛对患者,家庭和社会的影响不容低估。然而长期以来,人们对疼痛的认识较片面,认为疼痛是疾病带来的症状而尽量忍耐,不去接受疼痛治疗。
在慢性疼痛中,最急需治疗的是重症患者。在许多国家已将重度癌痛视为急症,患者有要求解除疼痛的权力,如果医师、药师对患者的疼痛不作为,可视为对患者基本人权的貌视和不尊重。尽管现在对疼痛的认识有了长足进步,但镇痛不足的情况仍相当普遍,为此国际疼痛研究会(IASP)呼吁“世界仍在疼痛之中”,“我们应当行动起来有所作为”。
我国疼痛处理专业起步已20余年,上世纪八十年代以后,在肿瘤学界广泛地开展了世界卫生组织(wHO)癌症药物治疗三阶梯的教育。2001年国内肿瘤学、麻醉学界的学者在存反复讨论的基础上,提出“规范化疼痛的处理”(Good Pain Management)的概念,其中药物治疗由于简便、有效、花费小、副作用少、依从性高一直扮演主要角色,恰当的药物治疗可以使约80%的癌痛患者无痛。在众多药物中,阿片类药物是中到重度疼痛使用最广泛和镇痛作用最强的药物。wHO疼痛三阶梯治疗原则的推广为阿片类尤其是强阿片类药光明正大和合理的应用起到重要的促进作用。
Catalogue

第一章 总论
第一节 疼痛的定义和疼痛治疗的重要性
一、疼痛的定义
二、疼痛是第五生命体征
三、慢性疼痛是一种疾病
第二节 疼痛发生的机制
一、急性疼痛的发生机制
二、慢性疼痛的发生机制
第三节 疼痛的分类
一、伤害感受性疼痛、神经病理性疼痛和混合性疼痛
二、急性疼痛和慢性疼痛
三、慢性非癌痛与癌痛
四、其他疼痛分类
第四节 疼痛的诊断和强度评估
一、病史
二、疼痛强度评估
三、体检、实验室检查和影像学检查

第二章 疼痛治疗的基本原则和常用方法
第一节 疼痛的规范化处理
一、明确治疗目的
二、疼痛的诊断及评估
三、制定治疗计划
四、采取有效的治疗
五、药物治疗的基本原则
六、镇痛治疗中医患的权利和责任
第二节 疼痛治疗的常用方法
一、药物治疗
二、多模式镇痛
三、超前镇痛
四、病人自控镇痛
五、硬膜外或蛛网膜下腔植入镇痛泵持续镇痛
六、神经阻滞疗法
七、物理疗法
八、微创疗法
九、手术疗法
十、中医中药及针灸
十一、电刺激疗法
第三节 与疼痛相关的心理问题与处理
一、常见心理问题的识别与预防总则
二、建议请精神科会诊的情况
三、常见心理问题的识别要点与处理

第三章 镇痛相关药物的临床药理
第一节 非甾体类抗炎镇痛药
一、非甾体类抗炎镇痛药作用机制和分类
二、非甾体类抗炎镇痛药的药理作用特点及不良反应
三、常用非甾体类抗炎镇痛药
第二节 阿片类镇痛药
一、作用机制
二、阿片类药物的分类
三、阿片类药物的临床给药途径和方法
第三节 辅助用药
一、抗抑郁药物
二、抗惊厥药物
三、催眠和镇静药物
四、a2肾上腺素能受体激动药
五、具有中枢性肌肉松弛作用的药物
六、其他辅助用药

第四章 癌痛的治疗
第一节 概述
一、癌症疼痛治疗现状
二、影响癌症疼痛治疗的障碍因素
三、癌症疼痛的原因及分类
第二节 癌痛的评估
一、评估原则
二、评估内容及方法
第三节 癌痛治疗
一、癌痛治疗方法
二、药物镇痛治疗
……
第五章 慢性非癌痛的治疗
第六章 急性疼痛的治疗
第七章 镇痛药不良反应的防治
第八章 疼痛治疗常见误区
第九章 精神药品的规范化临床应用
第十章 麻醉药品和精神药品的应用管理
附录一 麻醉药品品种目录
附录二 精神药品品种目录
附录三 处方管理办法
附录四 医疗机构麻醉药品、第一类精神药品管理规定和购用《印鉴卡》管理规定及使用培训与考核工作的通知
附录五 麻醉药品和精神药品临床应用指导原则
附录六 常用镇痛药品及辅助用药简介
附录七 常用精神药品简介

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