肿瘤的姑息治疗课件

1、肿瘤的姑息治疗2010 年, 美国麻省总医院肿瘤中心发表于新英格兰医学杂志的关于姑息治疗可延长进展期非小细胞肺癌患者生存期的临床研究报告受到普遍关注, 提高了肿瘤工作者对姑息医学实践的参与热情, 使业内有识之士从全新的角度对姑息医学的内涵进行审视。英文中姑息( palliative) 一词, 最早作为形容词出现于16 世纪40 年代, 引自14 世纪法语中的palliative以及中世纪拉丁语中的palliatus ，有记载的名词含意出现于1724 年 。汉语中“ 姑息”一词最早出自礼记 , 曾子曰：“尔之爱我也不如彼。君子之爱人也以德，细人之爱人也以姑息。 姑息医学发展简史姑息医学的建立是H

2、ospice 运动发展的必然结果。Hospice 做为一种慈善机构, 其雏形可追溯至公元4 世纪的罗马, 一位贵妇人为积德行善, 在自己家中为贫病患者提供照护。中世纪的欧洲, 宗教组织设立多处Hospice, 其性质类似收容所、济贫院, 专为朝圣者提供中途休息和给养。朝圣者中不乏身患重病的人, 有的甚至死在朝圣途中。Hospice 为这些患者提供服务,精心照顾他们, 并为他们祈祷和安葬。至19 世纪,Hospice 已演变成向疾病终末期患者提供医学照护的专业机构。现代姑息医学发展简史 1967 年, 英国西塞莉桑德斯( Cicely Saunders) 博士经过锲而不舍的长期努力, 在伦敦建立

3、了圣克里斯多弗宁养院( St . Christo pher s Hospice)。 业内普遍认为, 这一全球首家现代化宁养院建立标志着现代姑息医学的开始，而护士出身的西塞莉桑德斯博士则被公认为现代姑息医学运动的创始人。 1970年1990 年各种Supportive care unite 如雨后春笋,英国700 余家,美国3 000 余家其他欧洲及第三世界也陆续建立起Hospice 。 1987 年, 姑息医学( Palliative Medicine) 正式被英国卫生管理部门确定为一门独立的临床医学专业, 得到政府和社会各界的广泛支持, 基础教育、继续教育和姑息医学团队建设逐步善,渐成体系。

4、 1993 年由英国、加拿大学者编写的OxFord 大学教科书“姑息医学”把癌痛控制及姑息治疗推向更高的位置。 姑息医学的临床实践统称为Palliative Care, 常被译为姑息治疗、姑息照护或姑息疗护。 前些年, 姑息治疗常被业内外视为临终关怀( end of life care) 。其实, 临终关怀是对疾病终末期患者的姑息治疗, 仅是姑息治疗的一部分。 核心原则患者自主权，即尊重患者的选择行善 自主权非侵袭性公平性治疗措施的根本出发点是有益于患者的生存质量 疗过程中采取伤害最小的方法 公平的使用有限的资源 1234居丧关怀01. 心理辅导临终关怀01. 姑息治疗02.止痛、止吐、气管切

5、开等中晚期姑息治疗01. 缓解症状02. 改善生活质量早期支持治疗01. 相关副作用处理02. 合并症治疗03. 心里辅导与干预姑息治疗的内容 2010 年新英格兰医学杂志发表的由美国麻省总医院、耶鲁肿瘤中心和斯米诺肿瘤医院共同完成的，关于晚期非小细胞肺癌治疗的III期随机临床研究结果备受瞩目。 该研究将151 位晚期非小细胞肺癌患者随机分组, 分别接受单纯化疗或化疗联合早期姑息治疗, 研究结果显示: 化疗联合早期姑息治疗不仅显著改善了患者的生活质量, 还明显延长了患者的生存时间。单纯化疗组的总生存时间为8. 0 月, 而联合姑息治疗组则达到11. 6 月。 该研究显示, 姑息治疗花费很少,

6、而近4 个月的生存优势足以使其和目前公认的昂贵的生物靶向药物相媲美。 这一结果促使人们以更新的视角看待姑息医学, 以更理性客观的态度审视肿瘤的综合治疗, 将姑息治疗放到了重要位置。姑息医学展望姑息治疗临终关怀安宁服务舒缓治疗随着人们对医学本质和疾病规律认识的不断深入,由姑息治疗衍生的医学服务逐渐丰富发展, 成为一门正式的医学分支学科, 即姑息医学。姑息一词的内涵也随之发生变化, 其广度已远超出对症治疗的范畴, 深度也拓展至改善生活质量、甚至延长生存期的层面, 蕴含着积极主动的医学服务理念。因此, 许多学者曾建议为姑息医学更名, 试图采用更符合现代姑息医学理念的、带有积极意味的词汇取代原词, 使

7、其更贴近姑息医学的本质。我国港澳台地区已采用“安宁服务”、“舒缓治疗”等词汇代替姑息治疗的称谓, 大陆学者也在为此进行讨论。 谢谢！-50+70TG Diagram-simpleAdd text in here Add text in here too Add text in here Add text in here too Add text in here Add text in here too Add text in here too Add text in here3D Cubes Flow / ProcessAdd text here Add text in here too Ad

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