肿瘤的姑息治疗--课件

肿瘤的姑息治疗肿瘤的姑息治疗1ppt课件肿瘤的姑息治疗1ppt课件2010 年年,美国麻省总医院肿瘤中心发美国麻省总医院肿瘤中心发表于表于新英格兰医学杂志新英格兰医学杂志的关于姑的关于姑息治疗可延长进展期非小细胞肺癌患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者生存期的临床研究报告受到普遍关注注,提高了肿瘤工作者对姑息医学实提高了肿瘤工作者对姑息医学实践的参与热情践的参与热情,使业内有识之士从全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。新的角度对姑息医学的内涵进行审视。2ppt课件2010年,美国麻省总医院肿瘤中心发表于新英格兰医学杂英文中姑息(palliative)palliative)一词,最早作为形容词出现于16 16 世纪40 40 年代,引自14 14 世纪法语中的palliativepalliative以及中世纪拉丁语中的palliatus palliatus，有记载的名词含意出现于1724 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。3ppt课件英文中姑息(palliative)一词,最早作为形容词目录目录4ppt课件姑息医学发展历程姑息治疗概念、原则及内容姑息治疗发展前景LO姑息医学发展简史姑息医学的建立是Hospice Hospice 运动发展的必然结果。Hospice Hospice 做为一种慈善机构,其雏形可追溯至公元4 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,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 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 19 世纪,Hospice,Hospice 已演变成向疾病终末期患者提供医学照护的专业机构。5ppt课件姑息医学发展简史姑息医学的建立是Hospice运动发展的必现代姑息医学发展简史1967 年,英 国 西 塞 莉 桑 德 斯(CicelySaunders)博士经过锲而不舍的长期努力,在伦敦建立了圣克里斯多弗宁养院(St.ChristophersHospice)。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。6ppt课件现代姑息医学发展简史1967年,英国西塞莉桑德斯1970年1990年各种Supportivecareunite如雨后春笋,英国700余家,美国3000余家其他欧洲及第三世界也陆续建立起Hospice。1987年,姑息医学(PalliativeMedicine)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。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。7ppt课件1970年1990年各种Supportivec姑息医学的临床实践统称为Palliative Palliative Care,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 end of of life life care)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。8ppt课件姑息医学的临床实践统称为PalliativeCare姑息姑息治疗治疗姑息治疗的定义姑息治疗的定义WHO 1990 年对姑息治年对姑息治疗的定义是疗的定义是:姑息治疗医姑息治疗医学是对那些所患疾病对学是对那些所患疾病对根治性治疗无反应的病根治性治疗无反应的病人的积极的、整体的关人的积极的、整体的关怀照顾。镇痛怀照顾。镇痛,控制其他控制其他症状和减轻精神心理、症状和减轻精神心理、社会的创伤。社会的创伤。9ppt课件姑息治疗姑息治疗的定义WHO1990年对姑息治疗的定义是123410ppt课件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 无痛无痛 治疗治疗心理心理治疗治疗具体原则具体原则全面全面细致细致护理护理具体具体原则原则适度适度治疗治疗个体个体化治化治疗疗11ppt课件无痛心理具体原则全面细致护理具体原则适度治疗个体化12ppt课件居丧关怀01.心理辅导临终关怀01.姑息治疗中晚期姑息治肿瘤姑息治疗的几种方式一些癌症患者病情发一些癌症患者病情发展到晚期展到晚期,无法进行无法进行根治性手术根治性手术,但是为但是为了减轻患者的痛苦了减轻患者的痛苦,延长患延长患者生命者生命,也可进行手也可进行手术术,这种手术称为姑这种手术称为姑息性手术。息性手术。姑息性放疗是指应用姑息性放疗是指应用放疗方法治疗晚期肿放疗方法治疗晚期肿瘤及其复发和转移病瘤及其复发和转移病灶灶,以达到改善症状以达到改善症状的目的的目的。目前姑息性化疗在处目前姑息性化疗在处理晚期肿瘤患者症状理晚期肿瘤患者症状方面的作用尚未达成方面的作用尚未达成共识。共识。姑息性姑息性手术手术姑息性姑息性化疗化疗姑息性姑息性放疗放疗13ppt课件肿瘤姑息治疗的几种方式一些癌症患者病情发展到晚期,无法进行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。14ppt课件14ppt课件该研究将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。15ppt课件该研究将151位晚期非小细胞肺癌患者随机分组,分别该研究显示,姑息治疗花费很少,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。16ppt课件16ppt课件17ppt课件姑息医学展望姑息治疗安宁服务17ppt课件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。18ppt课件随着人们对医学本质和疾病规律认识的不断深入,由姑息治疗衍生的今后,在姑息治疗中,应力争逐步做到与患者开放地讨论死亡的问题,坦率地征求患者对临终或濒死阶段的治疗和抢救措施的意见,使他们正确表达自己的意愿和感受,令患者感觉“我在临终前还能做些有意义的事情”。同时,制定“生前预嘱”(livingwill),自己选择离世的地点,安排好后事。使患者在生命的最后阶段感受到亲情、尊重和关怀,平静面对自己病笃的现实,欣慰和有尊严的辞世。19ppt课件今后,在姑息治疗中,应力争逐步做到与患者开放地讨论谢谢！20ppt课件谢谢！20ppt课件21ppt课件21ppt课件22ppt课件22ppt课件23ppt课件-50+70TGDiagram-simpleAddtex3D 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