血液透析患者的綜述[關(guān)鍵詞]終末期腎臟病；血液透析；慢性疼痛；綜述[keywords]endstageofrenaldisease;maintenancehemodialysis;chronicpain;review慢性疼痛定義和分級(jí)國(guó)際上對(duì)于疼痛的定義：一種令人不愉快的感覺(jué)和情緒上的感[1][2]3[3]睡眠受干擾；重度疼痛：疼痛劇烈不能忍受，需要鎮(zhèn)痛藥物[4]。評(píng)估方法目前臨床上常用的評(píng)估方法有多種：視覺(jué)模擬評(píng)分(visualanaloguescales，vas)、面部表情疼痛量表(facespainscale，fps)、口述分級(jí)評(píng)分(verbalratingscales ，vrs)、數(shù)字評(píng)分numericratingscalenrs)、prince-henryprincehenrypainscalephpsmcgillmcgillpainquestionnairempQmcgillshort-fromofmcgillpainquestionnairebriefpainquestionnaire、briefpaininventorybpi)。目前疼痛強(qiáng)度常使用bpi進(jìn)bpi3個(gè)因素分別量化，此47100級(jí)1024h100級(jí)表示0~47~10bpi（）在癌癥bpi[5-8]，[3-9]。血液透析患者的慢性疼痛病因esrd患者尤其是血液透析患者，慢性疼痛的發(fā)生是相當(dāng)普遍的。研究顯示,37%~50%的血82%的折磨[9-11]。esrd患者一種特殊的問(wèn)題。疼痛可能是由（多囊腎），或者由esrd的治療引起；血液透析患者動(dòng)靜脈內(nèi)瘺缺血性神經(jīng)病[9]。肌肉骨骼疼痛是血液透析患者慢性疼痛最常見(jiàn)的原因[9]。和正常人群不同的eliezer等[12]慢性疼痛對(duì)血液透析患者生活質(zhì)量的影響疼痛對(duì)患者包括身體、心理、社davison等人對(duì)205個(gè)澳大利亞血液透析患者進(jìn)行研究，用bpi（bdi）評(píng)估抑郁[13]、使用匹茲堡睡眠（psqi）[14]103人（50.2%）85人（41.4%）（34.1%vs18.3%，or=2.31，p=0.01），和疼痛患者常出現(xiàn)失眠（74.7%vs53.0%,or=2.32,p=0.02）。因此，為了止痛藥的應(yīng)用及劑量問(wèn)題已有報(bào)道[15]（nsaids）。對(duì)乙酰氨基酚主要經(jīng)過(guò)肝臟代謝，對(duì)于血液透析患者無(wú)需調(diào)整[16]對(duì)于終末期腎臟病患者合并輕至中度疼痛首選非麻醉性鎮(zhèn)痛藥對(duì)乙酰氨基酚，nsaidsnsaids也可能nsaidsnsaids效果欠佳可以使用弱阿片類nsaids[參考文獻(xiàn)]loisvc,elizabethab,marilyncs.scientific inquiry:cancerpaininchildren:theselectionofamodeltoguideresearch[j].journalforspecialistsinpediatricnursing,2002,7(4):163-165.merbothmk,barnasons.managingpain:thefifthvitalsign[j].nursclinnortham,2000,35(2):375-383.davisonsn,jhangrigs.theimpactofchronicpainondepression,sleep,andthedesiretowithdrawfromdialysisinhemodialysispatients[j].jpainsymptommanage,2005,30(5):465-473.殷磊.[m].3版.北京,2004:160.klepstadp,logejh,borchgrevinkpc,etal.thenorwegianbriefpaininventoryquestionnaire:translationandvalidationincancerpainpatients[j].jpainsymptommanage,2002,24(5):517-525.mystakidouk,mendozat,tsilikae,etal.greekbriefpaininventory:validationandutilityincancerpain[j].oncology,2001,60(1):35-42.shinhc,wangxs,cleelandcs.developmentofacancer,painassessmenttoolinkorea:avalidationstudyofakoreanversionofthebriefpaininventory[j].oncology,2004,66(6):439-444.gerlp,host,sunwz,etal.validationofthebriefpaininventoryinataiwanesepopulation[j].jpainsymptommanage,1999,18(5):316-322.davisonsn.paininhemodialysispatients:prevalence,cause,severityandmanagement[j].amjkidneydis,2003,42(6):1239-1247.fainsingerr,davisonsn,brenneisc.asupportivecaremodelfordialysispatients[j].palliatmed,2003,17(1):81-82.fortinaf,agllatas,ragazzonie,etal.chronicpainduringdialysis.pharmacologictherapyanditscosts[j].minervaurolnefrol,1999,51(2):85-87.eliezerg,isabelleh,pninaos,etal.calcium,parathyroidhormone,andvitamind:majordeterminantsofchronicpaininhemodialysispatients[j].clinjamsocnephrol,2009,4(8):1374-1380.beckat,steerra,browngk.beekdepressioninventory,2ndedition(bdi-ii)[m].sanantonio:harcourtbraceandcompany,1996.buyssedj,reynoldscf,monkth,etal.thepittsburghsleepqualityindex:anewinstrumentforpsychiatricpracticeandresearch[j].psychiatryres,1989,28(2):193-213.kurellam,bennettwm,chertowgm.analgesiainpatientswithesrd:areviewofavailableevidence[j].amjkidneydis,2003,42(2):217-228.henrichwl,agodoale,barrettb,etal.analgesicsandthekidney:summaryandrecommendationstothescientificadvisoryboardofthenationalkidneyfoundationfromanadhoccommitteeofthenationalkidneyfoundation[j].amjkidneydis,1996,27(1):162-165.僅供個(gè)人用于學(xué)習(xí)、研究；不得用于商業(yè)用途Forpersonaluseonlyinstudyandresearch;notforcommercialuse.Nurfurdenpers?nlichenfueStUdirschung,zukommerziellenZweckenverwendetwe