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1 3 I..126II. 1..1262..1273..127 III. 1..1292..1303..1304..1385..1386..150IV. 1..1542..156V..157I. 5 , , , , (Brekken&Sheets,2008). 2,500 ,5,000 , (Pain&PolicyStudiesGroup,2007). , 30-50%, 60-70%, 80 90% , ( ,2003) (intolerance) (addiction) , , , (Brekken&Sheets,2008). , . II. 1. (InternationalAssociationforthestudyofPa in,1980) , (McCaffery,1979).2. 1) 1.

2 1. (6 ) (6 ) , , ( , , , , , ) 2) : ( ), ( , ), , : (cramping) : (burning), (tingling), , 3. 1) (Specificitytheory) , , . , (Phantompain), .2) (Gatecontroltheory)1965 Melzack Wall , .. (T-cell) (SubstantiaGelatinosa,SG) . , . , . T-cell (actionsystem).

3 3) (Endogenouspaincontroltheory) , enkephalin .enkephalin .. , .III. , , , . , , , (Miller,1984). , .1. 1 . , , , . WHO 5 . 1. 2. , .3. , , , , . , (Anderson,1982).1) PQRST( , , / , , )( 2) (painhistory) . 2. PQRSTP (Position) ? ?Q (Quality) ?

4 ?R (Relievingoraggravatingfactor) ? ?S (Severity) ? , ?T (Timing) ? , ? , ? (Position) . X . , , ( 2). 2. :TheUniversityofIowaCollegeofNursing(200 2).Evidence- (Quality) , , , , , , . (Relievingoraggravatingfactor) , , . : , , : , , , (Severity) ( , , , , ) . 3 .. (NumericRatingScale) 12 ( 3). 1-10 (1-4 ), (5-6 ), (7-10 ) , (WHO)3 .. 0 10 ?.

5 3. (NumericRatingScale) :AHCPR(AgencyforHealthCarePollicyandRese arch).(1992).Acutepainmanagement:Operati veormedicalproceduresandtrauma.( ).Rockville,MD:AgencyforHealthCarePolicy andResearch,PublicHealthService, .Wong-Baker (FacesPainRatingScale)3 , ( 4).. 4. (FacesPainRatingScale) ,Hockenberry-EatonM.,WilsonD., ,SchwartzP.(2001).Wong'sEssentialsofPedi atricNursing, , ,p1301 .FLACC (Face-Legs-Activity-Cry-ConsolabilitySca le)3 ( 3). (Face-Legs-Activity-Cry-ConsolabilitySca le)0 1 2 (Face) , , , , (Legs) , , (Activity) , , , , (Cry) , , , (Consolability) . :MerkelS.(1997). (3) (Timing) . ? ? ? ? (painhistory).

6 (opioid), , 1.. a,b,c,d .2. (sharp) (burning) (cutting) (tingling) (comesandgoes) (dull) (pressing) (numbing) (cramping) (radiating) . ( , , , ) , , , 2) ( 4). , , , , / , , . 4. ( ) a,b,c,d .3. * : 0 , 10 ? ____ , ____ , ___ , ___ 0 1 2 (Face) , , , , (Legs) , , (Activity) , , , , (Cry) , , , , (Consolability).

7 *3 4. 5. / :_____ :_____6. ( , )_____ _____ _____ _____ _____ ( , , )_____ ( , , , )_____ _____7. , , 8. ( : , ) 9. 3) , , 5 . :5 (WHO3 , ) : 1 , 15 ( ,2008) : 5 8 , , , 8 , . / / / ( a,b,c,d ) ( a,b,c,d ) ( a,b,c,d ) :() :() :() FLACCF 0 1 2 FLACCF 0 1 2 FLACCF 0 1 2L 0 1 2L 0 1 2L 0 1 2A 0 1 2A 0 1 2A 0 1 2C 0 1 2C 0 1 2C 0 1 2C 0 1 2C 0 1 2C 0 1 2 5.

8 4. ( , , , ) . : ) 5. 1) 6 . 6. Acetaminophen,Ibuprofen,Naproxen,Ketorol ac,Ketoprofen Morphine,Fentanyl,Codeine,Tramadol,Oxyco done,Hydromorphone Amitriptyline,Nortriptyline,Imipramine Phenytoin,Carbamazepine,Gabapentine Dexamethasone,Prednisolone Midazolam,Diazepam,Lorazepam Ketamine,Buscopan(1) . ( 5).. WHO 3 , , . (aspirin paracetamol ), (codeine ), (morphine ) .. , , ( , ) .. , . , .. (PRN) (Aroundtheclock,ATC) .. (breakthroughpain; ) ( 6).

9 6.. (placebo) .(2) .. , .. , ..NSAIDs ( ) WHO3 .. NSAIDs .. Warfarin ,methotrexate,digoxin,lithium, ,aminoglycoside . aldactone .. , ( 7,8 ). 7. (mg) (mg/ )50kg p-aminophenolderivativeAcetaminophenq4~6 h500-1,0004,00010-15mg/kg SalicylatesAspirinq4~6h500-1,0004,000 , , ,Reye NSAIDsIbuprofenq4~6h200-4002,4005-10mg/k g , , , , Naproxenq6~8h 500 2501,2505-10mg/kgKetoprofenq6~8h25-50300 Indomethacinq8~12h25100 , Ketorolacq630or60IM30IV , , , , :AmericanPainSociety(1999). ,IL:AmericanPainSociety (2008). 3 8. (mg/ ) (mg/ ) p-aminophenolderivativeAcetaminophenq4~6 h2,6004,000 SalicylatesAspirinq4~6h2,6006,000 PropionicacidsIbuprofenq4~8h1,6003,200 Naproxenq12h5001,500 Fenoprofenq4~6h8003,000 Ketoprofenq6~12h100300 Flurbiprofenq8~12h100300 Oxaprozinq12~24h600600 AceticacidsIndomethacinq8~12h75200 Propionicacids Sulindacq12h200400 Diclofenacq8~12h75200 Ketorolacq4~6h4040 Etodolacq6~12h6001,200 OxicamsPiroxicamq24h20403 Naphthyl-alkanonesNabumetoneq24h1,0002,0 00 FanamatesMefenamicacidq6h500 1 250q8h1,000 , Meclofenamicacidq6-8h150400selectiveCOX- 2inhibitorsCelecoxibq12~24h200400 , : (2008).

10 3 (3) (tolerance) (physicaldependence) , (addiction) , .. pentazocine,nalbuphine - . - .Meperidine(Demerol ) . , . (bythemouth), (bytheclock), (bytheladder) , .. , , , .. , ,( 9) . : 1 . : 30-60 . : ,fentanyl 1-5 ,morphine 15 30 . (PCA;patientcontrolledanalgesia): , ( 10). 9. 50kg Oral90-120mgq3-4hr90-120mgq3-4hr (Demerol) /hrpatchq72hr25 : (1999).. ,20(11) (2005).