極論で語る緩和ケア

出版社： 丸善出版
著者：
発行日： 2023-10-30
分野： 臨床医学：一般  >  癌/腫瘍一般
ISBN： 9784621308486
電子書籍版： 2023-10-30 （電子書籍版）
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プライマリ緩和ケアは全ての医師が身につけるべき基礎知識
植村健司医師が唱える緩和ケアは明解です。「苦痛（痛み）の緩和」「治療のゴールの話し合いと設定」「ケアの調整」。これらはがんの緩和ケアだけでなく、全ての重症疾患が対象になります。臨床において「これって、本当に患者さんのためになっているのだろうか？」と疑問に思った時こそ、緩和ケアが必要なのです。生活の質の向上、機能の保持、家族の負担の軽減など、患者や家族の価値観に寄り添い、治療のゴールを共に考え、適切に介入します。

目次

  • 第1部　緩和ケア総論
    　１章　緩和ケアとは？[What is palliative care？]
    　　極論1　緩和ケアはがんだけでなく，全ての重症疾患が対象
    　　極論2　緩和ケアは終末期だけにあらず
    　　極論3　プライマリ緩和ケアは全ての医師が身につけるべき知識
    　　極論4　生命延長だけがゴールではない
    　　コラム1　ホスピス・緩和ケアの母
    　　コラム2　日本における緩和ケアの発展

    　2章　予後の予測[prognostication]　
    　　極論1　終末期病を見逃すな
    　　極論2　危篤状態でも治癒の可能性は過少評価しない
    　　極論3　大きく4つのトラジェクトリ―を把握せよ
    　　極論4　緩和ケアはよりよく生きるためにあり
    　　コラム1　小児緩和ケアでは意思決定や死の説明が難しい

    　3章　死の過程[imminent death]　
    　　極論1　死の過程は進行性かつ不可逆性である
    　　極論2　治療のゴールを確認する
    　　極論3　躊躇せず集中的症状緩和を試みる
    　　極論4　comfort feedingで患者と家族をケア
    　　極論5　緩和的鎮静の深さはRASSで測る
    　　コラム1　在宅での看取り
    　　コラム2　死の過程で生じる症状と対処法

    　4章　コミュニケーション[communication]
    　　極論1　コミュニケーションのプロとして治療のゴールを話し合う
    　　極論2　キャパシティーは判断内容と時間に依存する
    　　極論3　「代理意思決定は複雑で難しい」と知る
    　　極論4　コミュニケーションスキルで感情に対処する
    　　極論5　SDMはソムリエの作業に似ている
    　　コラム1　ヘッドラインと沈黙の効果
    　　コラム2　ACP の進め方

    　5章　精神的症状・機能障害[psychiatric symptoms ＆ functional impairment]
    　　極論1　重症疾患患者にうつ症状は多いが見逃しも多い
    　　極論2　不安には非薬物療法も有効
    　　極論3　せん妄はキャムの流れで評価
    　　極論4　ADLとIADLで機能障害の低下を評価する
    　　コラム1　不眠

    第2部：疾患別の緩和ケア
    　6章　認知症［dementia] 　
    　　極論1　認知症は死に至る病である
    　　極論2　末期認知症患者を見逃すな
    　　極論3　体重減少・嚥下障害にPEGやTPNはNO
    　　極論4　痛みはあるが，その痛みは無言
    　　極論5　定時投与で認知症患者の痛みをコントロール
    　　コラム1　認知症患者はどのように亡くなるのか？
    　　コラム2　認知症の留意点

    　7章　が　ん[malignant tumor]
    　　極論1　進行した固形がんは早期から緩和ケアする
    　　極論2　がんの治療目的を患者と一緒に考える
    　　極論3　緩和目的の放射線治療はその目的を明確にする
    　　極論4　他科専門医を巻き込んで包括的なケアを提供
    　　極論5　急変する血液がんは事前準備がとにかく大事
    　　コラム1 　嘔気について
    　　コラム2 頭頸部がんはつらい症状が多く，多くの専門科との連携が必要
    　
    　8章　心不全[heart failure]
    　　極論1　心不全の死期予測はとにかく難しい
    　　極論2　最も効果のある緩和ケアは心不全の治療
    　　極論3　ゴールの話し合いも「最善を望み，最悪に備える」
    　　極論4　終末期ではICDの停止も検討する
    　　コラム1　destination therapyの是非

    　9章　肺疾患 [lung disease]
    　　極論1　呼吸困難には全人的な評価・介入が必要
    　　極論2　急性・慢性・強度・生活への影響で評価する
    　　極論3　呼吸困難の緩和は原疾患の診断・治療を優先する
    　　極論4　オピオイドは効果を見極めながら慎重に行う
    　　極論5　人工呼吸器の中止は患者・家族の権利　
    　　コラム1　意思疎通できない患者はRDOSで評価
    　　コラム2　COPDの緩和ケア

    　10章　腎不全［kidney failure]　
    　　極論1　血液透析は万能ではない
    　　極論2　腎不全患者のACPは緩和ケア医を巻き込む
    　　極論3　腎不全患者の痛みを見逃さない
    　　極論4　安全に使用できるオピオイドを知っておく
    　　極論5　透析中止の判断は慎重に．予後プロセスも説明する
    　　コラム1　透析を導入しない選択肢（＋緩和ケア）もある

    　11章　痛みの処方箋(オピオイド基本編) [Pain management: Opioids part 1] 　
    　　極論1　「オピオイドナイーブ」と「オピオイド常用者」に分けて考える
    　　極論2　短時間作用型モルヒネは4時間効果が持続する
    　　極論3　痛みの波に応じてレスキュー．目安は１時間毎
    　　極論4　オピオイドローテーションはオピオイド治療の要　
    　　極論5　オピオイドローテーションの黄金律をマスターする
    　　コラム1　持続静注か，間欠静注か

    　12章　痛みの処方箋(オピオイド応用編) [Pain management: Opioids part 2]
    　　極論1　オピオイドの副作用は3つのキモを押さえる
    　　極論2　PCAの有用性と禁忌を知る
    　　極論3　PCAの持続速度変更は原則24時間以上経ってから
    　　極論4　フェンタニルを使いこなす
    　　極論5　パッチは血中濃度の把握が大事
    　　コラム1　見逃されがちな副作用
    　　コラム2　フェンタニルパッチ
    　　コラム3　神経障害性疼痛
    　　コラム4　非がん性慢性疼痛

この書籍の参考文献

参考文献のリンクは、リンク先の都合等により正しく表示されない場合がありますので、あらかじめご了承下さい。

本参考文献は電子書籍掲載内容を元にしております。

第1部 緩和ケア総論

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第2部 疾患別の緩和ケア

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