维持治疗期白血病儿童生存质量及其影响因素分析

目的 分析白血病儿童维持治疗期生存质量,探讨对儿童生存质量形成影响的因素。方法 选择2016年5月至2018年5月郑州大学附属儿童医院维持治疗期白血病儿童112例,通过生存质量量表对患儿生存质量进行评价,通过单因素以及多因素分析探讨对生存质量存在影响的因素。结果 年龄、家庭教养方式、居住地与儿童白血病生存质量存在相关性(P 0. 05)。结论 多种因素都会影响维持治疗期白血病儿童生存质量,通过给予针对性的干预,帮助患儿社会适应能力逐渐提升,帮助患儿能够更快回归正常生活。     

白血病患儿父母的生存质量研究

[目的]调查白血病患儿父母的生存质量及其影响因素。[方法]采用描述性相关性研究的方法,对86名白血病患儿及其父母进行问卷调查。[结果]白血病患儿父母的生理、心理领域都明显低于全国常模（P〈0．01）;父母的生存质量与家庭关系相关（P〈0．01）,生存质量的主规评价、环境领域评分与家庭收入和经济情况、同伴关系有关,医疗费用情况与生理领域评分相关,孩子的学习成绩和心理、社会、环境领域得分有关,目前化疗阶段与社会领域和主观评价得分有关（P〈0．05）。[结论]应重视对白血病患儿父母的生存质量。     

院外延续管理对急性淋巴细胞维持期白血病患儿生存质量的影响

目的:探讨院外延续管理对急性淋巴细胞维持期白血病患儿生存质量的影响。方法:按相等对匹配的原则将在枣庄市5家二级以上综合医院治疗的急性淋巴细胞维持期白血病患儿52例分为干预组和对照组各26例,干预组在常规出院指导的基础上实施院外延续管理;对照组实施常规出院指导。出院1年后,采用生存质量量表(QLQ-C30)调查两组患儿生存质量。结果:出院1年后,干预组整体健康水平及生存质量、PF、RF、EF、CF和SF得分与对照组比较差异有统计学意义(P0.05,P0.01);FA、NV、PA、呼吸困难、失眠、食欲不振、便秘、腹泻症状较对照组明显减轻(P0.05,P0.01)。结论:院外延续管理对急性淋巴细胞维持期白血病患儿提高生存质量有积极作用。     

急性淋巴细胞维持期白血病患儿生存质量影响因素的调查分析

目的 探讨急性淋巴细胞维持期白血病患儿生存质量的影响因素.方法 采用儿童生存质量普适性核心量表(Peds-QL4.0)和艾森克个性问卷(成人卷),分别对2010年6～9月在北京儿童医院血液中心治疗的急性淋巴细胞维持期白血病惠儿(121例)及其家长(121名)进行调查.结果 2～7岁患儿的生理功能总分高于心理功能总分,8～12岁患儿的心理功能总分高于生理功能总分,5～7岁患儿的社会功能得分最低,急性淋巴细胞维持期白血病患儿的学业受到影响,患儿母亲神经质是生理功能的影响因素,患儿年龄是社会功能的影响因素.结论 应重视学龄期和青春期急性淋巴细胞维持期白血痛患儿的学业和5～7岁患儿社会交往功能的建立,并加强对患儿及其家长的心理教育.     

白血病患儿父母的生存质量研究

[目的]调查白血病患儿父母的生存质量及其影响因素.[方法]采用描述性相关性研究的方法,对86名白血病患儿及其父母进行问卷调查.[结果]白血病患儿父母的生理、心理领域都明显低于全国常模(P<0.01);父母的生存质量与家庭关系相关(P<0.01),生存质量的主观评价、环境领域评分与家庭收入和经济情况、同伴关系有关,医疗费用情况与生理领域评分相关,孩子的学习成绩和心理、社会、环境领域得分有关,目前化疗阶段与社会领域和主观评价得分有关(P<0.05).[结论]应重视对白血病患儿父母的生存质量.     

舒缓疗护对化疗期白血病患儿症状感知度、负性情绪及生活质量的影响

目的:探讨舒缓疗护对化疗期白血病患儿症状感知度、负性情绪及生活质量的影响。方法:选取2015年1月1日～2018年12月31日接受化疗的白血病患儿61例为研究对象,根据不同的护理方法将患儿分为对照组30例和观察组31例,对照组在化疗期间接受常规疗护,观察组给予舒缓疗护;比较两组症状体验、负性情绪[采用汉密顿抑郁量表(HAMD)评分、汉密顿焦虑量表(HAMA)]及生活质量[采用生存质量核心量表(QLQ-C30)]。结果:观察组症状感知度评分低于对照组(P 0. 05);化疗15 d,两组HAMD、HAMA评分均低于第1次化疗(P 0. 05),且观察组低于对照组(P 0. 05);观察组QLQ-C30症状评分低于对照组,QLQ-C30功能评分高于对照组(P 0. 05)。结论:对化疗期白血病患儿提供舒缓疗护,能有效降低患儿的症状感知度,改善负性情绪,提高生活质量。     

心理干预对住院期间白血病患儿抑郁焦虑的影响

目的：探讨心理干预对住院期间白血病患儿抑郁焦虑的影响。方法：66例住院白血病患儿分为干预组34例和对照组32例,均行化疗治疗。干预组在治疗原发病的基础上进行个体化心理干预。2组治疗前后采用儿童抑郁焦虑量表（DSRSC、SCARED）评价2组抑郁焦虑的程度,生存质量量表（QLQ-C30）评价生存质量。结果：心理干预15d后,DSRSC和SCARED评分干预组明显低于治疗前及对照组（均P〈0.05）;QLQ-C30评分明显高于治疗前及对照组（均P〈0.05）。对照组仅QL2、EF、FA、NV及PA评分较入院第1天有提升（P〈0.05）。结论：心理干预能有效改善白血病患儿的心理状态和生存质量。     

先天性肛门直肠畸形患儿术后生存质量影响因素的调查研究

目的探讨先天性肛门直肠畸形(ARM)患儿术后生存质量的影响因素。方法选取2017年4月至2019年4月我院收治的先天性肛门直肠畸形患儿93例为研究对象,采用儿童生存质量普适量表对患儿的生存质量进行评分;采用多因素logistic回归分析模型,分析患儿术后生存质量的影响因素。结果疾病临床分型、排便障碍、居住地是影响ARM患儿术后生存质量的独立危险因素(P 0. 05)。结论针对疾病临床分型、排便障碍、居住地实施个性化护理干预,帮助患儿及其家属正确认识疾病,提高其治疗依从性,对提高患儿生存质量至关重要。     

白血病患儿的心理干预

目的根据儿童不同年龄阶段心理活动所具有的特点,对白血病患儿进行相应的心理护理,观察其对患儿疾病治疗及恢复的作用。方法对不同年龄阶段患儿实施相应的心理护理措施。结果有效降低了白血病患儿的心理负担,减少了对陌生环境的恐惧感及对治疗的抵触感。使患儿及其家庭获得安全感,明显提高其生活质量,有效提升治疗效果。结论对白血病患儿进行正确、及时、有效的心理护理,有利于患儿的疾病治疗,恢复及提高生存质量。     

自我管理干预模式在7～12岁急性淋巴细胞白血病患儿中的应用价值

目的 探究自我管理干预模式对7～12岁急性淋巴细胞白血病患儿自我管理能力、缺陷感及生存质量的影响。方法 选取2019年3月—2021年6月本院收治的98例急性淋巴细胞白血病患儿作为研究对象，根据患儿入院先后顺序将其分为两组，对照组实施常规护理，观察组在常规护理的基础上实施自我管理干预模式。观察并比较两组患儿入组(T₀)、干预1周(T₁)、干预2周(T₂)、干预4周(T₃)、干预8周(T4)、干预12周(T₅)时的自我管理能力，以及两组患儿T₀和T₅时的心理状态与生存质量。结果 自我管理干预模式对患儿积极度量表评分的主效应具有统计学意义(P<0.05),时间因素对患儿积极度量表评分的影响具有统计学意义(P<0.05),组别×时间的交互作用具有统计学意义(P<0.05);T₅时观察组患儿儿童抑郁量表各领域评分及总分均低于对照组(P<0.05);T₅时观察组患儿儿童生存质量...     

直接RT-PCR扩增法研究miR-223在儿童急性淋巴细胞白血病血浆中的异常表达

本研究旨在探索miR-223在急性淋巴细胞白血病（ALL）患儿血浆中的表达情况及其在不同疾病状态下的表达特点。选取北京儿童医院2005年5月至2012年1月住院ALL患儿64例,包括初诊患儿30例,缓解患儿30例,复发患儿4例。直接使用血浆进行逆转录和实时荧光定量PCR的方法检测样本中miR-223的表达情况。结果发现,miR-223在初诊患儿血浆中表达较低,在缓解患儿中表达升高。由于复发例数太少,暂未发现差异性;在初诊或缓解患儿中,miR-223在TEL-AMLI阳性组和无融合基因B系ALL组表达均无明显差异。结论：miR-223在初诊患儿血浆中表达较低,在缓解患儿中表达明显升高,可能起着抑癌基因的作用,并可作为白血病的分子标志物以及监测疗效的指标。     

The Health Utilities Index 3 invalidated when completed by nurses for pediatric oncology patients

When health-related quality of life instruments developed for and validated in 1 respondent group are completed by a different respondent group, findings could be invalid. The purpose of this study was to summarize the instrument outcomes when a widely used health-related quality of life instrument (the Health Utilities Index 3 [HUI3]) created from a population-based strategy was completed by pediatric oncology nurses for their patients during cancer treatment. Fifty-four nurses completed the HUI3 a total of 261 times at 1 to 3 sequential data points (106, 94, and 61, respectively) for pediatric patients who were enrolled on a frontline therapeutic clinical trial for acute lymphoblastic leukemia. Data were collected at 2 children's hospitals. HUI3 scores could not be calculated for 52% to 61% of the nurse reports at each of the 3 data points because of nurses' use of the "do not know" response option. Missing data of this proportion indicate that the nurse serving as a proxy rater independent of directly soliciting responses from the patient will not be able to rate certain attributes of the HUI3 more than half of the time despite having ongoing familiarity with the patient. Because of this, use of the HUI3 by nurse proxies for patients with pediatric acute lymphoblastic leukemia is not recommended.     

急性白血病患儿合并间质性肺炎的护理

目的总结急性白血病合并间质性肺炎患儿的护理经验。方法对8例急性白血病合并间质性肺炎的患儿采取病情观察、保持呼吸道通畅、保证供氧、心理护理、营养支持、预防和控制感染、正确的出院指导等护理措施。结果本组8例,6例痊愈,2例因并发急性呼吸窘迫综合征死亡。结论采取有效的治疗措施及护理干预,可有效降低合并间质性肺炎的白血病患儿并发急性呼吸窘迫综合征的发生率,降低其死亡率。     

cdx2基因在儿童白血病的表达及临床意义研究

本研究旨在探讨cdx2基因在儿童急性白血病骨髓及外周血单个核细胞中的表达及临床意义。采取33例初发儿童白血病患儿骨髓及外周血,运用RT-PCR方法检测cdx2基因在各型白血病及正常对照组中的表达,随访25例并观察其与疗效的关系。结果发现,病例组中30例急性白血病(AL)患儿cdx2表达阳性25例(83.3%),30例中21例急性淋巴细胞白血病(ALL)和9例急性髓细胞白血病(AML)cdx2表达阳性分别为20例(95.2%)和5例(55.6%),两组相比有统计学意义(p<0.05);3例慢性粒细胞白血病(CML)中1例cdx2表达阳性。对照组20例健康体检者外周血cdx2表达阴性,与病例组比较差异有统计学意义(p<0.01)。25例AL患儿cdx2阳性21例(ALL17例,AML4例)与阴性者4例(ALL1例,AML3例)经治疗后均达到完全缓解(CR)。cdx2是否阳性表达可能与CR率无相关关系。对8例cdx2表达阳性AL患儿治疗后动态观察,结果初诊cdx2阳性表达在CR时仍阳性,但随着CR延长cdx2表达逐渐转为阴性,而初诊时cdx2阴性表达在骨髓CR时仍为阴性。结论:cdx2在儿童AL患者中广泛高表达,ALL者该基因表达阳性率高于AML患儿。CML患儿中也有cdx2表达;cdx2基因表达与AL患者CR率无明显相关。     

Efficacy of colony-stimulating factors in acute leukemia

OBJECTIVE: To evaluate the literature describing the safety and efficacy of the hematopoietic colony-stimulating factors (CSFs) for the management of treatment-related adverse effects in patients with acute leukemia. DATA SOURCES: A systematic MEDLINE search of the English-language literature (1995-April 2000) was performed to identify all randomized trials evaluating CSF use in acute leukemia. The following search terms were used: granulocyte colony-stimulating factor, filgrastim, granulocyte-macrophage colony-stimulating factor, sargramostim, acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML), acute nonlymphocytic leukemia, and acute myeloid leukemia. The references from relevant literature were also examined in order to identify reports not discovered in the MEDLINE search. DATA SYNTHESIS: Six randomized trials in pediatric ALL, nine in adult AML, and four in adult ALL have examined the safety and efficacy of the CSFs. Two of the pediatric trials supported a reduction in either the duration of hospitalization or in the incidence of febrile neutropenia when a CSF was employed during the consolidation or intensification phase of chemotherapy. The remaining pediatric trials failed to demonstrate a clinical benefit. In adult AML, eight of the nine trials showed a significant decrease in the time to neutrophil recovery when a CSF was used. Only one of these trials demonstrated a decrease in hospital stay and none showed a decreased incidence of infection for patients who received a CSF. Three of the four trials in adult ALL demonstrated the efficacy of a CSF in decreasing the number of days to neutrophil recovery. Only one trial demonstrated that a CSF led to a reduction in the number of hospital days. Trials in children or adults have not demonstrated that the CSFs influence the long-term outcome of patients with acute leukemia. CONCLUSIONS: The published studies document a decrease in the time to recovery from neutropenia when patients with acute leukemia are treated with a CSF. However, a consistent reduction in infectious complications or in the duration of hospitalization has not been demonstrated when a CSF is used for either pediatric or adult patients. Very limited data exist to support the premise that CSFs meet the criteria established by the American Society of Clinical Oncology for demonstrating the value of these agents. Further careful study focused on resource utilization and pharmacoeconomics may help to elucidate how healthcare institutions may most effectively employ CSFs to treat patients with acute leukemia.     

Retinoids in Pediatric Onco-Hematology: the Model of Acute Promyelocytic Leukemia and Neuroblastoma

Retinoids are lipophilic compounds derived from vitamin A, which have been extensively studied in cancer prevention and therapy. In pediatric oncology, they are successfully used for the treatment of acute promyelocytic leukemia (APL) and high-risk neuroblastoma (HR-NBL). APL is a subtype of acute myeloid leukemia (AML) clinically characterized by a severe bleeding tendency with a highrisk of fatal hemorrhage. The molecular hallmark of this disease is the presence of the promyelocytic leukemia (PML)-retinoic acid receptor-α (RAR α) gene fusion that plays a critical role in promyelocytic leukemogenesis and represents the target of retinoid therapy. The introduction in the late 1980s of all-trans retinoic acid (ATRA) into the therapy of APL radically changed the management and the outcome of this disease. Presently, the standard front-line therapeutic approach for pediatric APL includes anthracycline-based chemotherapy and ATRA, leading to a complete remission in almost 90% of the patients. Neuroblastoma (NBL) is an aggressive childhood tumor derived from the peripheral neural crest. More than half of patients have a high-risk disease, with a poor outcome despite intensive multimodal treatment. Although the exact mechanism of action remains unclear, the introduction of 13-cis-retinoic acid (13-cis-RA) in the therapy of NBL has improved the prognosis of this disease. Currently, the standard treatment for HR-NBL consists of myeloablative therapy followed by autologous hematopoietic stem cell transplantation (HSCT) and maintenance with 13-cis-RA for the treatment of minimal residual disease, leading to a 3-year disease-free survival rate (DFS) of about 50%. In this paper the authors provide a review of the peer-reviewed literature on the role of retinoids in the treatment of pediatric APL and HR-NBL, summarizing the most relevant clinical trial results of the last decades, analyzing the ongoing trials, and investigating future therapeutic perspectives of children affected by these diseases.     

结肠灌洗对造口病人生活质量的影响

[目的]探讨结肠灌洗对肠造口病人生活质量的影响。[方法]将52例直肠癌Miles术后病人随机分为两组,观察组(22例)采用结肠造口灌洗法,对照组(30例)采用自然排便法,根据测试评分分为优、良、中、差。[结果]观察组生活质量优占59.1%,对照组占23.3%,两组比较有统计学意义(P<0.01)。[结论]结肠造口灌洗可明显提高病人的生活质量。     

护理干预对宫颈癌病人心理状态及生存质量的影响

目的:探讨护理干预对宫颈癌病人心理状态及生存质量的影响。方法:采用抑郁自评量表和焦虑自评量表对63例宫颈癌病人进行心理状态分析,制定、实施护理干预措施,并于实施护理干预前后应用抑郁自评量表和焦虑自评量表评定病人心理状态评分,应用癌症病人生存质量核心问卷测量病人生存质量评分。结果:宫颈癌病人抑郁自评量表评分和焦虑自评量表评分在护理干预后均低于干预前(P<0.01);生存质量评分在护理干预后均高于干预前(P<0.05,P<0.01)。结论:护理干预能改善宫颈癌病人的心理状态,提高其生存质量。     

儿童反复肺炎相关危险因素分析

目的探讨儿童反复患肺炎的相关危险因素,筛查高危人群,指导医生对儿童反复肺炎早期预防及临床干预。方法采用病例-对照研究方法,对103例反复肺炎患儿,及同期就诊的103例非反复肺炎的患儿进行研究,采用单因素χ2检验及多因素logistic回归模型调查反复肺炎的危险因素。结果经过χ2检验显示组间存在明显差异的变量为早产史、反复上呼吸道感染史、既往住院史、每天户外活动时间少于30 min)、居住平房、被动吸烟史。多因素lo-gistic回归分析结果显示:反复上呼吸道感染史(OR=4.006,95%CI:1.827～8.786)、既往住院史(OR=9.408,95%CI:4.419～20.030)、每天户外活动时间少于30 min(OR=2.934,95%CI:1.289～6.679)、居住平房(OR=3.441,95%CI:0.786～15.060)、被动吸烟(OR=2.23,95%CI:1.030～4.861)是儿童反复肺炎的独立危险因素。结论反复上呼吸道感染、既往住院史、居住环境差、每天户外活动时间少、被动吸烟等可以增加儿童患反复肺炎的风险。     

Pediatric brain tumor rehabilitation

Children with brain tumors experience significant functional deficits related to the primary disease process and also as a consequence of its treatment. As in adults, childhood brain tumors represent a heterogeneous group of tumors, which vary in pathologic characteristics, tumor biology, response to therapy, anatomic location, and age at diagnosis. With the advances in diagnostic strategies, neurosurgical techniques and therapeutic trials over the last 30 years, a greater proportion of these children are surviving into adulthood. Accompanying this survival, knowledge and intervention regarding long-term effects and the consequences of functional deficits on independent living is necessary. Involvement of a pediatric physiatrist throughout the course of disease, from diagnosis through survivorship, assists in optimizing functional independence and quality of life for children with brain tumors.