放射治疗对鼻咽癌患者听功能损害因素分析

目的：探讨放射治疗对鼻癌患听的损害程度，为防治提供依据。方法：对38例鼻咽癌患放疗前和放疗后半年、1年和3年行听诱发电位，鼓室导抗图，纯音听阈检查。正常对照组为30例健康。结果：与放疗前比较，放疗后半年患听功能减退明显，1－3年听觉稍有改善，但未能达到放疗前水平，此后，再次出现听功能减退现象。结论：放疗可影响鼻咽癌患的听功能，放疗后患的听功能呈起伏式，不可逆的损害。     

脑干听觉诱发电位对鼻咽癌患者放疗后远期听功能和脑干损害程度的测试分析

目的探讨鼻咽癌患者放疗后远期听功能和脑干损害的程度。方法采用日本光电公司产的MEB-7102型诱发电位仪对19例无复发的鼻咽癌患者在放疗后3～5年进行脑干听觉诱发电位的测试。结果异常率为90%,与放疗前比较差异有非常显著性意义(χ2=6.80,P<0.01),但与放疗后两年内的测试比较则差异无显著性意义。异常主要表现在I,III,V波峰潜伏期延长,I～III,I～V峰间期延长,反应阈升高。结论放射治疗可损害听力及脑干功能,而且是缓慢进展的、不可逆的损害。     

脑干听觉诱发电位对鼻咽癌患者放疗后远期听功能和脑干损害程度的测试分析

目的 探讨鼻咽癌患者放疗后远期听功能和脑干损害的程度。方法采用日本光电公司产的MEB-7102型诱发电位仪对19例无复发的鼻咽癌患者在放疗后3～5年进行脑干听觉诱发电位的测试。结果异常率为90％，与放疗前比较差异有非常显著性意义(X^2=6．80，P&;lt;0．01)，但与放疗后两年内的测试比较则差异无显著性意义。异常主要表现在Ⅰ，Ⅲ，Ⅴ波峰潜伏期延长，Ⅰ～Ⅲ，Ⅰ～Ⅴ峰间期延长，反应阈升高。结论放射治疗可损害听力及脑干功能，而且是缓慢进展的、不可逆的损害。     

鼻咽癌及放疗对听觉功能损伤的影响因素分析

目的研究鼻咽癌(NPC)及放疗对听觉功能损伤的影响。方法用电测听和脑干听觉电位(BAEP)检查相结合的方法对112例鼻咽癌NPC放疗前和其中52例放疗后进行检查,并随访16例患者。结果放疗前电测听异常86例(159耳),占76.79％;脑干听觉电位(BAEP)异常89例(11耳),占79.46％,随访患者听力减退8例,电测听异常10例,脑干听觉电位(BAEP)异常13例。结论鼻咽癌(NPC)听觉功能损伤放疗前占86.61％,并随病情加重而严重,放疗后损伤达90.38％。其原因是多因素所致。     

鼻咽癌放疗后唾液腺损伤的康复

鼻咽癌放疗后，唾液腺受放射线损伤，分泌功能受抑制，给患者带来诸多不便，影响患者的生活质量。本文收集1990～1995年一程放疗后的鼻咽癌患者47例，根据放疗后不同的处理方法进行唾液腺损伤后的康复。1资料与方法1．l临床资料47例均为一程放疗后约1个月的鼻咽癌患者，根据放疗后处理方法的不同，分为2组。①观察组23例，男15例，女8例；年龄19～sl岁。鳞癌ZI例，其他2例；癌症1期1例，2期11例，3期9例，4期2例。②对照组24例，男14例，女10例；年龄21～50岁；鳞癌23例，其他1例；癌症1期2例，2期10例，3期11例，4期1例。1．2方法①观察组…     

鼻咽癌根治性调强放疗后晚期耳损伤的临床研究

目的:观察鼻咽癌根治性调强放疗后耳损伤听力学的改变.探讨其病变部位及影响其发生的因素.方法:采用调强放疗模式对早期鼻咽癌患者(T1-2N0-1M0)行根治性放疗Dt(66～70 Gy/6～7 w).分别于放疗前及放疗后1个月、6个月、1年及2年后行纯音测听、听性脑干反应和畸变产物耳声发射检查,并对包括就诊时年龄、患者性别、TNM分期、内耳剂量以及同步化疗在内的因素进行多因素分析.结果:鼻咽癌患者放疗后6个月后听阈升高>15 dB者占61.8%(47/76),2年后达76.3%(58/76).放疗后所有患者ABR检查与放疗前比较无显著差异.发生感音神经性耳聋的患者DPOAE幅值较放疗前明显下降,差异有显著性(P<0.05).多因素分析显示患者确诊时年龄以及同步顺铂化疗有统计学意叉(P<0.05).结论:鼻咽癌放疗后晚期耳听力损伤发生率高,主要为感音神经性耳聋的发生;耳损伤主要部位在内耳耳蜗,而听神经传导通路功能变化不明显;确诊时患者年龄以及放疗过程中合并同步化疗可能影响放疗晚期SNHL的发生.     

早期康复训练对鼻咽癌患者放疗后张口困难的疗效观察

目的观察早期康复训练对鼻咽癌患者放疗后张口困难的防治效果.方法78例鼻咽癌放疗患者随机分为观察组(40例)和对照组(38例):观察组自放疗即日起实施康复训练,持续1～2年;对照组仅接受放疗.在放疗结束后半年及2年内观察2组患者的张口困难发生率.结果放疗结束后半年及2年内,观察组张口困难发生率明显低于对照组.结论早期康复训练有助于降低鼻咽癌患者放疗后张口困难的发生率.     

出院后康复指导对老年鼻咽癌患者放疗后并发症的影响

目的探讨出院后康复指导对老年鼻咽癌患者放疗后并发症的影响。方法对85例老年鼻咽癌患者,随机分为观察组43例和对照组42例,放疗结束后,对照组接受常规出院指导;观察组接受常规出院指导＋定期强化康复指导。分别于出院后1个月、3个月、6个月、1年、2年进行随访干预。结果观察组患者放疗后颈部活动受限11．6％、张口困难18．6％、放射性龋齿32．6％、鼻窦炎30．2％,观察组并发症的发生率明显低于对照组（P〈0．01）。结论从患者心理、鼻腔、口腔、肌肉、关节功能锻炼等方面,对出院后老年患者进行定期强化康复指导,能有效减轻老年鼻咽癌患者放疗后并发症,提高生存质量。     

鼻咽癌放疗患者行内窥镜下修补脑脊液鼻漏术的疗效观察

目的:观察对鼻咽癌放疗患者行鼻内镜下修补脑脊液鼻漏术的临床疗效.方法:回顾分析575例鼻咽癌放疗患者的临床资料,并对其中的11例脑脊液鼻漏患者行修补术,观察并记录放疗结束后1 h、放疗后6个月及行修补术后1 h双侧颈内动脉(ICA )、双侧大脑中动脉(MCA)和基底动脉(BA)的平均流速值.结果:行放疗术的575例鼻咽癌患者,经统计有11例(1.91%)为脑脊液鼻漏.11例患者术后随访6个月～ 3年,取材部位伤口愈合良好,无明显嗅觉减退及鼻腔干燥病例,鼻腔功能较术前无明显变化.未见严重的并发症发生.其中一次性修复成功者10例,二次修复成功者1例.结论:脑脊液鼻漏在鼻咽癌并发症中并不多见,经鼻内镜脑脊液鼻漏修补术对其进行治疗,直视下操作,准确定位,损伤小,不损伤脑组织,避免开颅手术易致颅内并发症的危险,值得临床应用.     

CT扫描在鼻咽癌放疗后近期随访中的作用

本文收集了放疗前并在放疗后半年内进行CT检查的74例鼻咽癌患者，将放疗后每次CT检查所见与放疗前CT表现进行比较分析。结果提示：在鼻咽癌放疗后半年内，病变的消退程度迟早不一，其消退的快慢与放疗前病变的严重程度无关，要密切结合临床综合判断鼻咽部放疗疗效；鼻咽癌放疗后半年内CT检查一次，以后间隔半年CT复查，直至2年以后，这样较为合理。     

超声波终止早孕的母体安全性和遗传毒理评价Ⅰ:超声对小鼠安全性的细胞遗传学研究

目的：研究超声终止早孕的安全性。方法：本实验研究选用８周龄的ＩＣＲ小鼠，用不同剂量超声分组辐照后常规交配，连续对亲代母鼠和两代仔鼠进行细胞遗传学评价。诊断组频率５ＭＨｚ，强度２４ｍＷ／ｃｍ２，照射５ｍｉｎ；治疗组频率０．８ＭＨｚ，强度１．５Ｗ／ｃｍ２，照射１ｍｉｎ。结果：染色体畸变率、姊妹染色单体交换、微核率，各处理组与对照组比较均无显著性差异。结论：超声辐照在一定剂量范围内对体细胞和生殖细胞没有致突变作用。超声波抗早孕经遗传毒理评价对母体、仔代具有安全性。     

互动式针刺法对卒中后假性延髓麻痹吞咽困难的疗效

目的:观察互动式针刺法治疗脑卒中后假性延髓麻痹吞咽障碍的临床疗效.方法:脑卒中后假性延髓麻痹所致吞咽障碍患者90例,随机分为对照组30例、普针组30例、治疗组30例.各组患者均给予脑卒中常规处理、吞咽功能训练,普针组患者另给予常规针刺治疗,治疗组取额中线、廉泉、夹廉泉加用互动式针刺法.分别于治疗前、治疗3周和6周后,采用洼田饮水试验评价患者吞咽功能,观察脑干听觉诱发电位(BAEP)的变化.结果:与治疗前相比,三组患者治疗后吞咽功能有所改善,能有效缩短BAEP各波潜伏期和峰间潜伏期(P＜0.05),且随治疗时间的延长,疗效更加显著(P＜0.01).结论:互动式针刺法可能通过促进大脑皮质功能及脑干的吞咽反射恢复而发挥其治疗脑卒中后假性延髓麻痹吞咽障碍的作用.     

鼻内镜在鼻咽癌放疗后分泌性中耳炎中的应用

目的 探讨鼻内镜在鼻咽癌放疗后分泌性中耳炎治疗中的应用价值。方法 对47例68耳放疗后确诊为分泌性中耳炎的患者，在鼻内镜下清除鼻咽脓痂，鼻咽冲洗，分离咽鼓管咽口粘连，咽鼓管导管吹张，鼓膜穿刺、切开，鼓室置管等。结果 随访1年后，47例存活39例，存活患者中分泌性中耳炎治疗的有效率为89．1％。结论 鼻内镜是治疗鼻咽癌放疗后分泌性中耳炎较为理想的辅助工具。     

A 2-year follow-up of swallowing function after radiation therapy in patients with nasopharyngeal carcinoma

Chang Y-C, Chen S-Y, Ting L-L, Peng SS, Wang T-C, Wang T-G. A 2-year follow-up of swallowing function after radiation therapy in patients with nasopharyngeal carcinoma.

Objective

To evaluate over a 2-year period the serial swallowing function of patients with nasopharyngeal carcinoma (NPC) after completing radiotherapy (RT).

Design

Prospective longitudinal follow-up.

Setting

University hospital.

Participants

Patients with NPC (N=76) referred for RT: 53 of them at 1 year after RT, and 23 at 2 years after RT.

Interventions

Not applicable.

Main Outcome Measures

Participants completed a questionnaire and had a video-recorded fluoroscopic swallowing study before RT and 1 month, 1 year, and 2 years after RT.

Results

The highest incidence of dysphagia symptoms and retropharyngeal soft tissue swelling occurred in the first month after RT and decreased over time. Pharyngeal transit time was prolonged continuously up to 1 year after RT. Epiglottic vallecular stasis and pharyngeal mucosal coating were worst in the first month after RT and stable afterwards. Aspiration was uncommon during the first 2 years after RT.

Conclusions

At a 2-year follow-up after RT, patients with NPC had a progressively increasing pharyngeal transit time, although the subjectively identified symptoms of dysphagia decreased after the first month after RT.     

外耳道胆脂瘤的诊断与治疗

目的:探讨外耳道胆脂瘤(external auditory canal cholesteatoma,EACC)的临床特征和治疗方法。方法:回顾性分析1995年1月~2005年6月期间经手术治疗的46例(48耳)EACC患者的临床资料。结果:24例行单纯EACC清除术的患者听力恢复正常19例,5例改善;10例伴外耳道肉芽者行外耳道肉芽切除术和EACC清除术后恢复良好;3例行乳突根治术,6例行改良乳突根治术的患者,其中2例术后发生外耳道狭窄。随访2~12年,4例复发,再次清理治愈。结论:EACC对周围软组织及骨组织具有破坏性,治疗原则宜采用手术彻底清除胆脂瘤。     

小组认知行为治疗对精神分裂症顽固性幻听的疗效观察

目的：探讨小组认知行为治疗（GCBT）在治疗精神分裂症顽固性幻听中的作用和疗效。方法：精神分裂症伴有顽固性幻听患者120例,随机分为观察组和对照组各60例,均服用抗精神病药治疗,观察组同时合并GCBT,共9个月。分别于治疗前、治疗6及9个月后采用阳性与阴性症状量表（PANSS）和听幻觉评分量表（AHRS）评定临床疗效。结果：治疗6个月后,观察组PANSS及AHRS评分均较治疗前及同期对照组治疗后明显降低（P〈0．01,0．05）;治疗9个月后,观察组AHRS评分较治疗6个月后及同期对照组明显降低（P〈0．01,0．05）,观察组PANSS评分明显低于同期对照组（P〈O．01）。结论：GCBT不仅能治疗精神分裂症的顽固性幻听,而且对改善其余精神症状、提高社会功能有较好的效果。     

家庭氧疗配合呼吸操对慢性阻塞性肺疾病患者预后的影响

目的:观察家庭氧疗配合呼吸操对慢性阻塞性肺疾病患者肺功能、生存质量及急性发作次数的影响。方法:干预组及对照组各30例患者,观察时间为1年。干预组由医务人员指导进行家庭氧疗配合呼吸操训练,两组均在出院前和出院后6个月、1年检测肺功能和生存质量,同时通过电话、复诊、上门随访等方法随访1年,记录患者病情变化情况。结果:经1年干预后,干预组的肺功能、生存质量、急性加重及再次住院的频率与干预前和对照组比较有明显改善,差异具有显著性意义(P<0.05)。结论:家庭氧疗配合呼吸操康复治疗,能改善患者肺功能,延缓肺功能进一步恶化,提高患者的生存质量,改善预后,值得推广。     

EFFECT OF APPLYING “ACCEPTANCE AND COMMITMENT THERAPY” ON AUDITORY HALLUCINATIONS AMONG PATIENTS WITH SCHIZOPHRENIA

Experiencing persistent auditory hallucinations may contribute to unproductive struggle and interference with valued living among patients with schizophrenia. Acceptance and commitment therapy (ACT) represents a new generation of behavior therapies that proposes active acceptance and achievement of worthwhile goals despite experiencing auditory hallucinations. Utilization of acceptance commitment therapy may assist in reducing auditory hallucinations and may increase patient's feeling of control. Aim: Determine the effect of applying acceptance and commitment therapy on auditory hallucinations among patients with schizophrenia. Setting: The study was conducted at El-Maamoura Hospital for Psychiatric Medicine in Alexandria, Egypt. Subjects: A random sample of 70 male inpatients with schizophrenia was selected and divided equally into a study and a control groups (35 patients in each group). Both groups were matched as much as possible in relation to socio- demographic and clinical data. Tools: Psychotic Symptom Rating Scales (PSYRATS-AHs) and Voices Acceptance and Action Scale (VAAS). A quasi-experimental research design was utilized in this study. Results: Significant differences were found between the study and control groups immediately post and after 3 months of ACT on baseline PSYRATS& VAAS scores. Conclusion: ACT offers a promising new treatment for auditory hallucination among patients with schizophrenia. A significant improvement in auditory hallucination was found in the study group immediately after implementing ACT and after 3 months. As well as a decrement in re hospitalization rate and improvement in drug compliance for the study group compares to control one. Recommendations: ACT should be integrated in psychiatric treatment and nursing interventions of inpatients with schizophrenia who experiencing auditory hallucination.     

MRI增强及DWI对鼻咽癌放疗后复发的诊断价值研究

目的探讨磁共振平扫和增强扫描及弥散加权成像(diffusion weighted imaging,DWI)对鼻咽癌放疗后复发的诊断价值。材料与方法收集惠州市中心人民医院经病理证实为鼻咽癌并接受放射治疗的病例共380例,所有患者在放疗结束后进行6月至3年的随访复查并接受至少1次以上磁共振检查,常规进行MRI平扫和增强扫描,其中168例行DWI扫描。结果在复查过程中,共有32例证实为放疗后复发,复发的肿块形态不规则,T1WI呈等、稍低信号,T2WI呈等或稍高信号,增强后呈中等-明显强化,其中19例伴有新发颅底骨质破坏,12例伴有新增淋巴结肿大。复发肿块DWI呈高或稍高信号,其表观弥散系数(apparent diffusion coefficient,ADC)值为(0.96±0.08)×10~(-3) mm~2/s;无复发者DWI大部分呈等、稍高信号,部分呈稍低信号,其ADC值为(1.31±0.16)×10~(-3) mm~2/s,二者ADC值组间差异有统计学意义(P0.05)。结论 MRI增强和DWI成像对鼻咽癌放疗后复发诊断具有重要价值。     

Symptom distress, catastrophic thinking, and hope in nasopharyngeal carcinoma patients

The purposes of this study were to explore symptom distress, catastrophic thinking (catastrophizing) and hope, and factors predicting hope in Taiwanese nasopharyngeal carcinoma (NPC) patients within 3 years of receiving radiation therapy (RT). Instruments used were the modified Symptom Distress Scale, disease catastrophizing scale (modified from Coping Strategies Questionnaire), and Herth's Hope Index. Adult NPC patients (N = 115; 33 undergoing RT, 44 who completed RT within 1 year, and 38 who completed RT more than 1 year but less than 3 years) were recruited from an outpatient RT center in Northern Taiwan. Although participants' overall symptom distress was mild to moderate, they scored moderate level for several distressful symptoms: dry mouth, fatigue, hearing difficulty, loss of appetite, insomnia, and pain. Patients undergoing RT had greater symptom distress than subjects in the other 2 groups. Regression analysis revealed that catastrophizing was the only predictor of hope. Patients who engaged in catastrophizing reported much lower levels of hope. Particular care and attention are recommended to help NPC patients deal with the top distressful symptoms listed. Nursing interventions to reduce catastrophic thinking and enhance hope are discussed.