小细胞肺癌同期放射治疗 化学治疗致放射性肺炎的临床与影像学表现

<正>CT对放射性肺炎的病变程度具有较高度敏感性,可以为放射性肺炎的诊断、治疗及预后提供有力的影像学依据,故本研究利用CT对小细胞肺癌(small cell lung cancer,SCLC)患者在通过三维适形放射治疗加化学药物联合治疗后导致放射性肺炎的临床表现进行影像学诊断,探究不同因素对其发生放射性肺炎症状的影响指导临床规范化科学治疗,降低射线对肺组织的损伤程度,以降低放射性肺炎的发生率。对     

放射性肺炎的诊疗研究进展

放射性肺炎是胸部肿瘤放疗常见的严重并发症,虽然放疗技术有了革命性的提高,但放射性肺炎的发生率仍不低,严重者将危及生命。放射性肺炎一旦发展至放射性肺纤维化将不可逆转,故预防放射性肺炎的发生尤为重要。放射性肺炎的临床表现主要为呼吸困难、咳嗽、发热及肺衰竭,常用糖皮质激素及抗生素治疗。随着放疗技术的不断发展,放射性肺炎日渐受到重视。本文着重介绍放射性肺炎的诊断、防治手段及相关最新研究进展。     

放射性肺炎的CT影像学评价

目的 分析放射性肺炎CT的影像学表现对于临床诊断放射性肺炎所具有的重要价值,评价放射性肺炎CT图像与其病理及发病机制相关性.方法 收集确诊放射性肺炎30例,总结临床症状和CT的影像学表现;通过回顾放射性肺炎发生机制,并根据其病理变化分析所产生的CT影像表现.结果 30例放射性肺炎患者的CT均有典型表现,诊断正确率明显高于X线平片,表现为照射部位相一致的磨玻璃样、点片状模糊影,此外有纤维条形影、代偿性肺气肿、胸膜粘连、纵隔移位等影像学特征,这些影像学征象反映了放射性肺炎的病理改变,为临床诊断提供确切证据.结论 CT对于诊断放射性肺炎,确定其病变范围,肺内损害程度等提供诊断依据,对于指导临床及早控制病情,观察病情发展提供有力支持.甚至对评估放射治疗方案,放疗设备的质量控制等都具有很大意义.     

放射性肺炎CT及高分辨CT的征象分析与鉴别诊断

目的:分析放射性肺炎CT及高分辨CT(HRCT)的征象,并对其鉴别诊断,以提高对放射性肺炎的认识与影像诊断.方法:对48例胸部肿瘤并发放射性肺炎的患者CT及部分层面高分辨扫描,观察其不同征象,并对其相似的病理影像表现的胸部常见病进行鉴别.结果:总结出放射性肺炎4种CT及HRCT征象:(1)渗出型,(2)实变型,(3)含气不全性,(4)纤维化型.结论:掌握放射性肺炎的发生机理、病理学改变及其影像特征,鉴别与诊断是不难的.     

放射性肺炎的治疗

放射性肺炎是指肺组织在受到一定剂量的照射后,造成不同程度的组织形态学上的放射损伤,表现为间质充血水肿,肺泡内渗出增加。临床上一般表现为早期的放射性肺炎和晚期的放射性肺纤维化,严重的影响病人的生活质量,甚至生命。现将我院自2005年开展IMRT以来,对35例放射性肺炎进行总结分析,探讨放射性肺炎的诱因、早期诊断及有效、合理的治疗方法。     

参麦注射液雾化吸入防治急性放射性肺炎的临床效果

目的 探讨参麦注射液雾化吸入在防治急性放射性肺炎中的作用.方法 将2007年8月～2008年7月在该院治疗的局部晚期非小细胞肺癌患者60例,随机分成治疗组与对照组各30例,治疗组给予参麦注射液雾化吸入加同期化、放疗.对照组给予同期化、放疗,两组放疗方式及化疗方案相同.观察两组患者急性放射性肺炎开始出现的时间及反应程度.结果 实验组患者开始出现放射性肺炎的时间明显晚于对照组,差异有显著性:实验组患者出现放射性肺炎的程度明显轻于对照组,差异有显著性.结论 参麦注射液雾化吸入防治急性放射性肺炎疗效显著,使用方便,值得临床推广应用.     

放射性肺炎的X线诊断(附32例报告)

放射性肺炎是胸部恶性肿瘤放射治疗后较常见的并发症,严重者可危及病人生命。本文对32例放射性肺炎的X线征像进行分析,阐述了放射性肺炎的病理演变过程及X线征像与病理的相应关系。同时,提出了放射性肺炎的诊断与X-CT检查及临床表现的关系,从影像学角度为放射性肺炎的诊断提供了有力的依据。     

逆向调强放射治疗肺癌患者发生放射性肺炎相关因素分析

目的 分析逆向调强放射治疗(IMRT)肺癌患者的临床资料和放疗计划的物理参数,评估临床因素、物理参数与放射性肺炎发生的关系.方法 回顾性分析63例实施IMRT的肺癌患者资料,比较发生放射性肺炎和未发生放射性肺炎患者治疗计划的剂量体积直方图及临床影响因素.分析病理、肿瘤位置、同步化疗、照射剂量和放疗方式等临床数据,剂量学参数包括肺V5、V10、V15、V20、V25、V30、V35、V40和平均剂量等物理参数.分析上述因素对放射性肺炎发生率的影响.结果 发生2级以上放射性肺炎19例.单因素分析显示照射总剂量和病理类型为小细胞肺癌与放射性肺炎相关.多因素分析显示仅V5与放射性肺炎相关.结论 实施肺癌IMRT治疗时,需考虑病理类型及严格限制两肺V5,对于敏感的肺组织,低剂量亦可产生损伤.     

肺功能锻炼降低放射性肺炎发生率的临床分析

目的 评价肺功能锻炼对放射性肺炎的预防作用.方法 98例接受放射治疗的胸部肿瘤患者,随机分为锻炼组(n=49)和对照组(n=49),评价常规治疗基础上加强肺功能锻炼,包括缩唇式呼吸、腹式呼吸、深呼吸及雾化吸入对降低放射性肺炎发生的作用.结果 锻炼组放射性肺炎发生率明显降低,Ⅰ级放射性肺炎下降16.3%,Ⅱ级下降6.1%...     

中医药治疗放射性肺损伤急性期的研究进展

放射治疗肿瘤协作组将放射性肺损伤分为放射性肺炎和放射性肺纤维化,放射性肺炎属急性期,经系统治疗可以逆转,而放射性肺纤维化,对患者的生活、治疗及预后产生严重的影响,甚至危及生命,国内外尚无有效治疗方法.所以,对于放射性肺损伤急性期的治疗显得尤为重要.放射性肺损伤急性期又称放射性肺炎(Radiation Induced Pneumonitis,RIP),是由于肺癌、乳腺癌、食管癌、恶性淋巴瘤或胸部其它恶性肿瘤等患者接受放射治疗后出现的并发症,是放射野内的正常肺组织受到放射性损伤而导致的炎性反应.目前,西医多采用大剂量激素加抗生素治疗放射性肺损伤急性期,取得了一定的效果,但是副反应较大;中医药治疗则表现出了一定的优势,现将近年来中医药治疗进展综述如下.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.