中药联合多西他赛二线治疗晚期非小细胞肺癌36例临床观察

目的：观察中药联合多西他赛二线治疗晚期非小细胞肺癌患者的临床疗效。方法：68例患者随机分为2组,中药联合组36例,采用中药联合多西他赛化疗,多西单药组32例,单用多西他赛化疗,观察生存率、生存质量、症状变化、化疗毒性反应及肿瘤疗效,并检测治疗前后肿瘤标志物[癌胚抗原（CEA）、血清中糖链抗原CA19-9、神经原特异性小稀醇化酶（NSE）、癌抗原CA12-5]及免疫指标[外周T细胞亚群CD4/CD8、自然杀伤（NK）细胞活性]。结果：治疗后患者半年无进展生存率、1年无进展生存率、1年生存率、2年生存率、生存质量总有效率、肿瘤客观有效率（R R）、疾病控制率（DCR）中药联合组较多西单药组均显著提高,2组比较,差异均有显著性意义（P〈0.05）;中药联合组较多西单药组能明显改善肺癌相关的咳嗽、气急、胸闷症状（P〈0.05）,显著降低化疗后白细胞减少、血红蛋白减少、乏力、脱发、恶心呕吐、腹泻的发生（P〈0.05,P〈0.01）;中药联合组较多西单药组更能有效降低CEA、CA19-9、CA12-5、NSE值（P〈0.05）,提高CD4/CD8比值及NK细胞活性（P〈0.05）。结论：中药联合多西他赛单药二线治疗晚期非小细胞肺癌能改善患者生存质量,延长生存期,减轻肺癌相关症状,减轻多西他赛的毒性反应,并通过免疫调节抑制肿瘤增殖,延缓病情进展,在肺癌综合治疗中发挥重要作用。     

体外循环术后患者的心理状态分析及护理对策

目的：通过对体外循环术后患者心理状态调查,并分析其原因,及时给予相应的护理措施,从而使患者更积极主动的配合治疗,增进康复速度,减少住院时间.方法：使用精神症状评定量表筛选2009年10月至2010年10月心胸外科体外循环术后出现精神障碍的86例病人,在给予药物治疗的同时针对患者精神障碍的不同类型选择个体化的护理措施.结果：被调查对象均有不同程度和类型的焦虑、恐惧、情绪低落等精神症状,部分患者存在幻觉、被害妄想等精神病性症状.结合抗焦虑、镇静、催眠等药物治疗的同时,选择个体化的护理措施,取得了良好的临床效果.     

重组组蛋白去乙酰化酶2-pEGFP-C2质粒的构建及表达

目的将组蛋白去乙酰化酶2(HDAC2)基因克隆入pEGFP-C2载体,探讨构建的质粒转染进非洲绿猴肾成纤维细胞COS-7株相关蛋白和mRNA的表达及蛋白分布部位的情况。方法从人肝癌细胞(HepG2)中获得组蛋白去乙酰化酶2(HDAC2)的cDNA,采用Xho I和BamH I双酶切,用T4连接酶将该cDNA连接pEGFP-C2质粒,将构建成功的pEGFP-C2-HDAC2质粒经PCR、限制性内切酶酶切和测序鉴定后转染非洲绿猴肾成纤维细胞(COS-7),荧光显微镜下观察绿色荧光蛋白表达,RT-PCR和Western blot鉴定HDAC2的表达。结果双酶切鉴定可见HDAC2质粒片段,转染重组质粒后可观察到绿色荧光蛋白的表达,PCR结果可检测到HDAC2 mRNA表达,同时Western blot可检测HDAC2蛋白和GFP蛋白的表达。结论成功构建了重组pEGFP-C2-HDAC2表达质粒,HDAC2蛋白可与绿色荧光蛋白在COS-7细胞中融合表达。     

急性脑梗死患者上气道形态变化

Objective To investigate the feature of the morphology changes in the upper airway in patients with acute cerebral infarction and to find a new method to prevent and cure cerebral infarction.Methods Sixty-six patients with cerebral infarction confirmed by brain MRI or CT scan(within 3 weeks of onset) were recruited.The patients were examined by upper airway MRI scan and polysomnography (PSG).Then the patients were divided into obstructive sleep apnea hypopnca syndrome(OSAHS)group and non-OSAHS group.In addition.16 patients showing OSAHS but without stroke history(OSAHS nonstroke group)were included in the study.The sagittal and horizontal lengths of the nasopharynx,palatopharynx,glossopharynx and hypopharynx were measured and their closs-sectional areas were calculated.The length,thickness and cross-sectional area of the palate were also measured.Statistic analysis of each data among the groups was performed using SPSS software.Results Among 66 cases with acute cerebral infarction,75.8 % (50/66)were diagnosed with OSAHS.The anteropesterior diameer,left and right diameters and smallest section area in upper airway were all smaller in the OSAHS group with acute cerebral infaretion than those in the non-OSAHS group and OSAHS non-stroke group.The narrowest segments in upper airway were nasopharynx and ompharynx.which are caused by shortened left and right diameters.The area of the soft palate in the OSAHS-stroke group was significant bigger((452.2±99.6)mm2)than that in non-OSAHS group((350.0±69.4)mm2,t:4.575,P<0.05).The lowest SO2 in OSAHS-stroke group(68.9 % ±10.5 % )was the lowest among three groups.The more severe the airway constriction was.the higher the apnea-hypopnea index(AHI)was and the lower the lowest SO2 was.Conclusion Patients withl stroke show higher incidence of OSAHS and present more severe multilevel upper airway constriction.Upper airway constriction may be the new target of early treatment for better prognosis of cerebral infarction.     

急性脑梗死患者血清IL-17、hs-CRP及TNF-α的动态变化及临床意义

目的观察急性脑梗死(ACI)患者血清白细胞介素(IL)-17、超敏C反应蛋白(hs-CRP)及肿瘤坏死因子-α(TNF-α)水平的动态变化,分析其与脑梗死体积及神经功能缺损程度的关系。方法选取ACI患者45例设为研究组,同期健康体检者35例为对照组,酶联免疫吸附法测定血清IL-17、hs-CRP及TNF-α水平。结果研究组入院后第1天,血清IL-17、hs-CRP及TNF-α水平显著高于对照组(P<0.01),随后逐渐下降,各时间点间差异显著,至第14天仍显著高于对照组(P<0.05,P<0.01);入院第7、14天脑梗死体积及NIHSS评分显著下降(P<0.01);血清IL-17在入院第1天与脑梗死体积、NIHSS评分正相关(P<0.05);hs-CRP、TNF-α水平在入院第1、7、14天均与脑梗死体积和NIHSS评分正相关(P<0.05或P<0.01)。结论 ACI患者血清IL-17、hs-CRP及TNF-α水平显著升高,呈现动态变化过程,且与脑梗死体积和神经功能缺损程度相关,可作为评估病情变化的参考指标。     

中西药结合治疗肺癌放疗致放射性肺炎32例疗效观察

目的观察中西药结合治疗肺癌放疗致放射性肺炎的疗效及对肺功能等指标的影响。方法将62例放射性肺炎患者随机分为2组,对照组30例给予口服联合激素与抗感染治疗,辅以吸氧、止咳、解痉平喘等对症处理。治疗组32例在对照组基础上加用清肺百合汤。2组均4周为1个疗程观察临床疗效和治疗前后2组生活质量、临床症状积分改善情况,以及治疗前后肺功能、血气分析、外周血象等指标的变化。结果治疗组放射性肺炎总有效率、生存质量KPS评分改善总有效率显著优于对照组(P<0.05);与治疗前比较,治疗后2组症状积分均明显下降(P<0.01);治疗组优于对照组(P<0.05);治疗后2组肺功能指标(VC、FEV_1)、血气分析指标(PaO_2、PaCO_2)、血象(WBC、N)均有好转(P<0.05,P<0.01),但治疗组较对照组改善更明显(P<0.05)。结论清肺百合汤联合西药治疗可增强控制感染及机体炎性反应、改善肺功能和血气状况的作用,较单纯西药治疗能更好地改善放射性肺炎患者的症状,提高患者生存质量,控制病情。     

三尖瓣置换术后主要并发症的护理

三尖瓣病变是心脏瓣膜的常见病变,目前临床一般行三尖瓣成形处理即可获得满意疗效,但对于病变严重、无法行三尖瓣成形术的病例只能采用三尖瓣置换术(tricuspid valve replacement,TVR),此类病例极为少见。TVR手术患者的右心功能差,大多数为再次心脏手术,同期还需手术处理其他心脏病变,因此     

急性脑梗死患者上气道形态变化

Objective To investigate the feature of the morphology changes in the upper airway in patients with acute cerebral infarction and to find a new method to prevent and cure cerebral infarction.Methods Sixty-six patients with cerebral infarction confirmed by brain MRI or CT scan(within 3 weeks of onset) were recruited.The patients were examined by upper airway MRI scan and polysomnography (PSG).Then the patients were divided into obstructive sleep apnea hypopnca syndrome(OSAHS)group and non-OSAHS group.In addition.16 patients showing OSAHS but without stroke history(OSAHS nonstroke group)were included in the study.The sagittal and horizontal lengths of the nasopharynx,palatopharynx,glossopharynx and hypopharynx were measured and their closs-sectional areas were calculated.The length,thickness and cross-sectional area of the palate were also measured.Statistic analysis of each data among the groups was performed using SPSS software.Results Among 66 cases with acute cerebral infarction,75.8 % (50/66)were diagnosed with OSAHS.The anteropesterior diameer,left and right diameters and smallest section area in upper airway were all smaller in the OSAHS group with acute cerebral infaretion than those in the non-OSAHS group and OSAHS non-stroke group.The narrowest segments in upper airway were nasopharynx and ompharynx.which are caused by shortened left and right diameters.The area of the soft palate in the OSAHS-stroke group was significant bigger((452.2±99.6)mm2)than that in non-OSAHS group((350.0±69.4)mm2,t:4.575,P<0.05).The lowest SO2 in OSAHS-stroke group(68.9 % ±10.5 % )was the lowest among three groups.The more severe the airway constriction was.the higher the apnea-hypopnea index(AHI)was and the lower the lowest SO2 was.Conclusion Patients withl stroke show higher incidence of OSAHS and present more severe multilevel upper airway constriction.Upper airway constriction may be the new target of early treatment for better prognosis of cerebral infarction.     

急性脑梗死患者上气道形态变化

Objective To investigate the feature of the morphology changes in the upper airway in patients with acute cerebral infarction and to find a new method to prevent and cure cerebral infarction.Methods Sixty-six patients with cerebral infarction confirmed by brain MRI or CT scan(within 3 weeks of onset) were recruited.The patients were examined by upper airway MRI scan and polysomnography (PSG).Then the patients were divided into obstructive sleep apnea hypopnca syndrome(OSAHS)group and non-OSAHS group.In addition.16 patients showing OSAHS but without stroke history(OSAHS nonstroke group)were included in the study.The sagittal and horizontal lengths of the nasopharynx,palatopharynx,glossopharynx and hypopharynx were measured and their closs-sectional areas were calculated.The length,thickness and cross-sectional area of the palate were also measured.Statistic analysis of each data among the groups was performed using SPSS software.Results Among 66 cases with acute cerebral infarction,75.8 % (50/66)were diagnosed with OSAHS.The anteropesterior diameer,left and right diameters and smallest section area in upper airway were all smaller in the OSAHS group with acute cerebral infaretion than those in the non-OSAHS group and OSAHS non-stroke group.The narrowest segments in upper airway were nasopharynx and ompharynx.which are caused by shortened left and right diameters.The area of the soft palate in the OSAHS-stroke group was significant bigger((452.2±99.6)mm2)than that in non-OSAHS group((350.0±69.4)mm2,t:4.575,P<0.05).The lowest SO2 in OSAHS-stroke group(68.9 % ±10.5 % )was the lowest among three groups.The more severe the airway constriction was.the higher the apnea-hypopnea index(AHI)was and the lower the lowest SO2 was.Conclusion Patients withl stroke show higher incidence of OSAHS and present more severe multilevel upper airway constriction.Upper airway constriction may be the new target of early treatment for better prognosis of cerebral infarction.     

益气活血消肿汤治疗乳腺癌患者术后上肢淋巴水肿气虚血瘀、水湿停聚证的临床观察

目的 观察益气活血消肿汤治疗乳腺癌术后上肢淋巴水肿（BCRL）气虚血瘀、水湿停聚证的临床疗效。方法 将符合纳入标准的60例患者随机分为两组,各30例。对照组采用手法淋巴引流联合地奥司明片治疗,观察组在对照组的基础上加用中药益气活血消肿汤治疗,两组均持续治疗1个月。观察两组患者的疗效,评估患侧上肢周径、疼痛、肩关节活动度、中医临床症状改善情况、生活质量和安全性。结果 患侧上肢周径变化方面,观察组明显优于对照组（P<0.05）;疼痛缓解方面,两组患者VAS评分均较治疗前降低,且观察组改善更明显（P<0.05）;肩关节活动度方面,两组患者均较治疗前有所改善,且观察组在前屈方面的改善效果明显优于对照组（P<0.05）,而在后伸、内收、外展方面,两组无明显差异（P>0.05）;中医临床症状改善方面,观察组总有效率（86.67%）显著高于对照组（50.00%）（P<0.05）;生活质量方面,两组患者五项功能评分均校治疗前明显升高,且观察组生理状况改善程度显著优于对照组（P<0.05）,其余功能两组无明显差异（P>0.05）;安全性方面,两组患者治疗前后均未出现与治疗相关的不良反应,血常规、大小便常规、肝肾功能及心电图均未见异常,且无明显毒副作用。结论 益气活血消肿汤可有效减轻BCRL患者的患侧上肢水肿,缓解疼痛,改善肩关节活动度及临床症状,提高生活质量,且安全性较高。