头颈部肿瘤患者放疗期间放疗反应与体重变化分析

目的：分析头颈部肿瘤患者放疗期间放疗反应与体重变化情况。方法：选取接受头颈部位放射治疗的78位肿瘤患者作为研究对象,测量各放疗阶段患者体重,并对放疗反应进行评价。结果：除声音嘶哑外,放疗第十次、二十次以及放疗结束时的各个放疗反应评分高于开始前,比较差异显著（P＜0.05）;放疗期间至放疗结束,患者体重随着放疗次数的增加逐渐减少,与放疗前比较差异显著（P＜0.05）。结论：头颈部肿瘤患者放疗期间会出现多种不良反应,给身体机能带来了很大的负面影响,有必要给予适当的营养干预,改善患者预后。     

舒适护理在肿瘤放疗患者中的应用

放疗是一种对肿瘤患者常见的治疗方法,在放疗的过程中虽然能杀死大量的癌细胞,但在杀死癌细胞的过程中同时也会对患者身体的一些正常的组织造成一定的损伤,如何能让患者在放疗的同时保持较好的精神状态,就需要对患者实施舒适护理,舒适护理能够让患者在接受护理的过程中感到生理和心理上的放松和舒适感受,本文选取福建医科大学附属第二医院在2012年1月-2013年2月收治的74例肿瘤放疗患者进行研究护理,现报告如下。1资料和方法选取本院在2012年1月-2013年2月收治的74例肿瘤放疗患者进行护理,其中男性患者为39例,女性患者有35     

浅谈肿瘤放疗病人的护理

随着医学模式的转变,护理学已从单纯的治疗转为对病人的整体治疗,即把病人作为有心理活动和社会属性的生物机体而采取的整体护理.近年来,整体护理作为一种新的护理模式越来越广泛地受到医护人员和病人的推崇.我们肿瘤医院每天要接收大量放射治疗的病人,这些病人都是已明确诊断的癌症患者,他们带着沉重的心理压力和忧伤的心情来到我们放疗科接受治疗.由于他们对癌症缺乏全面正确的认识,谈癌色变已是普遍现象.有些病人对治疗信心不大,特别是从农村来的病人,他们不仅经受了疾病的折磨,而且还承受巨大的经济压力,担心最后人财两空.如何使癌症病人稳定情绪,增强同疾病作斗争的信心,与医务人员很好配合,笔者认为,对他们搞好整体护理十分重要.本文结合笔者多年的工作实践,谈谈对放疗病人实施整体护理的几点体会.     

肿瘤患者放疗前后氮平衡的研究

肿瘤患者是否要给予高蛋白质膳食，一直有争议，主要担心高蛋白质是否会促进肿瘤生长。接受放疗的肿瘤患者，除了肿瘤对蛋白质代谢影响外，急性放射反应使蛋白质分解代谢增强，但是也有报道低剂量照射后动物的氮代谢未受影响。为了明确放疗肿瘤患者是否需要高蛋白支持，我们对肿瘤患者接受放疗前、后的氮代谢进行了观察。     

肿瘤患者放疗前后细胞微核率变化的观察

目的 观察肿瘤患者放射治疗前后外周血淋巴细胞微核率与照射剂量间的关系。方法 采用淋巴细胞胞浆分裂阻滞微核法,即CB微核法检测微核率。结果 放疗后,患者的微核率,微核细胞率与照射累积剂量呈线性正比关系。Y_MNF=39.27+0.71X r=0.9720 P <0.01 Y_MNCF=34.05+0.58X r=0.9782 P <0.01。其中10例食管癌患者放疗后,疗效较优的6例的微核率明显高于疗效差的4例(P <0.01),而且肿瘤患者的自发微核率明显高于正常人(P <0.01)。结论 CB微核法在检测理化因子对人体的毒性方面是可行的。     

鼻咽癌调强放射治疗前后患者体重与腮腺变化相关性研究

目的：研究调强放射治疗前后患者体重的变化与腮腺变化的相关性。方法：入组57例进行调强放射治疗鼻咽癌患者。治疗前后各扫描一组CT图像。临床医生在这两组图像中分别勾画出腮腺。统计分析腮腺治疗前后的体积变化, DICE参数和患者的体重变化。并研究这些因素之间的相关性。结果：患者治疗前后,其中左右腮腺体积比较t＝2.00（P＜0.01）,有显著性意义。体重比较t＝2.00（P＜0.01）,有显著性意义。体重变化率≤5％;≥5％并≤10％,≥10％时,右左腮腺的体积变化为31.34％,26.54％;34.76％,34.54％;36.32％,28.59％。相应的右左腮腺的DICE参数为0.662,0.642;0.597,0.593;0.56,0.562。结论：放射治疗前后腮腺体积与空间位置与患者的体重有一定的相关性。可以使用患者体重的变化来确定对于放射治疗计划的修正时机,从而来更好的保护腮腺。     

肿瘤患者首次放疗前后抑郁症状的比较研究

目的:比较首次放射治疗前后肿瘤患者抑郁症状评分,并寻找导致评分增高的危险因素。方法:纵向比较126例接受放射治疗的肿瘤患者,比较化疗前后SDS评分升降情况。结果:3(2.38%)例患者治疗前后SDS评分相同,77(61.11%)例患者治疗后SDS评分高于治疗前,而46(36.51%)例患者治疗后SDS评分低于治疗前。平均年龄较小(20-29岁)、高龄或者接受头颈部放射治疗患者容易出现疲惫、焦虑及胃肠道等症状。结论:首次放射治疗会增加患者抑郁评分,但不是唯一因素。     

头颈部肿瘤2种放疗方式的剂量学比较

目的比较同步加量调强放射治疗(SMART)计划与常规适形放疗(CRT)计划应用于头颈部肿瘤放疗的剂量学特点。方法选择23例头颈部肿瘤患者分别用SMART束流调强放疗计划(SMART组)和常规放疗计划(CRT组)进行计划设计。用剂量体积直方图(DVH)分别评价2组靶区、腮腺、周围正常组织受量情况。结果 SMART组各靶区的受量与适形度均高于CRT组(P<0.05),而腮腺等正常组织受量明显低于CRT组(P<0.05)。结论 SMART调强适形放疗有效减少头颈部肿瘤患者的周围正常组织受量,提高靶区的适形度和平均剂量,是头颈部肿瘤患者首选的放疗方式。     

肿瘤放疗的最新技术装备—重粒子加速器“HIMAC”

肿瘤放疗的最新技术装备──重粒子加速器“ＨＩＭＡＣ”中日友好医院赵东晖，梁昌靖放射治疗是肿瘤治疗的三大技术手段之一。现在国内、外临床放疗广泛采用了钴６０产生的线和加速器产生的Ｘ线及电子线。尽管加速器工程师千方百计改善机器性能，物理师应用计算机放疗计划...     

灰色GM（1,1）模型预测高脂血症大鼠体重的探讨

为了探讨灰色模型应用于营养学的可能性，本文采用灰色系统ＧＭ（１，１）模型对高脂血症大鼠膳食治疗过程中体重的波动进行了预测。结果表明：（１）ＧＭ（１，１）模型预测方程对体重原始资料拟合精度高，平均误差小。（２）ＧＭ（１，１）模型近期预测值与实际值较吻合，外推预测效果好。（３）根据灰色系统改进理论，通过差分方程建立模型，预测效果与原ＧＭ（１，１）模型相近，运算简便。提示：ＧＭ（１，１）模型应用于营养上预测及评价膳食对机体生长发育的影响，有较高实用价值。     

Effect of Female Body Weight on Efficiency of Donor AI

A total of 1144 infertile women were treated by artificial donor insemination. Unsuccessful ovulation induction was found in 96 of these cases. The obese women (BMI: 28-36) had a relative risk of unsuccessful ovulation induction of 2.7 (95% confidence interval (CI)=2.1-3.4) compared with women lower or normal body weight (BMI: 20-24). The effect was smaller in women with a BMI 25-27 or <19 (relative risk (RR)=1.4, 95% CI=0.9-2.1 and 1.5, 95% CI=0.8-2.5), respectively. During the AID treatment 412 pregnancies occurred. Pregnancy rate achieved by insemination was 28% (50 pregnancies per 178 cases, BMI 16-19), 42% (251/599, BMI 20-24), 33% (92/286, BMI 25-27), and 21% (19/81, BMI 28-36), respectively, in the different BMI groups.     

个体化营养管理在肿瘤放疗患者中的作用

目的探讨个体化营养管理在肿瘤放疗患者中的应用价值。方法按照信封法将2017年1月—2018年12月期间在该院接受放疗治疗的肿瘤患者80例分为两组,40例对照组患者行常规饮食指导,40例观察组患者行个体化营养管理,对比两组的干预效果。结果观察组管理质量评分高于对照组(P<0.05);观察组不良事件发生率(2.5%)低于对照组(11.3%),差异有统计学意义(P<0.05);观察组满意度总分高于对照组(P<0.05)。结论个体化营养管理应用于肿瘤放疗患者中,可发挥积极作用,具有推广价值。     

Pre-pregnancy Body Mass Index, Gestational Weight Gain, and Other Maternal Characteristics in Relation to Infant Birth Weight

Objectives Infant birth weight is influenced by modifiable maternal pre-pregnancy behaviors and characteristics. We evaluated the relationship among pre-pregnancy body mass index (BMI), gestational weight gain, and infant birth weight, in a prospective cohort study. Methods Women were enrolled at ≤20 weeks gestation, completed in-person interviews and had their medical records reviewed after delivery. Infant birth weight was first analyzed as a continuous variable, and then grouped into Low birth weight (LBW) (<2,500 g), normal birth weight (2,500–3,999 g), and macrosomia (≥4,000 g) in categorical analysis. Pre-pregnancy BMI and gestational weight gain were categorized based on Institute of Medicine BMI groups and gestational weight gain guidelines. Associations among infant birth weight and pre-pregnancy BMI, gestational weight gain, and other factors were evaluated using multivariate regression. Risk ratios were estimated using generalized linear modeling procedures. Results Pre-pregnancy BMI was independently and positively associated with infant birth weight (β = 44.7, P = 0.001) after adjusting for confounders, in a quadratic model. Gestational weight gain was positively associated with infant birth weight (β = 19.5, P < 0.001). Lower infant birth weight was associated with preterm birth (β = −965.4, P < 0.001), nulliparity (β = −48.6, P = 0.015), and female babies (β = −168.7, P < 0.001). Less than median gestational weight gain was associated with twice the risk of LBW (RR = 2.04, 95% CI 1.34–3.11). Risk of macrosomia increased with increasing pre-pregnancy BMI and gestational weight gain (P for linear trend <0.001). Conclusions These findings support the need to balance pre-pregnancy weight and gestational weight gain against the risk of LBW and macrosomia among lean and obese women, respectively.     

Body weight relationships in early marriage. Weight relevance, weight comparisons, and weight talk

This investigation uncovered processes underlying the dynamics of body weight and body image among individuals involved in nascent heterosexual marital relationships in Upstate New York. In-depth, semi-structured qualitative interviews conducted with 34 informants, 20 women and 14 men, just prior to marriage and again one year later were used to explore continuity and change in cognitive, affective, and behavioral factors relating to body weight and body image at the time of marriage, an important transition in the life course. Three major conceptual themes operated in the process of developing and enacting informants’ body weight relationships with their partner: weight relevance, weight comparisons, and weight talk. Weight relevance encompassed the changing significance of weight during early marriage and included attracting and capturing a mate, relaxing about weight, living healthily, and concentrating on weight. Weight comparisons between partners involved weight relativism, weight competition, weight envy, and weight role models. Weight talk employed pragmatic talk, active and passive reassurance, and complaining and critiquing criticism. Concepts emerging from this investigation may be useful in designing future studies of and approaches to managing body weight in adulthood.     

山东省中小学生身高标准体重分布及变化趋势分析

目的分析山东省中小学生身高标准体重的分布状况及1995-2005年的变化趋势,为制定相应的营养干预策略提供依据。方法采用1985年制定的全国学生身高标准体重评价标准,对1995和2005年山东省7~18岁学生的营养不良、较低体重、超重和肥胖的检出率进行比较。结果山东省中小学生营养状况存在明显的“双峰现象”,即营养不良和低体重、超重和肥胖并存,而正常体重仅占50%。不同地区学生的营养状况存在明显差别。1995-2005年的10 a间,学生超重和肥胖率成倍增长,营养不良和低体重仍相当普遍,营养状况出现明显的两极分化趋势。结论山东省学生营养状况不容乐观,控制超重和肥胖率应成为今后工作的重点。     

Discordance Between Body Mass Index (BMI) and a Novel Body Composition Change Index (BCCI) as Outcome Measures in Weight Change Interventions

Objective: A general assumption is that the body mass index (BMI) reflects changes in fat mass (FM). However, it fails to distinguish the type of weight that is lost or gained—fat mass (FM) or fat-free mass (FFM). The BMI treats both changes the same although they have opposite health consequences. The objective of this study was to propose a more precise measure, a body composition change index (BCCI), which distinguishes between changes in FM and FFM, and this study compares it with using the BMI as an outcome measure.

Methods: Data were obtained from 3,870 subjects who had completed dual-energy x-ray absorptiometry (DEXA) total body scans at baseline and end-of-study when participating in a variety of weight-loss interventions. Since height remained constant in this adult cohort, changes in the BMI corresponded with scale weight changes (r = 0.994), allowing BMI changes to be converted to “lbs.” to match the statistic used for calculation of the BCCI. The BCCI is calculated by scoring increases in FFM (lbs.) and decreases in FM (lbs.) as positive outcomes and scoring decreases in FFM and increases in FM as negative outcomes. The BCCI is the net sum of these calculations. Differences between scale weight changes and BCCI values were subsequently compared to obtain “discordance scores.”

Results: Discordance scores ranged from 0.0 lbs. to >30.0 lbs. with a mean absolute value of between the two measures of 7.79 lbs. (99% confidence interval: 7.49-8.10, p <0.00001), SD = 7.4 lbs. Similar discordance scores were also found in subgroups of self-reported gender, ethnicity, and age.

Conclusions: A significant difference of 7.79 lbs. was found between the BCCI and the BMI to evaluate the efficacy of weight loss interventions. If assessing changes in body composition is a treatment goal, use of the BMI could result in significantly erroneous conclusions.     

负压密闭引流手术治疗肿瘤患者大面积压疮的护理效果观察

目的：探讨负压密闭引流手术治疗肿瘤患者大面积压疮的护理效果。方法：选取本肿瘤科2011年1月-2013年12月收治的大面积压疮患者70例,均采用负压密闭引流术治疗,按照随机数字表法将其分为对照组和干预组各35例,对照组给予常规护理,干预组在对照组的基础上给予干预性护理,观察比较两组的临床疗效。结果：干预组的总有效率94.29%明显高于对照组的57.14%,干预组的平均治愈时间明显短于对照组,平均换药次数明显少于对照组,平均换药间隔明显长于对照组,干预组治疗后并发感染率5.71%（2/35）明显低于对照组的22.86%（8/35）,差异均有统计学意义（P〈0.05）。结论：经临床结果可见,采用负压密闭引流手术治疗肿瘤患者大面积压疮有一定的临床效果,同时结合有效的护理干预其效果显著,值得临床推广应用。     

经尿道膀胱肿瘤电切术治疗浅表性膀胱肿瘤的手术的疗效观察

目的研讨论研究经尿道膀胱肿瘤电切术治疗浅表性膀胱肿瘤的临床疗效与价值。方法选取就诊于我院肿瘤科确诊的浅表性膀胱肿瘤患者100例。随机分为A组、B组,各50例。其中A组行经尿道膀胱肿瘤电切术进行治疗;B组行传统开放式手术进行切除。比较两组患者手术时间,术中出血量,恢复时间及复发情况等指标。结果不同方式治疗后两组手术时间及出血量比较显示A组其操作时间与术中出血量较使用B组具有显著差异（P〈0．05）,A组手术情况较好;治疗后置管时间及恢复时间比较显示A组患者置尿管时间及出院时间均显著短于B组（P〈0．05）;治疗后并发症发生人数及复发人数比较显示经尿道膀胱肿瘤电切术患者并发症发生人数及复发人数均显著少于使用常规手术患者（P〈O．05）。结论经尿道膀胱肿瘤电切术用于治疗浅表性膀胱肿瘤疗效显著。手术创伤小,可进行反复手术且术中出血量小,手术时间短。能够显著提高疾病治疗效率,缩短治疗时间。