抑郁症对老年慢性肾病患者营养状态研究

目的探讨抑郁症对老年慢性肾病患者营养状态的影响。方法选取自2016年9月至2017年9月南京医科大学第一附属医院老年肾科收治的110例老年慢性肾病(CKD)患者为研究对象。根据健康问卷抑郁量表(PHQ-9),将所有患者分为抑郁组(n=70)和非抑郁症组(n=40),比较两组患者血清蛋白(Alb)、血红蛋白(Hb)、三头肌部皮褶厚度(TSF)及上臂肌围(AMC)等营养指标;采用微型营养评估量表(MNA)评估两组患者的整体营养状况,比较不同抑郁程度患者MNA评分及营养不良率,分析老年CKD伴抑郁症患者PHQ-9评分与营养状态指标相关性。结果抑郁症组Alb、Hb、TSF和AMC等营养状态指标均低于非抑郁症组,两组比较,差异均有统计学意义(P<0.05);抑郁症组整体营养状态较非抑郁症组差,抑郁症组营养不良率高于非抑郁症组,两组比较,差异均有统计学意义(P<0.05);随着抑郁程度加重,患者MNA评分降低,营养不良率增加,两组比较,差异均有统计学意义(P<0.05);CKD合并抑郁症患者PHQ-9评分与ALb、Hb、TSF、AMC、MNA评分均呈负相关。结论抑郁可影响CKD患者的营养状态,抑郁程度越高,发生营养不良的风险越大,应及时监测并给予合理的干预措施。     

互联网+闭环式健康管理在尿毒症患者中的应用

目的探讨互联网+闭环式健康管理在尿毒症患者中的应用效果。方法选择2019年4月-2020年4月收治的130例尿毒症患者,按随机对照原则分为两组,各65例。对照组给予常规护理,观察组给予互联网+闭环式健康管理。比较两组营养状况[血清白蛋白(ALB)、血肌酐(SCr)、血红蛋白(Hb)]及并发症发生率。结果干预后,两组SCr水平均低于干预前,ALB、Hb水平均高于干预前,观察组SCr水平低于对照组,ALB、Hb水平高于对照组(P<0.05);干预后,观察组并发症发生率15.38%低于对照组36.92%(P<0.05)。结论互联网+闭环式健康管理能够有效改善尿毒症患者营养状况,降低并发症发生率。     

家庭肠内营养治疗对微创食管癌根治术后营养状况的影响

 目的 探讨家庭肠内营养治疗对食管癌患者微创食管切除术后营养状况的影响。方法 选取2018-11至2019-11在解放军总医院第六医学中心接受微创食管癌切除术的患者81例,随机分为干预组和对照组。其中对照组出院后仅给予普通居家膳食;而干预组在对照组基础上,另经空肠造瘘管泵入肠内营养制剂。在出院1个月后,对比两组患者的营养指标,包括欧洲营养风险筛查2002(NRS2002)得分、身体质量指数(BMI)和血清营养指标等。结果 两组患者术前各项病理生理学和营养指标的基线特征差异无统计学意义,具有可比性(P>0.05)。出院后1个月,欧洲营养风险指标干预组低于对照组,干预组BMI高于对照组,干预组实验室血清营养指标优于对照组,差异均具有统计学意义(P<0.05)。结论 微创食管癌根治术后开展家庭肠内营养治疗,可明显改善患者的营养状况,降低术后营养不良风险。     

老年直肠癌手术患者围术期营养状况调查及营养护理干预研究

目的：研究老年直肠癌手术患者围术期营养状况及营养护理干预措施。方法选择就诊的70例老年直肠癌患者作为研究对象,采用主观全面营养评价法（ SGA）分析患者在围术期内的营养状况,并研究个体化肠内营养护理干预方法对改善围术期老年直肠癌营养状况的效果。结果直肠癌切除术前后营养不良率分别为51.42％和68.57％,差异具有统计学意义（ P＜0.05）,个体化肠内营养护理干预后营养不良率为34.29％,显著低于常规营养支持的60％,差异具有统计学意义（ P＜0.05）。两组营养护理干预后BMI、TP、TF及上臂肌围比较,差异均具有统计学意义（ P＜0.05）。结论老年直肠癌切除术对患者营养状况具有一定影响,个体化肠内营养支持对改善围术期营养状况效果显著。     

术中关节腔内注射氨甲环酸对老年人工全膝关节置换术后引流量及血清白细胞计数、血红蛋白水平变化影响

目的探讨术中关节腔内氨甲环酸注射对老年膝关节骨性关节炎进行人工全膝关节置换术(TKA)术后引流量及血清白细胞计数(WBC)、血红蛋白(Hb)水平变化的影响。方法选取2014年12月至2016年11月首都医科大学附属北京潞河医院收治的101例老年膝关节骨性关节炎患者,按照随机数字表法将患者分为常规组(n=50)与观察组(n=51)。常规组患者于TKA术中注射0.9%氯化钠溶液,观察组患者于TKA术中关节腔内注射氨甲环酸治疗。观察并比较两组患者术后引流量、总失血量、膝关节功能(HSS)评分及血清WBC、Hb水平变化情况,并统计两组活化部分凝血活酶时间、凝血酶原时间及并发症发生情况。结果观察组患者总失血量及术后引流量均低于常规组,组间比较,差异有统计学意义(P<0.05);术后血清Hb水平高于常规组,血清WBC低于常规组,组间比较,差异有统计学意义(P<0.05);术后,观察组HSS评分高于常规组,组间比较,差异有统计学意义(P<0.05);术中、术后两组活化部分凝血活酶及凝血酶原时间比较,差异无统计学意义(P>0.05)。观察组并发症发生率为3.9%(2/51),低于常规组的18.0%(9/50),组间比较,差异有统计学意义(P<0.05)。结论对行TKA术后的老年膝关节骨性关节炎患者给予氨甲环酸关节腔内注射治疗,效果显著,并发症发生率低,可改善患者膝关节功能及血清学各指标水平,减少术后引流量及总失血量。     

奈达铂联合替吉奥同步放疗治疗进展期食道癌患者临床疗效及对患者肿瘤坏死因子、C反应蛋白水平影响

目的探讨奈达铂联合替吉奥同步放疗治疗进展期食道癌的临床疗效,以及对患者肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平的影响。方法选取自2016年2月至2017年4月吉林大学白求恩第一医院收治的确诊为进展期食道癌的患者86例为研究对象。采用随机数字表法将患者分为观察组和常规组,每组各43例。常规组患者接受标准的放疗治疗,观察组患者在常规组治疗的基础上另接受替吉奥及奈达铂治疗。观察并比较两组患者的临床疗效及TNF-α、CRP水平变化情况。结果观察组患者的治疗有效率为95.3%(41/43),明显高于常规组的72.1%(31/43),组间比较,差异有统计学意义(P<0.05)。观察组患者的不良反应发生率为41.9%(18/43),明显低于常规组的72.1%(31/43),组间比较,差异有统计学意义(P<0.05)。治疗前,两组患者的TNF-α、CRP水平比较,差异无统计学意义(P>0.05);治疗后,观察组患者的TNF-α水平降低幅度明显高于常规组,CRP水平升高幅度明显高于常规组,差异有统计学意义(P<0.05)。结论奈达铂联合替吉奥同步放疗治疗进展期食道癌,临床疗效显著,不良反应发生率低,能够明显调节TNF-α与CRP水平。     

营养干预对胃部肿瘤化疗患者生活质量及依从性的影响

 目的 探讨PG-SGA评估2~3分的复发或转移的胃部肿瘤患者化疗期间实施营养干预对患者生活质量及化疗依从性的影响。方法 选取2015-06至2017-05收治的PG-SGA评估的2~3分(可疑营养不良组)复发或转移的胃部肿瘤化疗患者86例,随机分为观察组、对照组,每组43 例。观察组采用饮食联合口服营养补充(oral nutritional supplements,ONS)施行营养干预,对照组采用饮食联合营养教育施行营养干预,采用欧洲肿瘤研究与治疗组织(EORTC)肿瘤患者生活质量量表(QLQ-C30)对两组患者化疗前与化疗后7~14 d 的生活质量进行调查。结果 观察组健康状况、躯体功能、角色功能、情绪功能、认知功能、社会功能、乏力评分较对照组高,差异均有统计学意义(P值分别为0.006、0.012、0.040、0.039、0.028、0.017、0.006;P＜0.05);观察组患者化疗减量、延迟化疗、中止化疗的比例均明显低于对照组,差异有统计学意义(P＜0.05)。结论 基于PG-SGA 的2~3分的复发或转移的化疗胃部肿瘤患者实施饮食联合口服营养补充的营养干预措施较饮食联合营养教育的营养干预措施更能提高患者总体生活质量,改善其乏力症状,提高患者的躯体功能,提高患者化疗依从性。     

胃癌围术期全营养联合目标营养支持治疗对胃肠功能恢复及预后影响

目的探讨给予胃癌围术期患者全营养联合目标营养支持治疗对胃肠功能恢复情况及预后的影响。方法选取自2010年1月至2017年1月十堰市郧西县人民医院收治的56例行根治性全胃切除术的胃癌围术期患者为研究对象,采用随机数字表法将患者分为常规组(n=28)与观察组(n=28)。常规组患者采用传统肠内营养支持治疗,观察组患者采用全营养联合目标营养支持治疗。比较两组患者术前及术后1、7 d的营养指标,包括前清蛋白、清蛋白及转铁蛋白水平;比较两组患者的术后胃肠功能指标,包括术后首次排便、排气时间。结果术后1 d,两组患者前清蛋白、清蛋白水平较术前降低,差异有统计学意义(P<0.05);转铁蛋白水平较术前比较,差异无统计学意义(P>0.05)。术后7 d,常规组患者前清蛋白、清蛋白水平与术后1 d比较,差异无统计学意义(P>0.05);观察组患者前清蛋白、清蛋白水平较术后1 d升高,且高于常规组,差异有统计学意义(P<0.05);两组患者转铁蛋白水平比较,差异无统计学意义(P>0.05)。观察组术后首次排气、排便时间均短于常规组,差异有统计学意义(P<0.05)。结论全营养联合目标营养支持治疗可加快胃癌患者围术期胃肠功能的恢复,改善患者预后。     

经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折临床疗效及常见并发症

目的探讨经皮椎体后凸成形术在骨质疏松性椎体压缩骨折患者中的临床治疗效果及并发症情况。方法选取骨质疏松性椎体压缩骨折患者70例,采用随机数字法分为常规组(n=35)与观察组(n=35)。常规组采用常规保守治疗,观察组采用经皮椎体后凸成形术治疗,比较两组患者临床疗效及并发症发生情况。结果观察组治疗后1年,损伤椎体高度显著高于常规组,差异有统计学意义(P<0.05);后突角度变化显著低于常规组,差异有统计学意义(P<0.05);观察组术后视觉疼痛评分(VAS)低于常规组,差异有统计学意义(P<0.05);观察组治疗后Barthel指数评定量表(BI)评分高于常规组,差异有统计学意义(P<0.05);观察组术后并发症发生率为5.7%,低于常规组的20.0%,差异有统计学意义(P<0.05)。结论骨质疏松性椎体压缩骨折患者采用经皮椎体后凸成形术治疗效果理想,能降低术后并发症发生率,值得推广应用。     

阿替普酶联合依达拉奉治疗急性脑梗死患者疗效及对氧化应激水平影响

目的探讨阿替普酶联合依达拉奉治疗急性脑梗死(ACI)患者的疗效及对氧化应激水平的影响。方法选取自2014年6月至2018年6月上海中医药大学附属第七人民医院收治的156例ACI患者为研究对象。采用随机数字表法将患者分为观察组与常规组,每组各78例。在一般治疗基础上,常规组给予阿替普酶0.9 mg/kg,观察组在常规组的基础上静脉滴注依达拉奉。14 d为1个疗程,比较两组患者的临床疗效、神经功能评分及氧化应激水平。结果观察组治疗有效率为91.0%(71/78),显著优于常规组的79.5%(62/78),差异有统计学意义(P<0.05)。治疗14 d后,两组患者神经功能评分均低于治疗前,且观察组低于常规组,差异均有统计学意义(P<0.05)。治疗14 d后,两组患者的超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-px)水平均高于治疗前,丙二醛(MDA)水平低于治疗前,差异有统计学意义(P<0.05);且观察组的SOD和GSH-px水平高于常规组,MDA水平低于常规组,差异有统计学意义(P<0.05)。结论阿替普酶联合依达拉奉可减轻急性脑梗死患者的氧化应激反应,在恢复血流的同时,减少再灌注损伤,改善患者神经功能。     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。