The terminal care of patients with lung cancer

Lung cancer is the commonest form of malignant disease seen at St Christopher''s Hospice. More than 35% of the male and about 8% of the female cancer patients are admitted with this diagnosis. This means that each year approximately 100 patients with lung cancer are amitted and cared for at the hospice. The more common symptoms experienced by 185 consecutive terminal lung cancer patients admitted to St Christopher''s Hospice are listed in Table 1.     

晚期肿瘤患者临终关怀的护理效果

目的 观察晚期肿瘤患者临终关怀的护理效果.方法 回顾性分析2015年8月—2016年9月我院收治的晚期肿瘤患者42例,将其随机平分为2组,每组患者21例,对试验组患者采取临终关怀护理模式,对照组患者采取常规护理模式,比较2组临床护理效果.结果 试验组患者临终时期的生活质量评分(79.8±3.6)分,患者与家属对护理的满意度95.2%,均显著高于对照组.试验组患者住院期间病死率和日平均费用显著优于对照组.结论 临终关怀护理模式在晚期肿瘤患者护理中的应用,能够有效提高患者与家属对护理工作满意度、提高晚期肿瘤患者临终前的生活质量,有利于降低住院期间的病死率、减少住院费用,值得临床推广.     

The ethics of terminal care

The widely used notion of dignity is questioned as an adequate ideal for care of terminally ill persons. Instead of dying with dignity, the essential ethical components of dying with a sense of worth are proposed as comprising truly humane and personal care.     

The ethical and legal implications of deactivating an implantable cardioverter-defibrillator in a patient with terminal cancer

In this paper, the ethical and legal issues raised by the deactivation of implantable cardioverter-defibrillators (ICDs) in patients with terminal cancer is considered. It is argued that the ICD cannot be well described either as a treatment or as a non-treatment option, and thus raises complex questions regarding how rules governing deactivation should be framed. A new category called "integral devices" is proposed. Integral devices require their own special rules, reflecting their position as a "halfway house" between a form of treatment and a part of the body. The practical problems faced by doctors working in palliative medicine with regard to the deactivation of ICDs are also considered.     

晚期癌症患者姑息性放射治疗的伦理道德思考和人文关怀

以医学伦理学为指导，正确认识恶性肿瘤患者姑息性放射治疗的治疗价值；把人文主义精神与放射治疗技术相结合，最大程度减轻恶性肿瘤患者终未期的疼痛，提高生存质量，并给予人文关怀。     

A case of informed consent obtained from a patient with terminal cancer and his family using family function by the primary care physician

We evaluated the contents and characteristics of informed consent obtained by the primary care physician from a male patient with advanced cancer and his family, and clarified the influences of the informed consent on family function. This patient was diagnosed as having advanced cancer at the age of 46 years, underwent surgery/chemotherapy, but died after 4 months at the hospital. Semi-structured interviews were held with the elder daughter of the patient, and notes on the patient's disease, the course of treatment, his family's responses, and the informed consent obtained by the primary care physician were taken during the interview. The informed consent obtained by the primary care physician had the following characteristics: (1) The physician transmitted accurate and detailed information on the treatment methods, side effects, and prognosis by appropriate communication techniques with consideration for the feelings of the patient and his family, and proposed choices so that they could participate in the decision of treatment principles. (2) During the entire course, the primary care physician frequently visited the bedside and encouraged the patient and his family to express their feelings of anxiety and to ask questions, giving continuous emotional support. With the progression of the disease and explanation by the primary care physician, the patient and his family expressed and shared feelings such as grief and powerlessness and supported each another. Gradually, they began to show practical/adaptive coping behavior and could accept the patient's death. Appropriate informed consent obtained by the primary-care physician promoted the family function of this family.     

对肺癌合并肺毛霉菌感染患者的药学监护

目的探讨肺癌合并肺毛霉菌感染患者的药学监护及不良反应监测,探索临床药学实践方法。方法对1例肺癌合并肺毛霉菌感染的患者提供了用药分析、给药剂量的换算及药物不良反应监测等多种药学监护。结果通过此病例,临床药师对肺毛霉菌的诊断、治疗及预后积累了更多经验,对药物治疗的使用及不良反应的监测有了深刻体会。结论临床药师在药学实践中应兼顾药物的安全和有效,真正的做一名合理用药的参与者。     

喉癌术后患者延续性护理的研究进展

喉癌是头颈部肿瘤中常见的恶性肿瘤,近年来该病的发病率略呈上升趋势。手术是喉癌患者的主要治疗方法之一,术后出院的患者,往往需要长期乃至终身的治疗和护理。延续性护理是针对出院患者的实际需求而提供的一种连续性、可靠性、安全性的医疗保健服务,通常包括患者回归家庭或社区后的持续随访与指导。对喉癌患者实施延续性护理干预,可能是帮助患者适应术后功能变化,预防并发症和提高生活质量的有效策略。本综述首先从“喉癌术后的特殊生理心理改变需要延续性护理、社会对延续性护理的发展提出了明确的要求”两方面阐述了喉癌术后患者实施延续性护理的必要性;其次从“喉癌术后患者延续性护理的主要内容及主要方式”两方面总结了国内外喉癌术后患者实施延续性护理的现状,并对实施的效果评价进行了清楚的展示;最后,本文通过对喉癌术后患者的延续性护理进行综合的评价,指出了现如今在实施过程中存在的不足,剖析出国内外目前针对喉癌延续性护理研究比较少的两点原因,一是患者的护理需求得不到充分表达;二是喉癌患者出院后延续性护理的内容广泛,专业性强,操作复杂,实施耗费大量的人力物力。这些分析便于指导医护人员结合我国的医疗现状和国外先进经验,积极开展相关研究,以期在未来可以进一步提高喉癌患者的生活质量。      

晚期癌痛家庭病床治疗的护理体会

自 1 995年 1 1月至 1 999年 5月我们开展了晚期癌痛用硬膜外腔注药的方法治疗疼痛的家庭病床 3 6例 ,现将护理体会报告如下 :1　资料与方法本组 3 6例 ,男 2 1例 ,女 1 5例 ,年龄 2 5～ 72ａ ,其中肝癌 9例、乳腺癌 7例、胃癌 6例、直肠癌 5例、宫颈癌 5例、肺癌和骨癌各 2例。全部为由癌肿引发的顽固性疼痛 ,并经口服和肌肉注射止痛药物效果不佳而强烈要求用此方法止痛者。医生根据患者疼痛部位的不同选择相应的椎间隙行硬膜外腔穿刺 ,成功后置入硬膜外导管用胶布、敷料固定。一般平卧给药 ,单次注药结束后用烧灼封闭导管末端 ,以保持管内…     

人文关怀结合姑息护理在晚期癌症患者中的应用研究

目的观察人文关怀结合姑息护理在晚期癌症患者中的应用效果。方法选取2012年5月至2013年12月于本院进行治疗的58例晚期癌症患者为研究对象,将其随机分为对照组（常规护理组）和观察组（人文关怀结合姑息护理组）各29例,然后将两组患者护理前与护理后1个月、2个月的EORTCQLQ．C30量表与Zung量表评估结果进行比较。结果观察组护理干预后1个月与2个月的EORTCQLQ．C30量表与Zung量表评估结果分别优于对照组相同时间段的评估结果,差异均有统计学意义（P〈0．05）。结论人文关怀结合姑息护理在晚期癌症患者中的应用效果较佳,可明显改善晚期癌症患者的不良生活质量与心理状态。     

晚期癌症患者社区居家临终关怀服务效果观察

对北京西城区德胜社区卫生服务中心48例晚期癌症患者实施社区居家式临终关怀,内容包括日常生活护理、心理干预以及缓解疼痛等姑息式治疗.接受临终关怀服务的患者在癌痛、情绪情感等方面均较实施前有明显改善,疼痛平均分由5.6±2.7降到3.0±2.4,焦虑平均分由14.2±6.8降到6.3±3.0,抑郁平均分由15.2±8.2降到8.4±5.0,前后差异均具有统计学意义（P＜0.01）.     

晚期癌症患者疼痛的护理体会

根据世界卫生组织统计,全世界癌症患者伴有疼痛的比例为30％-50％,晚期患者为60％～90％,我国近年来的调查显示约50％的患者伴有疼痛,直接由癌症引起疼痛为癌症患者疼痛的主要原因,占65％～85％。癌症疼痛可从心理、生理、精神和社会等多个方面干扰和破坏患者的生存质量,有效缓解或解除癌症患者的疼痛,提高生存质量是医护人员共同关注的问题,现就110例癌症患者的疼痛干预及临床护理体会论述如下。