卵巢癌化疗引起粒细胞缺乏症的护理

卵巢癌是发生于卵巢组织的恶性肿瘤,占所有妇科恶性肿瘤15%左右,在女性生殖道恶性肿瘤中占第3位,仅次于宫颈癌和宫体癌[1]。手术是治疗卵巢癌的主要手段,但不少病人就诊时已处于晚期,因此化疗在卵巢癌的治疗中占有重要地位。近年来,紫杉醇联合卡铂全身性化疗是一项最重要的辅助治疗方法。卵巢癌术后一般要补充4个～6个疗程全身性化疗和3次腹腔灌注化疗。多次化疗后,常出现骨髓抑制等毒副反应,     

卵巢恶性肿瘤患者化学治疗期间生存质量的调查与研究

目的:探讨卵巢恶性肿瘤患者进行化学治疗期间的生存质量.方法:采用QLQ-C30 调查表调查49例卵巢恶性肿瘤患者的生活质量情况.结果:化疗期间总体生存质量呈上升趋势,与化疗前比较,化疗后三个阶段的各项指标均有显著性差异(P<0.05);与化疗第一阶段比较,化疗前及第三阶段有显著性差异(P<0.05).结论:卵巢恶性肿瘤患者化学治疗期间特别是第一阶段影响患者生存质量,要求给予及时、合理、有效的治疗、护理及心理干预,尤其需要更多的心理帮助.     

卵巢恶性肿瘤患者化学治疗期间生存质量的调查与研究

目的：探讨卵巢恶性肿瘤患者进行化学治疗期间的生存质量。方法：采用QLQ-C30调查表调查49例卵巢恶性肿瘤患者的生活质量情况。结果：化疗期间总体生存质量呈上升趋势,与化疗前比较,化疗后三个阶段的各项指标均有显著性差异（P〈0.05）;与化疗第一阶段比较,化疗前及第三阶段有显著性差异（P〈0.05）。结论：卵巢恶性肿瘤患者化学治疗期间特别是第一阶段影响患者生存质量,要求给予及时、合理、有效的治疗、护理及心理干预,尤其需要更多的心理帮助。     

生物治疗在妇科恶性肿瘤治疗中的应用

目的 为了延长妇科恶性肿瘤患的生存期和提高生存质量。方法 对26例恶性肿瘤患除手术、化疗外并用了生物治疗。自体瘤苗均于术后第8天皮下（臀部）注射，每次2mL，间隔1wk 1次，3－4次为1疗程，一般患均为1个疗程，只有黑色素瘤患2个疗程，卵巢癌的患按常规进行化疗，腹腔放药化疗的同时腹腔内放入干扰素2000－2400万U。结果 卵巢癌2a生存率I期、Ⅱ期、Ⅲ期为100％，Ⅳ期为66．67％，转移癌术后1.5a仍健在。子宫内膜癌2a生存I期、Ⅱ期为100％，Ⅲ期、Ⅳ期为0。宫颈恶性肿瘤Ⅱa期已存活7a，其余分别2a、3a（黑色素瘤患）。结论 生物治疗可用于妇科恶性肿瘤治疗，尤其是各种生物治疗与化疗、放疗并用对晚期肿瘤患延长生存期和提高生存质量是有一定作用的。     

复发性卵巢恶性肿瘤再次手术的意义

目的探讨复发性卵巢恶性肿瘤再次手术的指征和临床意义。方法回顾性分析复发性卵巢恶性肿瘤28例共39次再次手术的临床资料。根据病理类型分为上皮性卵巢癌组和其他类型组,上皮性卵巢癌组又根据复发时间分为>6个月组、≤6个月组和肿瘤进展组。依据复发灶的数目分为单病灶组和多病灶组两组。观察比较每组再手术的满意减灭术例数,手术并发症例数及术后生存时间。结果上皮性卵巢癌组中单病灶组获得满意减灭术67.8%,多病灶组为45.4%,上皮性卵巢癌生存时间中位数11个月,其中>6个月组,≤6个月组和进展组生存时间分别为14.5个月,10个月和6个月,而其他类型组2年存活率82%(7/8),5年存活率50%(4/8)。手术并发症以多病灶组为高。结论单病灶复发,停止化疗>6个月复发者再次手术可以获得较满意疗效;非上皮癌则不受此限制。     

云芝糖肽配合化疗对罗口巢和子宫体癌患者免疫功能及生活质量的影响

背景：生物反应调节剂己成为继化疗、手术及放疗后第4种治疗肿瘤的方法。云芝糖肽是一种生物反应调节剂物质，在肿瘤治疗中具有重要作用，己被应用于胃癌、肺癌、食道癌等的治疗。目的：观察云芝糖肽对因妇科恶性肿瘤而化疗的患者免疫功能与生活质量的影响。设计：对比观察。单位：上海交通大学附属第一人民医院妇产科。对象：选择1999—06／2002-12上海交通大学附属第一人民医院妇产科已手术确诊的妇科恶性肿瘤住院患者共40例。其中卵巢癌36例，平均年龄52岁；子宫体癌4例，平均年龄54岁。纳入标准：卵巢或子宫体癌患者，手术后没有化疗禁忌征。排除标准：有化疗禁忌征的患者。方法：将患者按期别及年龄配对分成试验组和对照组，每组20例：试验组接受化疗加云芝糖肽；对照组单用化疗。卵巢癌采用PAC方案化疗，子宫体癌用MFP方案。实验时机于第2次化疗开始前至第4次化疗前，共2个月。主要观察指标：各组治疗前后血免疫功能指标及生活质量指数的变化。结果：纳入患者40例，均进入结果分析。①治疗前后Kamofsky评分值试验组分别为（84&;#177;9．6），（90&;#177;8．6）分，（P〈0．05）；对照组分别为（83&;#177;9.2）及（80&;#177;12．8）分．（P〉0．05）；治疗后试验组比对照组高10分，（P〈0．05）。（劣治疗后试验组和对照组的CD4^＋分别为28．14&;#177;4．10及23．12&;#177;3．97，（P〈0．05）；CD4＋／CD8^＋为0．96&;#177;0．17及0．75&;#177;0．21，（P〈0．01）；自然杀伤细胞为23．80&;#177;4．90，5．32&;#177;3．90，（P〈0．01），试验组均明显高于对照组．结论：云芝糖肽能提高卵巢和子宫体癌患者的细胞免疫和生活质量.     

淋巴瘤患者化疗期间症状群与生活质量相关性的纵向研究

目的：调查淋巴瘤患者在化疗期间不同时间点症状群与生活质量现状,并探讨症状群与生活质量相关性的动态变化。方法：采用纵向研究的方法,便利选取初次化疗的159例淋巴瘤患者作为调查对象,于化疗前、化疗第3周期后和第6周期后调查患者的症状出现情况及生活质量。结果：化疗前患者存在胃肠道症状群、心理相关症状群和淋巴瘤B症状群,化疗第3周期后和第6周期后淋巴瘤B症状群消失,增加化疗相关症状群。3个周期的生活质量中躯体功能、角色功能和认知功能比较差异有统计学意义（P<0.01）。化疗前和第6周期后各症状群与生活质量各维度得分呈负相关（P<0.05）;化疗第3周期后化疗和心理相关症状群与生活质量各维度得分呈负相关（P<0.05）。结论：淋巴瘤患者化疗期间存在多个稳定症状群,且与生活质量得分呈负相关,提示临床工作者应对化疗期间的淋巴瘤患者进行症状管理,减轻症状负担,以提升其生活质量。     

妇科恶性肿瘤术后化疗患者心理弹性与生存质量的相关性研究

目的探讨妇科恶性肿瘤术后化疗患者心理弹性与生存质量之间的关系。方法采用一般资料问卷、心理弹性量表、癌症治疗功能评价系统核心量表对广州市3所三级甲等医院住院治疗的100例妇科恶性肿瘤术后化疗患者进行问卷调查。结果妇科恶性肿瘤术后化疗患者心理弹性总分为(59.26±16.31)分、生存质量总分为(72.67±16.28)分,心理弹性总分及其各维度得分与生存质量总分、社会/家庭状况维度、情感状况维度、功能状况维度得分均存在显著的正相关(P0.01)。结论妇科恶性肿瘤术后化疗患者心理弹性、生存质量均处于中等水平,医护人员应重视患者的心理弹性水平,有针对性地采取干预措施,提高患者的心理弹性,从而提高患者的生存质量。     

人参多糖注射液联合化疗治疗晚期恶性肿瘤的临床观察

目的提高晚期恶性肿瘤患者的生活质量，减轻化疗引起的毒副作用，从而提高机体免疫功能。方法治疗组采用人参多糖注射液6mg/2ml肌内注射，1次／d，30d为1个疗程，同时合并全身化疗，对照组单用化疗。结果治疗组有效率50％，对照组有效率35％。结论人参多糖注射液联合化疗可以提高患者的生活质量，减轻毒副反应。     

CA125在卵巢癌患者化疗过程中的临床表达及预后评估

卵巢癌是卵巢组织的恶性肿瘤,在女性生殖道恶性肿瘤中占第三位,并且有逐渐上升的趋势.肿瘤抗原(CA125)是一种相对分子量大于2×109的糖蛋白抗原,它与上皮卵巢抗原有关[1],又成为卵巢相关抗原.随着对CA125研究的日益增多,此指标己广泛用于临床,升成为卵巢癌诊断的重要指标[2,3],为了进一步探讨CA125在卵巢癌患者化疗过程中治疗疗效与预后中的价值,笔者对55例卵巢癌患者进行深入探讨.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.