中西医结合舒缓疗护在恶性肿瘤患者热疗护理中应用的临床观察

目的:探讨并总结舒缓疗护在肿瘤患者热疗过程中的作用和护理效果。方法:选取60例恶性肿瘤晚期热疗患者,通过随机数字表法分成基础护理组30例和舒缓疗护组30例。观察两组患者对热疗温度的耐受情况,比较两组热疗耐受率以及肿瘤热疗所产生的不良反应发生率。结果:舒缓疗护组在热疗耐受率方面优于基础护理组(P0.05),舒缓疗护组热疗不良反应发生率均显著低于基础护理组(P0.05)。结论:对采取热疗的晚期恶性肿瘤患者在护理过程中实施合理化的舒缓疗护疗效更好,值得应用于临床并加以推广。     

Clinical application of the Distress Thermometer to malignant tumor patients

目的 评估美国国立综合癌症网推荐的心理痛苦温度计在中国癌症患者中的临床应用情况,了解中国癌症患者心理痛苦的现状及其相关因素.方法 使用心理痛苦温度计对3所医院的143例癌症患者进行问卷调查.结果 癌症患者心理痛苦得分为4.69±1.97,中重度心理痛苦占73.43％.不同诊断、年龄、学历、付费方式患者的心理痛苦得分比较,差异有统计学意义(均P＜0.05);情绪问题、躯体问题显著影响患者心理痛苦(P＜0.01,P＜0.05).结论 心理痛苦温度计适用于中国临床,能压时发现患者心理痛苦的程度及原因,为临床医护人员进行个体化的心理干预提供依据.     

临床护士《安宁疗护实践指南》践行行为调查

目的了解临床护士对卫生行业标准《安宁疗护实践指南》的践行行为现状。方法采用便利抽样法,抽取收治疾病末期患者较多科室的216名护士,采用自行设计的调查问卷进行调查。结果临床护士《安宁疗护实践指南》践行行为总分为(119.40±22.03)分,症状控制维度得分最高,心理支持维度得分最低;不同特征护士践行行为得分比较,差异无统计学意义(均P0.05)。结论临床护士《安宁疗护实践指南》总体践行行为处于中等水平,护理管理者要针对薄弱环节,采取针对性措施提高护士践行行为,以提高安宁疗护护理质量。     

首次住院恢复期精神病患者心理需求调查分析

目的 探讨首次住院恢复期精神病患者心理需求特点及影响因素,指导临床护理人员有针对性地进行护理.方法 采用自行设计的心理需求调查表,对96例首次住院恢复期精神病患者进行问卷调查.结果 患者对疾病知识的需求率为54.17%,对治疗期望的需求率为66.67%,对心理支持的需求率为48.91%,对周围环境的需求率为54.17%.4个病种在治疗期望和心理支持2个方面差异有显著性意义(P＜0.05,P＜0.01);患者对疾病知识的需求与文化程度、婚姻状况,对周围环境的需求与职业呈显著正相关(P＜0.05,P＜0.01).结论首次住院恢复期精神病患者心理需求程度高,需针对患者的需求特点及影响因素,提供针对性的健康教育和心理支持,以提高治愈率和其社会功能.     

山西省25所三甲医院护士安宁疗护临床实践的调查分析

目的了解三甲医院护士安宁疗护临床实践现状及影响因素,为提高护士安宁疗护水平提供参考。方法采用自行设计的问卷,对山西省25所三甲医院481名护士进行调查。结果护士的临床实践总分(70. 97±14. 40)分,各维度得分由高到低依次为症状控制(74. 06±11. 18)、心理支持(73. 52±19. 64)、死亡教育(67. 24±21. 89)、哀伤辅导(66. 69±21. 54)。经方差分析,接受安宁疗护相关培训、对《指南》了解情况2项得分差异有统计学意义(均P 0. 01),其中接受培训≥3次者得分显著高于其他人员,从未听说过《指南》护士得分显著低于其他人员(均P 0. 05)。结论护士安宁疗护实践处于中等水平,受安宁疗护知识培训、对《指南》了解程度的影响。管理者应加强安宁疗护系统化、规范化继续教育,提高安宁疗护临床实践水平。     

胃癌术后化疗期患者心理痛苦度及其影响因素的纵向研究

目的调查胃癌患者术后化疗期间心理痛苦变化情况及影响因素,为改善其负性心理提供参考。方法采用一般资料调查问卷、心理痛苦温度计及综合医院焦虑抑郁量表,分别于化疗前1 d(T1)及第1、3、6次化疗(T2、T3、T4)进行问卷调查。结果共212例完成研究。4个时间段中重度心理痛苦检出率分别为62.74%、70.28%、47.17%、31.60%;4个时间段心理痛苦、焦虑抑郁得分差异有统计学意义(均P0.01);其中心理痛苦得分T2最高(4.84±1.27)、T4最低(2.67±1.23)。多元回归分析结果显示:性别、年龄、文化程度、焦虑4个变量进入4个时间段、抑郁进入3个时间段(T2未能进入)、个人月收入进入T1、T3时间段、肿瘤分期进入T1时间段心理痛苦影响因素预测模型(调整R~2:T1为0.836,T2为0.512,T3为0.683,T4为0.605;P0.05,P0.01)。结论胃癌患者术后化疗期间心理痛苦发生率高,不同阶段心理痛苦呈动态变化趋势。应采取针对性措施干预,尤其对女性、高龄、文化程度偏低、个人月收入较少,以及焦虑、抑郁情绪较重患者应强化干预,以减轻患者心理痛苦水平,促其完成全程化疗和提高生活质量。     

心理痛苦温度计用于恶性肿瘤患者的研究

目的评估美国国立综合癌症网推荐的心理痛苦温度计在中国癌症患者中的临床应用情况,了解中国癌症患者心理痛苦的现状及其相关因素。方法使用心理痛苦温度计对3所医院的143例癌症患者进行问卷调查。结果癌症患者心理痛苦得分为4.69±1.97,中重度心理痛苦占73.43%。不同诊断、年龄、学历、付费方式患者的心理痛苦得分比较,差异有统计学意义(均P<0.05);情绪问题、躯体问题显著影响患者心理痛苦(P<0.01,P<0.05)。结论心理痛苦温度计适用于中国临床,能及时发现患者心理痛苦的程度及原因,为临床医护人员进行个体化的心理干预提供依据。     

首次住院恢复期精神病患者心理需求调查分析

目的探讨首次住院恢复期精神病患者心理需求特点及影响因素,指导临床护理人员有针对性地进行护理。方法采用自行设计的心理需求调查表,对96例首次住院恢复期精神病患者进行问卷调查。结果患者对疾病知识的需求率为54.17%,对治疗期望的需求率为66.67%,对心理支持的需求率为48.91%,对周围环境的需求率为54.17%。4个病种在治疗期望和心理支持2个方面差异有显著性意义（P〈0.05,P〈0.01）;患者对疾病知识的需求与文化程度、婚姻状况,对周围环境的需求与职业呈显著正相关（P〈0.05,P〈0.01）。结论首次住院恢复期精神病患者心理需求程度高,需针对患者的需求特点及影响因素,提供针对性的健康教育和心理支持,以提高治愈率和其社会功能。     

神经语言程序技术在肿瘤患者心理舒缓疗护中的应用

目的减轻肿瘤患者患病期间的心理痛苦,使之以积极的心态面对疾病与死亡。方法成立舒缓疗护中心,与专业心理咨询师合作采用神经语言程序技术对11例有心理咨询需求的中晚期肿瘤患者进行心理辅导,每次60~90min,间隔1周1次。结果11例患者经1~5次神经语言程序技术疗护,10例获得预期效果:2例达成愿望,在亲人的陪伴下安详离世;8例对待疾病的态度改变,积极配合治疗与保健,病情好转,遵医嘱出院继续门诊治疗。1例失败。结论运用神经语言程序技术对肿瘤患者进行心理疏导,可激发患者潜意识自动选择最佳的能力,克服负性情绪,以积极平静的心态面对疾病与死亡。     

口腔颌面部恶性肿瘤术后患者心理痛苦及相关因素分析

目的探索口腔颌面部恶性肿瘤术后患者心理痛苦状况并分析其相关因素,为开展有效心理支持干预提供参考。方法采用心理痛苦温度计及其相关问题列表、自尊量表、知觉压力量表对399例口腔颌面部恶性肿瘤术后患者进行调查。结果口腔颌面部恶性肿瘤术后患者心理痛苦得分为(3.34±2.81)分,显著心理痛苦水平检出率为43.6%。患者心理痛苦水平与自尊水平呈负相关,与知觉压力水平呈正相关(均P<0.01)。Logistic回归分析结果表明,人均月收入、无时间精力做家务、经济问题、恐惧、悲伤、担忧、睡眠问题、便秘、口腔疼痛、疼痛等是口腔颌面部恶性肿瘤患者术后心理痛苦的影响因素(P<0.05,P<0.01)。结论口腔颌面部恶性肿瘤患者术后心理痛苦检出率较高,影响因素较多,医护人员应予以重视并给予有效措施减轻其心理痛苦水平。     

左半结直肠癌并肠梗阻的外科治疗及预后分析

目的探讨左半结直肠癌并肠梗阻的外科治疗及其影响预后的因素。方法回顾性分析2001年1月至2006年12月间在青岛大学医学院附属医院行外科治疗的93例左半结直肠癌并肠梗阻患者的临床资料。结果93例患者中男53例,女40例;中位年龄61岁;其中51例合并内科疾病。行根治性切除术67例。其中一期切除吻合21例、Hartmann手术35例、Miles手术11例;行姑息性手术26例,其中单腔或双腔造瘘术14例,短路手术7例．姑息性切除5例。93例患者均获随访,1、3、5年生存率分别为94％、59％、38％。单因素和多因素预后分析显示,手术根治性、TNM分期和术前CEA水平是影响患者预后的独立因素（均P〈0．05）。结论手术根治性、TNM分期和术前CEA水平是左半结直肠癌并肠梗阻患者预后影响因素：早期诊治、根治性手术及合理地选择手术方式有助于提高患者生存率。     

肿瘤患者PICC导管相关性血栓形成的相关因素分析

目的探讨肿瘤患者PICC导管相关性血栓形成的相关因素。方法对1 030例PICC带管肿瘤患者进行上肢静脉超声检查并分析临床资料。结果 PICC带管肿瘤患者PICC导管相关性血栓发生率为5.44%;其中无症状血栓占76.79%,有症状血栓占23.21%。肠外营养的使用、导管相关并发症、高血压、带管时间、年龄60岁5个因素对血栓的发生有显著影响(P0.05,P0.01)。结论 PICC导管相关性血栓临床表现多数无症状,PICC导管相关性血栓形成的风险因素较多,需针对风险因素进行预警管理干预,以降低其发生率。     

甲状腺滤泡癌105例预后分析

目的 分析甲状腺滤泡癌的临床生物学特征及影响预后的因素.方法 回顾性分析1970-1990年间天津市肿瘤医院收治的105例甲状腺滤泡癌患者的临床资料.结果 本组病例5、10和15年生存率分别为85.3％、76.7％和72.9％.≥45岁及＜45岁患者15年生存率分别为45.9％、89.8％.双侧腺叶及单侧腺叶发病患者15年生存率分别为50.0％、76.2％.有颈淋巴结转移及无颈淋巴结转移患者15年生存率分别为54.2％、79.2％.AJCC分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者15年生存率分别为89.3％、70.0％、45.5％、35.3％.随访中11例发生远处器官转移,发生转移时间为术后1 ～33年,9例在发生转移后5年内死亡.17例发生局部复发,复发时间为术后3个月至34年,10例因复发死亡,占55.8％.结论 甲状腺滤泡癌患者的年龄、临床分期、双侧甲状腺叶发病和颈部淋巴结转移与预后关系密切.早期诊治和密切随访是改善患者预后、延长术后生存的主要手段.     

影响Ⅱ期结直肠癌患者预后的临床病理因素分析

目的 分析影响Ⅱ期结直肠癌患者预后的临床病理因素,进一步探讨Ⅱ期结直肠癌患者进行辅助化疗的必要性.方法 收集2000年1月至2005年12月中山大学附属第一医院(作者原工作单位)收治的符合纳入标准的255例Ⅱ期结直肠癌患者的临床资料.采用Kaplan-Meier法绘制患者的生存曲线,Log-rank法分析患者生存情况,对各种影响预后的因素分别进行单变量和多变量Cox回归分析.结果 随访截至2010年4月23日,平均随访时间为(63±22)个月,中位生存时间为63个月.255例患者5年总生存率和无瘤生存率分别为85.3％和83.7％.术前无肠梗阻或肠穿孔患者的5年总生存率和无瘤生存率分别为86.9％和85.6％,高于术前出现肠梗阻或肠穿孔患者的72.7％和68.4％(x2=4.546,4.573,P＜0.05).手术切缘阴性患者的5年总生存率和无瘤生存率分别为85.5％和83.9％,高于手术切缘阳性患者的75.0％和75.0％(x2=7.020,6.009,P＜O.05).多因素分析结果提示术前肠梗阻或肠穿孔是Ⅱ期结直肠癌患者生存的独立影响因素(Wald=4.477,相对危险度为2.371,95％可信区间为1.066～5.275,P＜0.05);接受辅助化疗和无辅助化疗患者的5年总生存率分别为87.3％和82.2％,无瘤生存率分别为86.0％和80.3％,两者比较,差异无统计学意义(P＞0.05).结论 术前肠梗阻或肠穿孔是影响Ⅱ期结直肠癌患者生存的独立危险因素;术后行辅助化疗并不能改善Ⅱ期结直肠癌患者的预后.     

结肠癌术后肠梗阻影响因素分析

目的随访调查结肠癌病人术后1个月肠梗阻发生率,分析其影响因素。方法系统收集2014年10月至2016年10月解放军总医院普通外科行结肠癌根治术227例病人的临床资料,术后密切随访1个月,统计病人肠梗阻发生情况,回顾分析其可能的影响因素,运用卡方检验对单因素进行筛选,并将可能的影响因素纳入多因素非条件Logistic回归分析。结果 227例结肠癌病人术后1个月内共有19例发生肠梗阻,发生率为8.37%,经影像学、相关实验室检查及术中所见证实,19例肠梗阻病人中炎症性肠梗阻11例,机械性肠梗阻4例,麻痹性肠梗阻4例;其中年龄偏高、术前血红蛋白偏低、术前已发生肠梗阻、术前有胃肠肿物切除史、T分期偏高、左半结肠癌的病人术后1个月内肠梗阻发生率显著高于年龄偏低、术前血红蛋白在正常范围内、术前无肠梗阻、无胃肠肿物切除史、T分期偏低、右半结肠癌的病人;腹腔镜手术后1个月肠梗阻发生率显著低于开腹手术的病人,差异有统计学意义(P0.05)。多因素非条件Logistic回归分析显示,年龄(OR=1.894,95%CI:1.019~2.664)、术前肠梗阻(OR=1.894,95%CI:1.019~2.664)、T分期(OR=5.542,95%CI:2.264~8.721)是结肠癌病人术后1个月肠梗阻的危险因素,而腹腔镜手术(OR=1.894,95%CI:1.019~2.664)则是其保护因素。结论结肠癌病人术后肠梗阻发生概率较高,对于高危人群应规避风险,采取例如选择合适的术式、改善病人一般情况等必要的预防措施,避免肠梗阻的发生。     

结直肠神经内分泌癌的临床诊治及预后

目的探讨结直肠神经内分泌癌的临床诊治及预后。方法回顾性分析1995年1月至2010年1月间河南省肿瘤医院收治的39例结直肠神经内分泌癌患者的临床资料。结果39例患者中男27例．女12例。所有病例均未出现内分泌紊乱的表现,术前有14例（35．9％）经病理学诊断为神经内分泌癌。22例患者行根治性手术．14例行姑息性切除术,3例仅行活检术。所有病例均予顺铂加依托泊苷的术后辅助化疗。36例切除的病灶中,27例（75．0％）有脉管浸润,29例（80．6％）有淋巴结转移：全组患者中有11例（28．2％）出现远处转移。病理分型：高分化型22例（56．4％）,中间型9例（23．1％）．小细胞型8例（20．5％）。全组患者术后获得4．67个月的随访,1、3、5年生存率分别为48．2％、16．5％和6．8％。患者的生存状况与肿瘤的分期、脉管浸润和手术根治性有关（P〈0．05）;而与年龄、性别、肿瘤的大小和位置无关（P〉0．05）。结论结直肠神经内分泌癌无特异性临床表现,恶性程度高．预后差,肿瘤分期、有无脉管浸润和能否根治切除是影响预后的重要因素。     

Assessing patient risk from cancer and COVID-19: Managing patient distress

The rapid spread of coronavirus disease 2019 (COVID-19) beginning in Spring 2020 necessitated significant changes to day-to-day interactions in society, as well as to the practice of medicine. Particularly in patients with cancer, these changes can exacerbate the pre-existing psychological stress associated with cancer diagnosis and treatment. We performed a narrative review, encompassing changes to cancer care as a result of COVID-19, the psychological effects of treatment delays, and strategies to mitigate these effects. A number of review articles and guideline bodies have provided guidance on patients for whom treatment may be safely delayed, including low-risk bladder, prostate and kidney tumors, as well as intermediate and high-risk prostate cancer. Mental health diagnoses are prevalent in patients with genitourinary malignancies. Evidence regarding psychologic effects of deferred treatment is limited to those with low risk of disease related morbidity. In this population, psychologic distress attenuated with time. However, in the COVID-19 context, patients with advanced disease are particularly prone to psychologic distress, as are women and younger patients. Strategies to mitigate this distress are emerging and center on recognition from the treating oncologist with appropriate referral as necessary to psycho-oncology providers and engagement of peer-supports. The COVID-19 pandemic has reshaped social structures and health care delivery. For patients with genitourinary malignancies, this may be associated with significant distress, particularly among those with advanced disease and those undergoing active treatment. Physicians treating these patients need to be aware of the psychologic stress the combined effects of the COVID-19 pandemic, cancer diagnosis, and cancer treatment can have and make appropriate referrals to support the holistic care of their patients.     

Management of lung cancer in South East Scotland.

BACKGROUND: There are few reports which describe the management of unselected groups of patients with lung cancer. This study was undertaken to audit prospectively the presentation, diagnosis, management, and outcome of patients presenting with lung cancer in South East Scotland. METHODS: Data were recorded on all patients with newly diagnosed lung cancer who presented to a multidisciplinary group of clinicians over a 12 month period. Subsequent follow up data on treatment and survival were collected. RESULTS: Six hundred and twenty two patients were registered, 80% of whom were referred from primary care. There was a considerable variation in the length of history, but the diagnosis was rapidly made after referral (87% within two weeks). In 82% of patients the pathological examination was positive; 70% were treated with palliative intent. Only 36% of patients who underwent surgery had computed tomographic scanning and 55% had sampling of mediastinal nodes. A wide variety of regimens was used for treatment with radiotherapy and chemotherapy, and follow up data were difficult to obtain in these patients. Survival was poor in all patients treated with palliative intent. CONCLUSIONS: This audit confirms the importance of previously noted prognostic factors. Significant variation in referral practice, diagnostic and management evaluation has been shown. The data serve as a useful background for the formation of local management guidelines.     

Patterns of primary care and survival in 336 consecutive unselected Norwegian patients with bladder cancer.

The outcome of 336 unselected patients diagnosed as having bladder cancer in 1985 in a southern health region of Norway was studied. Two hundred and forty patients had superficial bladder cancer (Tis, Ta and T1). Seventy-four had T2-3 and 17 had T4 bladder tumours at the time of diagnosis (the T-category was unknown in five cases). In 46 of 248 evaluable cases (19%) 12 or more months had elapsed between the onset of symptoms and the histological confirmation of the diagnosis. The information received from the initial routine histology report was inadequate in 51 of 240 (21%) of the patients with superficial bladder cancer. Among the 91 patients with muscle-infiltrating tumours the primary treatment varied considerably, and only 15 patients underwent total cystectomy as the initial treatment. Only 46 in whom muscle-infiltrating tumours were diagnosed initially were referred to the regional uro-oncological unit during the course of the disease. The cancer-corrected, four-year survival was 86% and 42% for superficial and muscle infiltrating bladder cancer, respectively. The comparable figures for crude survival were 64% and 34%, respectively. The lack of optimal standard treatment of muscle-infiltrating bladder cancer warrants the introduction of clinical trials to assess both curative and palliative regimens as well as to study prognostic factors such as proliferation and immunohistochemical parameters by uro-oncological units. Scandinavian Cancer Registries should consider the optional recording of the T category on the case record forms for newly diagnosed cases of bladder cancer.     

Prostate cancer: palliative care and pain relief

Metastatic prostate cancer is incurable, and both the disease and other comorbidities as well as side effects from treatments can be very disabling for patients who are generally elderly. Past reviews on palliative care in prostate cancer have tended to concentrate on methods of active intervention with palliative intent rather than the principles of palliative care in a broader context. This paper is intended to introduce the principles and practice of modern palliative care as applied to care of patients with prostate cancer. Current National Institute for Clinical Excellence guidelines for urological cancers recommends provision of palliative care for all patients with prostate cancer, according to need. Palliative care aims to improve the quality of life of patients and their families. It is a holistic and personal approach to patient care, consisting of patient centred multiprofessional teams. Symptoms such as pain, psychological, spiritual and social problems are given equal weighting and tackled simultaneously. When treating pain, hormonal manipulation, radiotherapy, chemotherapy and surgery should always be considered alongside analgesic therapy, with realistic aims in mind. Towards the end of life, palliative care for patients will generally increase in line with increasing symptoms and other problems. Achieving a peaceful and comfortable death for our patients should be a priority in hospitals.