稿乳腺癌患者对化疗不良反应的自我报告与护理记录的一致性研究

目的 调查并分析乳腺癌术后辅助化疗患者相关不良反应的自我报告与护理记录之间的一致性。方法 采用便利抽样法,选取2017年7月-2018年7月在江苏省某三级甲等肿瘤医院就诊的乳腺癌术后首次辅助化疗患者128例,采用一般资料调查表、乳腺癌患者对化疗不良反应的自我报告问卷对患者进行调查,同时从电子护理病例中提取患者不良反应的信息,与患者自我报告的结果进行比较,探讨两者一致性。结果 患者自我报告的化疗不良反应的发生率及严重程度均高于护理记录的数据(P＜0.05);仅“呕吐”这一不良反应,患者自我报告与护理记录之间的一致性一般(0.4≤ Kappa值＜0.75)；其余不良反应,两者之间的一致性均较差(kappa值＜0.4)。结论 大多数护理人员存在漏记录或低估患者不良反应的情况,甚至包括一些可能导致严重并发症的症状。今后应考虑将患者自我报告作为常规数据收集,以便促进患者参与决策,改善就医体验,同时也为最新治疗方案的实施和相关医疗政策的制订提供依据。     

乳腺癌化疗患者不良反应自我报告与护理记录一致性研究

目的探讨乳腺癌患者对化疗不良反应自我报告与护理记录的一致性。方法选取2018年1—12月入住本院的乳腺癌行术后标准辅助化疗患者100例,采用调查问卷形式,问卷调查患者的一般资料、对化疗不良反应自我报告情况,然后与本院电子病历系统中显示的护理记录内容比较二者的一致性。结果自我报告的恶心、食欲降低、脱发、疼痛、呼吸困难的发生率均明显高于护理记录(P 0. 05);自我报告的恶心、食欲降低、疲惫的严重程度评分均明显高于护理记录(P 0. 05);自我报告中恶心、食欲降低、疲惫、疼痛均与护理记录中一致性差(Kappa值0. 4);自我报告中腹泻、脱发均与护理记录中一致性一般(Kappa值在0. 4～0. 75);自我报告中呕吐、呼吸困难均与护理记录中一致性良好(Kappa值 0. 75)。结论乳腺癌患者对化疗不良反应的自我报告与护理记录的多种不良反应记录不相一致,护理记录对其存在低估现象,护理人员应高度重视,及时改进,提高护理质量。     

60例化疗患儿不良反应自我报告与护理记录一致性研究

目的 调查急性淋巴细胞白血病患儿初次诱导化疗2次鞘内注射后不良反应自我报告及同时期护理记录单中不良反应情况,比较2种评估的一致性。方法 采用便利抽样法,选取2018年5月—2019年7月在海南省某三级甲等综合医院儿科亚重症病房首次辅助化疗并行鞘内注射的60例急性淋巴细胞白血病患儿作为研究对象,采用鞘内注射后患儿不良反应自我报告问卷,在2次鞘内注射24 h后分别对其进行调查;同时从电子护理记录中提取同期护士对患儿鞘内注射后不良反应的记录信息,与患儿自我报告结果进行一致性比较。结果 第1次鞘内注射后,在不良反应发生率方面,患儿不良反应自我报告与护理记录的12项不良反应中有9项差异有统计学意义（P<0.05）,分别为恶心、呕吐、便秘、食欲减退、疲劳、肢体麻木、腰痛、头晕、头痛;在不良反应严重程度方面,患儿自我报告与护理记录比较,仅疲劳的差异有统计学意义（P<0.05）;患儿自我报告与护理记录不良反应严重程度评估一致性比较,恶心、食欲减退、疲劳、肢体麻木、腰痛、头晕的一致性均较差（Kappa<0.4）。第2次鞘内注射后,在不良反应发生率方面,患儿不良反应自我报告与护理记录的12项不良反应中有10项差异有统计学意义（P<0.05）,分别为恶心、呕吐、食欲减退、味觉障碍、腹泻、疲劳、肢体麻木、腰痛、头晕、头痛;不良反应严重程度方面,患儿自我报告与护理记录比较,差异均无统计学意义（P>0.05）;患儿自我报告与护理记录不良反应严重程度评估一致性比较,恶心、呕吐、食欲减退、味觉障碍、腹泻、疲劳、肢体麻木、腰痛、头晕的一致性均较差（Kappa<0.4）。结论 护理人员对急性淋巴细胞白血病患儿诱导化疗鞘内注射的不良反应发生率及严重程度存在低估与忽视,临床工作中护士应更加重视患儿不良反应自我报告,以提高临床治疗方案的疗效评价准确性,为提高白血病患儿的照护水平提供更有价值的信息。     

基于手机和纸笔调查的中文版乳腺癌自我效能感量表测量等价性研究

目的 检验基于手机调查和纸笔调查的中文版乳腺癌自我效能感量表是否具备测量等价性。方法 通过方便抽样,采用一般资料问卷及中文版乳腺癌自我效能感量表对上海某三级甲等医院乳腺中心就诊的302例乳腺癌患者进行调查,其中145例使用手机调查,157例使用纸笔调查。采用多组验证性因子分析检验量表采用不同测量方式的测量等价性。结果 基线模型、形态等价模型、单位等价模型及尺度等价模型的各项模型拟合指标均达到统计学要求,提示模型拟合良好。结论 乳腺癌自我效能感量表在2种测量方式下具备强测量等价性,研究者可根据需要选择适合的方式进行数据收集并进行数据合并。     

全程个案管理对乳腺癌患者康复效果的影响

目的 探讨全程个案管理模式对乳腺癌患者康复效果的影响。方法 选取2018年7月—2019年6月乳腺外科收治的100例乳腺癌患者为研究对象。将2018年7-12月入院的46例患者设为对照组,2019年1-6月入院的47例患者设为观察组。对照组予常规管理,观察组给予全程个案管理,比较2组生存质量、化疗不良反应和非计划再住院率。结果 干预1个月后,观察组生存质量总分及生理状况、情感状况得分均高于对照组(P＜0.05);干预3个月后,观察组生存质量总分和各维度得分均高于对照组(P＜0.05),干预6个月后,2组患者生存质量总分及各维度得分比较,差异无统计学意义(P＞0.05);观察组出院1年内化疗不良反应发生率和非计划再住院率均低于对照组(χ²=4.028,P=0.045;χ²=4.271,P=0.039)。结论 全程个案管理能够改善乳腺癌患者术后早期的生存质量,降低患者化疗严重不良反应发生率和非计划再住院率。     

延续性社会支持对乳腺癌术后化疗期患者生存质量的影响

目的 探讨乳腺癌患者术后化疗期延续性社会支持系统与生存质量之间的关系,为化疗期护理提供理论依据。 方法 将80例乳腺癌根治术后化疗患者随机分为对照组与观察组,每组40例。对照组进行常规护理,观察组在对照组基础上实施延续性社会支持干预。应用焦虑自评量表(self-rating anxiety scale, SAS)、抑郁自评量表(self-rating depression scale, SDS)和生存功能质量评价量表对2组进行调查研究。 结果 化疗期结束后,观察组SAS和SDS评分明显低于对照组;观察组在躯体功能、情绪功能、认知功能、社会功能4个方面的生存功能质量评分明显高于对照组,2组在角色功能评分上比较,差异无统计学意义。 结论 认知感支持是延续性社会支持的重要措施,延续性社会支持系统的建立和完善,可提高乳腺癌术后化疗期患者的生存质量。     

情绪释放技术对乳腺癌术后化疗患者预期性悲伤的影响

目的 探讨情绪释放技术对改善乳腺癌术后化疗患者预期性悲伤的效果。方法 采用便利抽样法选取乳腺癌术后化疗患者60例为研究对象,采用随机数字表法将其分为对照组和干预组,各30例。对照组给予常规护理,干预组在对照组的基础上实施情绪释放干预疗法。比较干预前后2组心理痛苦程度和预期性悲伤得分水平。结果 干预后,干预组心理痛苦程度低于对照组(t=-17.930,P＜0.001);预期性悲伤总分及各维度得分均低于对照组(P＜0.001)。结论 对乳腺癌术后化疗患者应用情绪释放技术进行护理干预,可以减轻患者心理痛苦程度,降低患者预期性悲伤,值得临床推广应用。     

4例心脏移植术后肺动脉高压患者行右心辅助循环治疗的护理

目的 探讨右心辅助循环治疗心脏移植后引起肺动脉高压的术后护理。方法 总结4例心脏移植术后引起肺动脉高压患者行右心辅助循环治疗情况,着重分析其术后监护护理要点与措施。结果 4例患者均成活且成功撤除右心辅助装置。结论 加强心脏移植术后并行右心辅助循环患者的术后监护护理,能降低术后并发症,促进疾病康复。     

基于健康促进模型的结直肠癌永久性肠造口患者体力活动影响因素分析

目的 调查结直肠癌永久性肠造口患者术后半年的体力活动水平,并基于健康促进模型探讨结直肠癌永久性肠造口患者体力活动的影响因素。方法 采用纵向研究设计,在术后出院前采用一般资料调查表、运动益处和障碍量表、慢性病自我效能量表对201例结直肠癌永久性肠造口患者进行调查,并于术后6个月左右采用国际体力活动问卷短卷调查体力活动水平。结果 65.7%的结直肠癌永久性肠造口患者在术后半年报告低水平的体力活动;二分类Logistic回归分析结果显示：年龄（OR=1.062,P=0.006）、术后辅助化疗和放疗（OR=3.855,P=0.009）和运动障碍（OR=1.163,P=0.005）是体力活动的危险因素;自我效能（OR=0.709,P=0.002）是体力活动的保护因素。结论 结直肠癌永久性肠造口患者术后半年的体力活动水平较低,年龄、术后辅助治疗、运动障碍和自我效能是结直肠癌永久性肠造口患者体力活动的重要预测因素,建议术后制定适合老人术后康复的体力活动策略,积极改善放疗和化疗伴随的毒副作用,尽早开展延续性的健康促进行为,干预结直肠癌永久性肠造口患者术后的体力活动。     

夫妻自我表露在青年乳腺癌患者癌症复发恐惧干预中的应用研究

目的 探讨夫妻自我表露在青年乳腺癌患者癌症复发恐惧干预中的应用效果。方法 便利选取2018年3月—2019年1月在郑州市某三级甲等医院肿瘤科住院治疗的62例青年乳腺癌患者,按入院顺序分为试验组和对照组各31例。对试验组实施夫妻自我表露干预,对对照组实施常规护理,干预前及干预12周后采用一般资料调查表、癌症患者恐惧疾病进展简化量表、中文版痛苦自我表露指数量表进行评价。结果 试验组中途退出1例,最终试验组30例,对照组31例。干预前两组一般资料、自我表露及复发恐惧水平差异均无统计学意义（P>0.05）;干预12周后,试验组自我表露得分高于对照组（P<0.05）,复发恐惧总分及维度得分均低于对照组（P<0.05）。结论 夫妻自我表露干预可有效提高青年乳腺癌患者的自我表露水平,降低患者癌症复发恐惧。     

肿瘤晚期患者生存期预测研究进展

从肿瘤晚期患者的预后因素、肿瘤晚期患者生存期的评估工具、国内外相关的研究现状等进行综述,为建立符合我国特点的晚期肿瘤患者生存期预测的评估工具,探索患者进入安宁疗护的最佳时机提供依据。     

白血病患儿鞘内注射后去枕平卧时间对并发症的影响研究

目的 探讨白血病患儿鞘内注射后不同去枕平卧时间对并发症发生情况的影响,以确定适宜的术后去枕平卧时间,提高患儿耐受性。方法 2017年6月5日一12月28日,选取北京市某三级甲等儿童专科医院处于维持治疗阶段,需进行鞘内注射的白血病患儿为研究对象,按照患儿入院先后顺序,应用随机数字表将患儿随机分为3组,鞘内注射后分别去枕平卧2h、3h、4h,观察患儿去枕平卧期间及鞘内注射后1周内并发症的发生情况、患儿对去枕平卧体位的耐受程度以及去枕平卧期间患儿的主要活动。结果 共有180例患儿完成研究,每组60例,3组在去枕平卧期间及鞘内注射后1周内并发症发生情况比较,差异无统计学意义(P>0.05);组间去枕平卧体位的耐受性比较,差异具有统计学意义（P<0.05),去枕平卧2h患儿耐受性最好;3组平卧期间的主要活动比较,差异无统计学意义（P>0.05),卧床时间越长,患儿生理需求越多。结论 白血病患儿鞘内注射后去枕平卧2h不增加并发症的发生率,且能够提高患儿的耐受性,建议白血病患儿鞘内注射后去枕平卧2h。     

中医药抗肝纤维化作用机制概述

肝纤维化是由于多种原因导致的肝细胞外基质异常沉积的病理状态,因此,及时逆转肝纤维化是治疗疾病的关键。相关研究结果表明,白藜芦、苦参、白芍、丹参等单味中药及中药复方具有明显抗肝纤维化效果,其机制主要是抑制肝星状细胞活性、减少细胞外基质沉积及调节相关信号通路等。     

Effects of the N-methyl-D-aspartate receptor antagonist dextromethorphan on temporal summation of pain are similar in fibromyalgia patients and normal control subjects.

Temporal summation of second pain at least partly reflects temporal summation of dorsal horn neuronal responses, and both have been termed windup (WU), a form of nociception-dependent central sensitization. Animal and human experiments have shown that both forms of WU depend on N-methyl-D-aspartate (NMDA) and substance P receptor systems. WU of second pain (WU(SP)) in patients with fibromyalgia (FM) is enhanced compared with normal control (NC) subjects and is followed by exaggerated WU(SP) aftersensations and prolonged WU(SP) maintenance at low stimulus frequencies. Because the enhanced WU(SP) of FM patients could be related to abnormal endogenous modulation of NDMA receptors, we tested the effects of the NMDA receptor antagonist dextromethorphan (DEX) on WU(SP) in FM and NC subjects in a double-blind, placebo-controlled, crossover study. WU(SP) was elicited by trains of 0.7-second duration thermal pulses applied to the glabrous surface of the hands or by 1-second mechanical stimuli to the adductor pollicis muscle of the hands at a frequency of 0.33 Hz. In comparison to baseline and placebo conditions, single oral doses of DEX 60 and 90 mg reduced thermal and mechanical WU(SP) in NC and FM subjects, with DEX 90 mg being most effective. These effects did not differ for male and female NC subjects. FM subjects required less thermal and mechanical stimulus intensity than NC to achieve maximal WU(SP), but the extent of WU(SP) reduction by DEX did not statistically differ between NC and FM subjects for all study conditions. Thus, central pain processing of FM subjects is not different from NC in at least one important aspect, namely their NMDA receptor system responsiveness to pharmacologic inhibition by DEX. PERSPECTIVE: Results of this study demonstrate that FM patients show abnormal WU(SP) during thermal and mechanical stimulation compared with NC. Because oral doses of the NMDA receptor antagonist DEX attenuated thermal and mechanical WU(SP) similarly in FM patients and NC, other mechanisms than WU(SP) need to be considered for the widespread pain of FM patients. These mechanisms might include tonic nociceptive input from peripheral tissues and/or enhanced descending facilitation.     

Ratings of experimental pain and pain-related negative affect predict clinical pain in patients with fibromyalgia syndrome

Patients with fibromyalgia syndrome (FMS) report chronic pain related to abnormal sensitivity of muscles that is reflected by so-called tender points (TP). TP represent areas of abnormal mechanical pain thresholds that have only shown a minor correlation with clinical pain of FMS patients and seem to be better suited for predicting distress. Pain-related negative affect (PRNA), abnormal temporal summation of second pain (termed wind-up or WU), and abnormal WU decay are frequently present in FMS patients. WU and WU decay can provide measures of central sensitization, which may contribute to clinical FMS pain. We therefore investigated the role of WU, WU decay, TP count, and PRNA as predictors of clinical pain in FMS subjects.Fifty-five FMS subjects rated their clinical pain at entry into the study using a visual analogue scale (VAS). After a TP evaluation, all subjects received two trials of thermal WU and WU decay testing. Hierarchical regression analysis demonstrated that the combination of PRNA ratings, TP count, and WU decay ratings predicted 49.7% of the variance of clinical pain in FMS. This model demonstrates independent relationships of biological and psychological factors to clinical pain and underscores the important role of abnormal peripheral and central pain mechanisms for FMS. Therefore, the combination of PRNA, TP count, and WU decay may provide an excellent measure for future clinical studies of FMS patients.     

右室流出道血流频谱形态与肺动脉高压血流动力学的关系

目的 探讨肺动脉高压患者右室流出道血流多普勒频谱形态(FVERVOT)与血流动力学的关系.方法 以超声心动图右室流出道血流频谱形态分为无切迹组(no notch,NN)、收缩晚期切迹组(1ate systolic notch,LSN)、收缩中期切迹组(mid-systolic notch,MSN).回顾分析88例肺动脉高压患者临床、血流动力学资料.结果 MSN组肺血管阻力(PVR)高[(9.2±3.5)WU,(5.7±3.1)WU,(3.3±2.4)WU].肺血管的顺应性(每搏输出量/肺动脉脉压差,SV/PP)也随右室流出道血流频谱形态的不同而变化(MSN组为1.2±0.5,LSN为1.7±0.8,NN为2.6±1.7,与NN组相比,P值分别为0.01和0.04).通过MSN诊断PVR≥5WU,特异性为96%、敏感性为71%、阳性预测值为98%.在众多原因导致的肺动脉高压患者中,右室流出道血流频谱收缩期出现切迹预示PVR＞3 WU(OR 22.3,95%CI5.2～96.4),而无切迹预示PVR≤3 WU和肺动脉锲压(PAWP)＞15 mmHg(OR 30.2,95%CI6.3-144.9).结论 右室流出道血流多普勒频谱的形态可以判断肺动脉高压患者血流动力学状态.

Abstract：

Objective To investigate whether simple visual assessment of FVERVOT(the right ventricular outflow tract Doppler flow velocity envelop) graphs aids in hemodynamic differentiation. Method The hemodynamics, echocardiography, and clinical data of 88 patients with pulmonary hypertension (PH) were reviewed. The FVERVOTgraphs were categorized into normal pattern (no notch; NN), late systolic notch pattern (LSN) or mid-systolic notch pattern (MSN). Results The pulmonary vascular resistance (PVR) was highest in the MSN pattern (9.2±3.5 WU; P＜0. 001), in comparison with LSN (5,7 ±3. 1 WU) and NN (3.3±2.4 WU) patterns. The ratio of stroke volume to pulse pressure (compliance) also varied with different patterns of FVERVOr graph (MSN = 1.2 ± 0. 5; LSN = 1.7 ± 0.8; NN = 2.6 ± 1. 7, P = 0.001 and 0.04 respectively compared with NN). The specificity and sensitivity of MSN were 96% and 71%, respectively in case of a PVR ＞ 5 WU (PPV 98%). In the patients with PH, any notching pattern of FVERVOT graph was highly associated with PVR ＞ 3 WU (OR = 22.3, 95 % CI: 5.2 ～ 96.4), whereas the NN pattern predicted a PVR ≤3 WU and pulmonary artery wedge pressure (PAWP) ＞ 15 mmHg (OR =30.2, 95%CI: 6.3 ～ 144.9). Conclusions Visual inspection of the shape of the FVERVOT graphs provides insight into the hemodynamic status of patients with PH.     

护生防范针刺伤操作行为规范视频创建与临床应用效果研究

目的 探讨护生防范针刺伤操作行为规范视频创建与临床应用效果。方法 便利抽取我院2017年度实习护生100名为研究对象,采取抽签法确定对照组和观察组各50名,对照组采用传统的医院岗前理论知识培训,观察组采用传统的医院岗前理论知识培训和护生防范针刺伤操作行为规范视频演示培训,2组护生培训后均接受自制“护生防范针刺伤知识问卷调查表”调查,比较2组护生对防范针刺伤知识的掌握及实习期间针刺伤的发生率。结果 观察组护生对防范针刺伤知识的掌握好于对照组（P<0.05）;观察组护生实习期间针刺伤发生率低于对照组（P<0.05）。结论 护生防范针刺伤操作行为规范视频创建与临床应用,有效提高护生对防范针刺伤知识的掌握,操作行为规范,降低针刺伤发生率,保障职业健康,值得医院与学校推广应用。     

Maintenance of windup of second pain requires less frequent stimulation in fibromyalgia patients compared to normal controls

Many chronic pain syndromes, including fibromyalgia (FM), show evidence of central nervous system hyperexcitability related to central sensitization. Windup (WU) of second pain reflects increased excitability of spinal cord neurons that is related to central sensitization. Psychophysical testing can help characterize this important central nervous system phenomenon because of the parallels between electrophysiological WU and WU of second pain. Animal experiments have shown that once WU has been established, only low frequency tonic nociceptive input is required to maintain the sensitized state of dorsal horn neurons (WU-maintenance or WU-M). The stimulus frequency necessary to maintain the hyperexcitability of spinal cord neurons can provide a measure of central sensitization. Because central sensitization plays an important role in many chronic pain syndromes including FM, we compared WU-M in 72 normal controls (NC) and 104 FM subjects. WU of second pain was produced by a train of 0.7 s duration thermal pulses applied to the glabrous surface of the hands at a frequency of 0.3 Hz. Enhanced second pain associated with WU could, thereafter, be maintained in FM but not NC subjects for up to 120 s by stimuli delivered at 0.16 and 0.08 Hz (WU-M stimuli). These two frequencies of stimulation do not produce WU when delivered alone. Thus, unlike NC subjects, FM subjects showed enhanced second pain during WU-M stimuli at very low stimulus frequencies, indicating central sensitization. Increased WU sensitivity, enhanced WU-M, and increased WU-related aftersensations help account for persistent pain conditions in FM subjects. In addition to WU, WU-M appears to be a useful tool to study mechanisms of pain in patients with characteristics of central sensitization.     

Noninvasive measurement of systemic vascular resistance using Doppler echocardiography.

BACKGROUND: Systemic vascular resistance (SVR) is an integral therapeutic component of patients with heart failure and shock. We hypothesized that the ratio of the peak mitral regurgitant velocity (MRV) (m/s) to left ventricular outflow time-velocity integral (TVI(LVOT)) (cm) by Doppler would provide a noninvasive correlate of SVR. METHODS: SVR was correlated to MRV/TVI(LVOT) in 33 patients undergoing right heart catheterization. Receiver operating characteristic curves were generated to determine the best-balanced sensitivity and specificity to identify SVR > 14 Wood units (WU) and <10 WU. RESULTS: MRV/TVI(LVOT) correlated well with SVR (r = 0.842, 95% confidence interval 0.7-0.92, P <.001, Y = 0.459 + 49.397*X). By receiver operating characteristics, MRV/TVI(LVOT) > 0.27 had a 70% sensitivity and a 77% specificity to identify SVR > 14 WU. MRV/TVI(LVOT) < 0.2 had a 92% sensitivity and a 88% specificity to identify SVR < 10 WU. CONCLUSION: Doppler echocardiography provides a reliable noninvasive assessment of SVR.     

心脏起搏器植入术后压迫袋固定装置的设计及应用

目的 自制心脏起搏器植入术后压迫袋固定装置并探讨其应用效果。 方法 将88例心脏起搏器植入术后患者按照入院时间先后顺序分为实验组和对照组。实验组采用自制压迫袋固定装置压迫切口,对照组直接放置压迫袋压迫切口,比较两组电极移位、囊袋血肿、皮下瘀血、术肢肿胀、切口坠涨感的发生率和压迫袋移位次数。 结果 两组术后均未发生电极移位,两组囊袋血肿发生率的比较,差异无统计学意义（P>0.05）;实验组术后皮下瘀血、术肢肿胀、切口坠涨感的发生率及术后压迫袋移位次数低于对照组,差异具有统计学意义（P<0.05）。 结论 使用自制压迫袋固定装置能降低心脏起搏器植入术后患者的术后相关并发症。