影响卵巢癌患者生活质量因素的典型相关分析

目的了解影响卵巢癌患者生活质量(quality of life,QOL)的相关因素。方法采用生活质量测量量表调查行手术治疗91例和非手术治疗45例卵巢癌患者的生活质量,并采用典型相关分析法分析其主要影响因素。结果在生活质量评分中,行手术治疗的卵巢癌患者的生理状况和社会/家庭状况的得分均高于非手术治疗患者,差异具有统计学意义(均P0.05)。典型相关分析表明,卵巢癌分期越晚,生理状况越差;手术治疗能改善患者功能状况;家庭月人均收入越高,社会/家庭支持越高。结论卵巢癌患者的生活质量与卵巢癌分期、手术治疗和家庭月人均收入水平有关。     

喉癌切除术后患者的生存质量

目的：探讨影响喉癌患者术后生存质量（QOL）的相关因素，并寻找提高其生存质量的方法。方法：38例喉癌全切除（A组）和21例部分切除（B组）术后的患者进行头颈肿瘤治疗功能性评估量表问卷调查，并比较2组患者总的生存质量和生存质量各个方面之间的差异，分析导致产生差异的相关因素。结果：B组生存质量总分及各个分项分（包括生理、社会家庭、情感、功能状况及附加关注得分）均高于A组（P〈0．01、0．05）。影响喉癌患者术后生存质量的相关因素从大到小依次为放化疗、并发症、手术方式及疾病分期。结论：在彻底切除喉部癌症病变的前提下尽量选用喉部分切除术，保证患者生存率的同时使术后获得较高的生存质量。     

社会支持对乳腺癌手术患者生活质量的影响

目的探讨社会支持与乳腺癌手术患者生活质量的关系。方法采用乳腺癌生活质量测定量表FACT-B和社会支持评定量表（SSRS）对78例乳腺癌患者的生活质量和社会支持现状进行测评,并对结果进行分析。结果乳腺癌患者在生活质量的情感状况及功能状况2个领域得分较低,分别为（9．10±3．99）分和（12．81±7．99）分;乳腺癌患者获得的社会支持总分为（36．93±6．42）分,显著高于正常人的社会支持总分（34．56±3．73）分;乳腺癌患者生活质量中的生理状况、社会／家庭状况及情感状况与社会支持总分呈显著正相关。结论社会支持是影响乳腺癌患者生活质量的重要因素,临床护理工作中应重视并充分利用患者的社会支持来源,通过各种干预措施改善和提高患者的生活质量。     

肺癌化疗患者主要照顾者生活质量的影响因素研究

目的探讨肺癌化疗患者主要照顾者生活质量的影响因素.方法采用自编的一般情况问卷、Zarit护理负担量表及癌症患者照料者生活质量调查表(Caregiver Quality of Life,CQOL)对294例肺癌化疗患者主要照顾者进行问卷调查.结果肺癌化疗患者主要照顾者生活质量总得分为(171.18±34.96)分,得分由低到高分别为心理健康、精神健康、社会健康和生理健康.影响肺癌化疗患者主要照顾者生活质量的主要因素有照顾负担、有无慢性病、文化程度以及患者年龄和疾病分期(P<0.05).复相关系数R=0.685,决定系数R2=0.469.结论肺癌化疗患者主要照顾者生活质量以心理健康维度得分最低,总体生活质量与照顾负担、照顾者文化程度、是否有慢性病、患者年龄、患者疾病分期有关,其中照顾负担对生活质量的影响尤为显著.     

围手术期肺癌患者症状群与生活质量相关性的纵向研究

目的 调查肺癌患者在围手术期不同时间点的症状群和生活质量,并分析两者的相关性,为临床护士动态管理其症状群及改善其生活质量提供依据。方法 便利选取2019年1月—9月就诊于合肥市某三级甲等医院胸外科行手术治疗的217例肺癌患者为调查对象。在患者入院当天、术后2~4 d和术后1个月,采用一般资料调查表、中文版安德森症状评估量表-肺癌模块及肺癌患者生活质量评估量表进行调查。结果 入院当天肺癌患者存在呼吸道症状群、疼痛-疲乏-睡眠障碍症状群、心理情感症状群及神经系统症状群,共4个症状群;术后2~4 d和术后1个月患者增加了消化道症状群,共5个症状群,各时间点群内症状组成不同。肺癌患者围手术期不同时间点生活质量总分及各维度得分（除社会与家庭状况维度）比较,差异有统计学意义（P<0.001）。入院当天,呼吸道症状群严重程度得分与患者生活质量总分及各维度得分均呈负相关（P<0.01）;术后2~4 d,呼吸道及疼痛-疲乏-睡眠障碍症状群严重程度得分均与患者生活质量总分呈负相关（P<0.05）;术后1个月,5个症状群严重程度得分均与患者生活质量总分呈负相关（P<0.01）。结论 肺癌患者围手术期存在多个稳定的症状群,且症状群严重程度得分与生活质量得分负性相关。医护人员应对围手术期肺癌患者症状群进行有效的动态管理以提升其生活质量。     

肺癌患者癌因性疲乏与生活质量的相关性研究

目的探讨肺癌患者癌因性疲乏（CRF）的相关因素及其对生活质量的影响。方法选取98例肺癌住院患者为研究对象,采用一般资料调查表、Piper疲乏修正量表（Revise—Pfs）、癌症生命质量评定量表（QLQ-C30）对其进行问卷调查,了解肺癌患者疲乏程度及生活质量水平,分析其相关因素。结果98例肺癌患者中18．4％轻度疲乏,59．2％中度疲乏,22．4％重度疲乏;疲乏总分（5．18±1．61）分,行为疲乏（5．66±2．22）分,情感疲乏（5．36±2．26）分,躯体疲乏（5．69±1．97）分,认知疲乏（4．11±1．81）分;患者整体健康状况得分（51．02±19．67）分属于中等水平,功能维度中情感功能（80．95±16．01）分,认知功能（81．97±19．98）分得分较高,症状条目中经济困难（58．50±27．52）分得分较高;是否有宗教信仰及不同病程的患者癌因性疲乏总分比较差异均有统计学意义（t=5．979,F=3．251;P〈0．05）;而不同职业状况、年龄、临床分期患者在QLQ—C30个别维度中也存在差异;患者疲乏总分与整体健康状态及疲乏症状均相关,差异均有统计学意义（r分别为-0．425,0．303;P〈0．01）。结论癌因性疲乏是影响肺癌患者生活质量的重要因素,临床上应提供相应的护理干预缓解患者疲乏程度,提高癌症患者的生活质量。     

肺癌围手术期死亡的高危因素分析

目的 探讨引起肺癌手术死亡的高危因素，进一步降低肺癌手术的病死率。方法 回顾性总结手术切除的2439例肺癌患者的临床资料，对其中76例围手术期死亡患者的临床及病理资料进行单因素和Cox（多因素时间-常数回归模型）回归分析。结果 单因素分析影响肺癌手术死亡的主要因素为术后并发症、术前合并心肺疾病、高龄、手术切除范围（P〈0．01），临床病理分期、癌残留情况（P〈0．05）。多因素分析影响肺癌手术死亡的独立危险因素为术后并发症、合并心肺疾病、高龄、手术切除范围、临床病理分期、癌肿残留。结论 术后并发症、严重肺功能不全、心功能不全及高龄是肺癌手术死亡的主要原因，患侧全肺切除、病理分期晚期及癌肿残留也是肺癌术后死亡的重要原因。     

肺癌化疗患者生活质量的影响因素调查

目的探讨人口学因素、疾病因素(病理分型、疾病分期)对肺癌患者在化疗期间生活质量的影响。方法采用问卷调查法对100例肺癌患者进行调查,分析人口学因素与疾病因素对肺癌患者生活质量的影响。结果年龄、性别和疾病分期对化疗中和化疗后肺癌患者的生活质量总分和生理指标有显著影响(P<0.01或P<0.05);文化程度对化疗后肺癌患者的社会指标有显著影响(P<0.05);年龄、性别对化疗前、化疗中、化疗后肺癌患者的其他指标有显著影响(P均<0.01)。结论人口学因素和疾病因素可影响肺癌患者的生活质量,临床护理工作中需加以重视。     

原发性肝癌介入治疗患者的生活质量及影响因素研究

目的：探讨原发性肝细胞肝癌患者介入治疗后生活质量现状及其影响因素。方法对200例曾进行介入治疗的原发性肝癌患者进行问卷调查,采用美国肝胆肿瘤治疗功能评定量表评估生活质量状况,采用一般资料调查问卷、Child-Pugh分级法和巴塞罗那肝癌临床分期系统测量其影响因素。结果200例研究对象中,45.5%处于中晚期肝癌,生活质量总分为（133.25±23.15）分。影响原发性肝癌患者介入治疗后生活质量的因素依次为：巴塞罗那肝癌临床分期系统分期、是否继续就业、家庭人均月收入、四肢活动能力和医疗付费方式（P＜0.05）。结论原发性肝癌患者介入治疗后的生活质量现状较佳,影响因素包括肝癌分期、就业、四肢活动能力和家庭经济状况。鼓励患者早期治疗、治疗后重返工作岗位、维持四肢功能有利于生活质量的提高。     

新型冠状肺炎疫情下肺癌放化疗患者生存质量现状及影响因素分析

【摘要】目的 调查新冠疫情下肺癌放化疗患者生存质量现状,探讨肺癌放化疗患者生存质量影响因素。 方法 采用便利抽样的方法,选取2020年2月10日～2月20日某三级甲等专科医院的 170位患者为研究对象。采用一般资料调查问卷、欧洲癌症研究与治疗组织生命质量测定量表、简短疲乏量表、焦虑自评量表和抑郁自评量表对患者进行调查。共发放问卷170份,回收有效问卷134份。 结果 新冠疫情下,134位肺癌放化疗患者生活质量总得分（72.326±11.129）分;单因素分析显示,放化疗是否延期、复诊交通是否困难、饮食生活保障是否充足、临床分期、不同合并症数目分组和不同疲乏程度分级的患者生活质量差异具有统计学意义（P＜0.05）;Pearson 相关分析显示,肺癌患者焦虑抑郁得分与生活质量呈负相关（P＜0.05）。多元回归分析显示,临床分期、放化疗是否延期、疫情知识得分、SAS共4项因素是肺癌放化疗患者的主要影响因素。 结论 新冠疫情下肺癌放化疗患者生存质量较低,护理人员应根据其影响因素为患者进行多方位的健康指导,改善其其生活质量。     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.