乳腺癌患者肿瘤相关疲劳影响因素的有序多分类回归分析

摘 要：［目的］ 探讨年龄、疾病阶段、放化疗情况等对乳腺癌患者肿瘤相关疲劳的影响。［方法］ 采用FS-14量表对患者进行问卷调查,建立患者疾病信息表,通过SPSS20.0 进行有序多分类回归分析。［结果］ 乳腺癌患者躯体疲劳在年龄段分布上呈现“N”型,以50~59岁组及70岁以上组较为明显,但无统计学差异;脑力疲劳呈现逐渐上升趋势,70岁以上组最为明显。随着乳腺癌疾病的进展,患者的脑力疲劳、躯体疲劳均呈现加重趋势。化疗对脑力疲劳及躯体疲劳均有加重趋势,而放疗仅对脑力疲劳有一定影响。［结论］ 乳腺癌患者肿瘤相关性疲劳持续存在,且与肿瘤发展阶段、化疗持续时间及放疗的实施有关。     

癌症患者化疗前后疲劳状况及其影响因素

目的：调查肿瘤患者化疗前后疲劳状况并探讨其影响因素。方法：应用翻译的FSI量表及自行编制的疾病及一般情况登记表,对121例住院肿瘤患者进行面对面问卷式调查,计算FSI量表各维度得分,采用方差分析方法分析其主要影响因素。结果：肿瘤病人化疗前不同性别、不同肿瘤分期疲劳评分有明显差异（P〈0.05）。化疗后疲劳评分多有不同程度的增加,差异有统计学意义（P〈0.01）。使用不同化疗方案的患者化疗后疲劳评分有显著差异（P〈0.05）。化疗过程中有恶心呕吐症状者化疗后疲劳各维度评分均明显增高（P〈0.05）。结论：肿瘤病人化疗后疲劳评分明显增高。女性、肿瘤分期晚、联合化疗、化疗中有恶心呕吐症状疲劳评分较高,不同的化疗药物所导致的疲劳程度不同。     

癌症患者化疗前后疲劳状况及其影响因素

目的:调查肿瘤患者化疗前后疲劳状况并探讨其影响因素。方法:应用翻译的FSI量表及自行编制的疾病及一般情况登记表,对121例住院肿瘤患者进行面对面问卷式调查,计算FSI量表各维度得分,采用方差分析方法分析其主要影响因素。结果:肿瘤病人化疗前不同性别、不同肿瘤分期疲劳评分有明显差异(P<0.05)。化疗后疲劳评分多有不同程度的增加,差异有统计学意义(P<0.01)。使用不同化疗方案的患者化疗后疲劳评分有显著差异(P<0.05)。化疗过程中有恶心呕吐症状者化疗后疲劳各维度评分均明显增高(P<0.05)。结论:肿瘤病人化疗后疲劳评分明显增高。女性、肿瘤分期晚、联合化疗、化疗中有恶心呕吐症状疲劳评分较高,不同的化疗药物所导致的疲劳程度不同。     

肺肿瘤运动规律及其影响因素的研究

目的 探讨肺肿瘤运动规律及其影响因素,指导精确放疗临床靶区外放.方法 搜集射波刀治疗的原发或转移肺肿瘤患者70例共83个病灶,其中7例患者7个病灶侵犯胸壁.CT引导下将纯金标记(金标)置入肿瘤体内或邻近位置.X线模拟定位机下测量金标(肿瘤)的运动幅度.1周后行层厚为1.25 mm的16层螺旋肺部CT扫描,根据解剖学标志划分肺尖部、中部、底部,记录不同部位的左右(x轴)、前后(y轴)、头脚(z轴)方向移动数据.结果 63例患者的76个病灶肺尖部、中部、底部x轴移动距离分别为(1.6±0.8)、(2.6 4±1.1)、(2.8±1.7)mm(F=1.76,P=0.179),y 轴的分别为(2.0±1.3)、(4.3±2.8)、(4.0.4±2.0)mm(F=2.06,P=0.135),z轴的分别为(2.7±0.8)、(7.3±3.6)、(12.0±5.3)mm(F=16.33,P=0.000).7个侵犯胸壁病灶移动距离很小,分别为(0.9±0.7)、(0.7±0.7)、(2.0±0.6)mm.相关分析显示x、y、z轴方向移动距离与患者性别、年龄、身高、体重和1s呼吸率无关(r=-0.001～0.136,P均>0.05).结论 呼吸导致的肺肿瘤移动距离主要受肿瘤位置和是否侵犯胸壁影响,了解其运动规律及影响因素有利于肺肿瘤放疗内边界的确定.

Abstract：

Objective To investigate the mobility of the lung tumors in order to guide the margin that CTV is to be expanded to PTV during stereotaetic radiotherapy for lung tumors.Methods Eighty-three lung tumom ineluded,in which 7 invaded the chest wall.1-2 gold marker(s)was/were implanted into or nearby the tumor.The motion of lung tumors in x(right-left),y(superior-inferior)and:(anterior-posterior)directions were measured via X-ray simulator system.One week later,1.25 mm thick of 16-slice spiral CT lung scan were taken.Apex,middle,and bottom of the lung were classified according to anatomic boderlines.Results No significant difference was detected among movements of apex,middle and bottom of the lung lesions in x axis direction((1.6±0.8),(2.6±1.1),(2.8±1.7)mm,respectively(F=1.76,P=0.179))and,y axis direction((2.0±1.3),(4.3±2.8),(4.0±2.0)mm,respectively(F=2.06,P=0.135))in 76 lesions of 63 patients.Significant differences were detected in:axis((2.7±0.8),(7.3±3.6),(12.0±5.3)mm(F=16.33,P=0.000)).The mobilities of the 7 lesions of 7 patients invading the chest wall were very small in all directions(0.9±0.7,0.7±0.7.and 2.0±0.6 mm,respectively).Motion amplitude did not correlate with the sex,age,height,weight and FEV1/FVC(r=-0.001-0.136.all P>0.05).Conclusions Motion amplitude of lung tumor due to breathing is associated with tumor loeation and status of chest wall invoivement.Identification of the mobile rules and the influencing factors is important for the internal margin set-up in lung tumor radiotherapy.     

肿瘤相关性抑郁及其相关因素分析

[目的]分析肿瘤相关性抑郁的发生情况及相关因素,为临床诊疗提供依据.[方法]对213例恶性肿瘤患者以问卷调查方式收集临床资料,采用Zung抑郁自评量表分析肿瘤相关性抑郁的相关因素.[结果]肿瘤相关性抑郁的发生率为46.0％,其发生率与肿瘤发病部位、家族史、居住地无关(P＞0.05),但与性别、年龄、肿瘤分期、中医分型、慢性癌痛、KPS评分、化疗方案种类、治疗副作用、知情情况、费用负担方式、文化程度、收入相关(P＜0.05).[结论]肿瘤相关性抑郁发生率较高,尤其是女性、中晚期、有多次化疗史、KPS评分低、伴慢性癌痛患者,应重视其心理状况,身心同治,以提高患者生存质量.     

肿瘤患者红细胞输注无效的影响因素分析

摘 要：［目的］ 分析肿瘤患者红细胞输注无效的相关因素,为临床肿瘤患者科学、有效的输血提供依据。［方法］ 回顾性分析2014年1月至2016年4月衢州市柯城区人民医院485例肿瘤患者红细胞输注无效与相关因素之间的关系,分析输血不良反应发生率与输血效果的关联性。用Logistic回归分析可能影响肿瘤患者红细胞输注无效的因素。［结果］ 肿瘤患者红细胞输注无效比例为21.65%(105/485)。单因素分析显示肿瘤患者红细胞输注无效与既往输血次数、既往输血量及妊娠次数密切相关;迟发型溶血反应的发生率与肿瘤患者红细胞输注效果密切相关。Logistic回归分析显示多次输血(OR=8.48,P=0.00)是肿瘤患者红细胞输注无效的独立危险因素。［结论］ 有多次输血史的肿瘤患者发生红细胞输注无效的风险较高。针对有反复输血史的肿瘤患者,应制定独立、安全、有效的个体化输血策略。     

118例癌症长期生存者疲劳状况及影响因素分析

[目的]调查癌症长期生存者疲劳发生情况并探讨其影响因素。[方法]应用FSI量表及自行编制癌症长期生存者疾病和人口统计学相关信息登记表对118例癌症长期生存者进行调查,统计学方法采用Logistic回归和t检验等分析。[结果]118例研究对象中,63例疲劳者疲劳程度为2.84±1.47、持续时间3.51±1.73、对生活质量影响2.12±1.7。疲劳者与非疲劳者人口统计学及肿瘤特征差异无显著性(P>0.05),而在合并症数目、有无规律体育锻炼之间比较有明显差异(P<0.05)。疲劳者的疲劳程度、持续时间、对生活质量影响,有无规律体育锻炼之间比较有明显差异(P<0.05)。[结论]癌症长期生存者中合并症少、有规律参加体育锻炼者疲劳发生少,应重视合并症的治疗,鼓励其规律地参加体育锻炼。     

宁养肺癌患者生存状况及其影响因素研究

背景与目的 生存期和生活质量结合能更全面地评价患者的生存状况.本研究旨在分析宁养肺癌患者的生存期与生活质量,探讨二者的影响因素,为改善患者生存状况提供依据.方法 对盛京医院宁养病房收治的晚期肺癌患者进行回顾分析及随访,采用SPSS 13.0软件处理数据,用Kaplan-Meier法计算中位生存期,用肿瘤患者生活质量量表评价患者生活质量,研究两者与各因素间的关系.结果 269例患者生活质量平均得分28.76分,中位生存期为10个月.患者对病情的了解、止痛效果、KPS评分和营养状况是生活质量的独立影响因素;手术、疼痛出现早晚、止痛效果和KPS评分是生存期的独立影响因素.结论 晚期肺癌患者生存状况较差,应从上述因素加强和完善宁养服务,提高患者生活质量并延长其生存期.     

影响肿瘤病人健康教育效果的因素

目的提高肿瘤病人健康教育的效果。方法随机调查80名病人及72名护士进行问卷调查。结果病人对健康教育的满意度为95．6％，认为影响健康教育的因素主要有教育形式单一，方法不好，无法理解及记忆，护士知识不够，病情影响、时机不当等。护士认为影响健康教育的因素主要是缺乏教育时间，知识不够，教育方法不当，流于形式及健康教育的材料不足、不适用等。结论应采取切实可行的健康教育的方法增加对健康教育的投入、加强护士知识培训、制作VCD等教育材料，加强对健康教育的管理，重视对健康教育效果评价；向临床护士提供教育的时间，有条件的配备专职护士。     

肿瘤重症患者导管相关性感染的危险因素分析

目的探讨肿瘤重症患者导管相关性感染(CRI)的危险因素和病原学特点。方法回顾性分析158例留置中心静脉导管肿瘤重症患者的临床资料,对可能引起CRI的临床因素进行比较和分析,包括年龄、性别、近期手术史及放疗史、导管留置部位、导管腔数、营养方式、导管留置时间、经导管输血史。结果患者CRI的发病率为35.4%,导管腔数、导管留置时间和经导管输血史是发生CRI的独立危险因素(均P<0.05)。细菌培养结果显示,革兰氏阳性菌占46.4%,革兰氏阴性菌占33.9%,真菌占19.6%。最常见的病原体是表皮葡萄球菌,占21.4%。结论导管腔数多、导管留置时间过长和有经导管输血史是肿瘤重症患者导管相关性感染发生的危险因素,临床治疗时应尽量减少和避免。     

肿瘤相关性疲乏的研究现状

疲乏（fatigue）是肿瘤病人治疗前、治疗中或治疗后重要的主诉之一，它不同程度的影响着病人的日常生活，乃至延缓疾病的治疗过程，然而在临床工作中很少引起我们的重视。所谓肿瘤相关性疲乏就是指由于肿瘤本身或者肿瘤的治疗而引发的一种持续的主观的疲乏感觉，且与病人的日常活动量无关，它影响到病人的活动，而且不能因休息而缓解。在国外有关疲乏的研究有较多报道，但其发生的确切机制还不十分清楚，目前认为和肿瘤本身、治疗、焦虑、疼痛等较多因素相关。由于疲乏的评估缺乏客观指标，所以很难建立一个国际公认的标准，对疲乏的治疗措施也仅仅是纠正相关因素而不是对其成因的治疗。目前国内尚缺乏肿瘤相关性疲乏的报道，本文就有关的研究现状做一介绍。     

Mechanisms of cancer-related fatigue

Cancer-related fatigue (CRF) is one of the most prevalent symptoms patients with cancer experience, both during and after treatment. CRF is pervasive and affects patients' quality of life considerably. It is important, therefore, to understand the underlying pathophysiology of CRF in order to develop useful strategies for prevention and treatment. At present, the etiology of CRF is poorly understood and the relative contributions of the neoplastic disease, various forms of cancer therapy, and comorbid conditions (e.g., anemia, cachexia, sleep disorders, depression) remain unclear. In any individual, the etiology of CRF probably involves the dysregulation of several physiological and biochemical systems. Mechanisms proposed as underlying CRF include 5-HT neurotransmitter dysregulation, vagal afferent activation, alterations in muscle and ATP metabolism, hypothalamic-pituitary-adrenal axis dysfunction, circadian rhythm disruption, and cytokine dysregulation. Currently, these hypotheses are largely based on evidence from other conditions in which fatigue is a characteristic, in particular chronic fatigue syndrome and exercise-induced fatigue. The mechanisms that lead to fatigue in these conditions provide a theoretical basis for future research into the complex etiology of this distressing and debilitating symptom. An understanding of relevant mechanisms may offer potential routes for its prevention and treatment in patients with cancer.Disclosure of potential conflicts of interest is found at the end of this article.     

Management of cancer-related fatigue

Fatigue is among the most commonly reported symptoms of patients with cancer, with prevalence exceeding 60% in many studies. It is among the most distressing symptoms associated with cancer and cancer treatments because it substantially disturbs patients' quality of life and ability to function optimally on a daily basis. Although the development of this condition has been associated with a number of factors, its etiology remains poorly understood. Important elements to include in any definition of cancer-related fatigue include its pervasiveness, persistence, detrimental effect on quality of life, and its inability to be relieved by rest or sleep. Several validated questionnaires can be used to measure fatigue in patients with cancer, and research efforts are currently focused on ways to distinguish it from depression with which it shares many symptoms. All patients with cancer should be evaluated for fatigue, and treatment options should be considered for those who are experiencing excessive levels of fatigue. Treatment should be individualized according to the underlying pathology when a specific cause has been identified (e.g., anemia, sleep disorder, depression, or metabolic disorder). Nonspecific therapies may be useful in short- and long-term cancer-related fatigue management in many patients. In addition to older therapies, such as hematopoietics, antidepressants, corticosteroids, and psychostimulants, the effectiveness of the new wake-promoting agent modafinil is currently being studied. A more thorough evaluation of the various therapeutic options is required to better define their efficacy and safety profiles in this patient population.     

癌症相关性疲劳的治疗

 癌症相关性疲劳(CRF)是癌症患者尤其是治疗后长期生存患者重要症状之一。疲劳的复杂性以及与其他伴随症状的依赖性导致无法清晰识别潜在的机制,目前尚无一个病因学模型能够完全解释癌症相关性乏力的起因。建议对轻度疲劳患者推荐使用非药物治疗,对中重度疲劳患者推荐使用非药物治疗结合药物治疗。     

癌症相关疲劳的诊断与处理

癌症相关疲劳(CRF)严重影响患者生活质量,干扰治疗的正常进行。CRF在肿瘤临床并不少见,但至今未引起重视。现综述CRF的发生率、发病机制,重点介绍其诊断与鉴别诊断及其处理。     

Pharmacologic treatment of cancer-related fatigue

Fatigue is the most commonly reported symptom in patients with cancer, with a prevalence of over 60% reported in the majority of studies. This paper systematically reviews pharmacologic agents in the treatment of cancer-related fatigue (CRF). We conducted a literature review of clinical trials that assessed pharmacologic agents for the treatment of CRF. These agents include hematopoietics (for anemia), corticosteroids, and psychostimulants. Other therapeutic agents that are less well studied for CRF but are currently the focus of clinical trials include l-carnitine, modafinil, bupropion, and selective serotonin reuptake inhibitors such as paroxetine. Disclosure of potential conflicts of interest is found at the end of this article.     

癌性疲劳的相关研究进展

过去的几十年中,化疗药物所引起的副反应对肿瘤患者产生的影响一直以疼痛最为明显,近年来随着吗啡、芬太尼制剂等止痛药物的广泛应用,这一主诉对患者的影响逐渐下降,而疲劳感对肿瘤患者的影响逐渐凸显出来.本文旨在对癌性疲劳（cancer-related fatigue,CRF）的相关研究进展作一综述.     

肿瘤相关性疲乏的研究进展

疲乏是肿瘤患者最常见的临床症状之一,它影响着生活的方方面面,但是该症状始终没有得到足够重视和及时治疗。对肿瘤相关性疲乏的原因及治疗措施、评估量表、治疗方面的相关研究进行综述。