气压治疗仪联合全程健康教育干预对宫颈癌术后患者下肢深静脉血栓形成的预防效果

目的 探讨气压治疗仪联合全程健康教育干预对宫颈癌术后患者下肢深静脉血栓形成的预防效果.方法 根据干预方式的不同将118例宫颈癌根治术后患者分为观察组和对照组,每组59例.对照组患者予以气压治疗仪治疗,观察组患者在对照组的基础上予以全程健康教育干预,两组患者均治疗1个月.比较干预前后两组患者的凝血指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)以及纤维蛋白原(FIB)水平]和干预后的下肢深静脉血栓发生率.分别采用生活质量综合评定问卷-74(GQOL-74)和自制调查问卷评价两组患者的生活质量和护理满意度.结果 干预后,观察组患者的TT、APTT、PT均短于对照组,FIB水平低于对照组,差异均有统计学意义(P﹤0.05).观察组患者的下肢深静脉血栓总发生率为10.17％,低于对照组的25.42％(P﹤0.05).干预后,观察组患者的社会功能、心理功能、躯体功能及物质生活评分均高于对照组,差异均有统计学意义(P﹤0.05).观察组患者的护理满意度为89.83％,高于对照组的71.19％(P﹤0.05).结论 对宫颈癌术后患者予以气压治疗仪治疗联合全程健康教育干预,有利于降低凝血指标水平和下肢深静脉血栓发生率,提高术后生活质量和护理满意度.     

分级心理干预联合气压泵气压治疗对宫颈癌术后患者下肢深静脉血栓形成的预防效果

目的 探讨分级心理干预联合气压泵气压治疗对宫颈癌术后患者下肢深静脉血栓形成的预防效果。方法 采用随机数字表法将108例宫颈癌手术患者分为对照组（n=54）和观察组（n=54）,对照组患者予以气压泵气压治疗,观察组患者在对照组的基础上予以分级心理干预。比较两组患者的凝血指标[凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）以及纤维蛋白原（FIB）水平]、血流速度、下肢深静脉血栓发生率及满意度。结果 干预后,两组患者PT、APTT、TT均短于本组干预前,FIB水平均低于本组干预前,观察组患者PT、APTT、TT均短于对照组,FIB水平低于对照组,差异均有统计学意义（P﹤0.05）。干预后,两组患者下肢股静脉和足背静脉血流速度均高于本组干预前,且观察组患者下肢股静脉和足背静脉血流速度均高于对照组,差异均有统计学意义（P﹤0.05）。观察组患者下肢深静脉血栓发生率低于对照组,满意度高于对照组,差异均有统计学意义（P﹤0.05）。结论 对宫颈癌术后患者应用分级心理干预联合气压泵气压治疗,能够改善患者的凝血指标,加快患者血流速度,预防下肢深静脉血栓形成,且患者满意度较高,...     

脑胶质瘤术后发生下肢深静脉血栓的影响因素分析

目的 探讨脑胶质瘤患者术后发生下肢深静脉血栓的影响因素,为临床防治提供参考和依据。方法将76例脑胶质瘤患者根据术后是否发生下肢深静脉血栓分为下肢深静脉血栓组(n=21)与非下肢深静脉血栓组(n=55)。比较两组患者的临床资料,采用多因素Logistic回归分析筛选脑胶质瘤患者术后发生下肢深静脉血栓的危险因素。结果 下肢深静脉血栓组中年龄>60岁及合并高血压、脑血栓、下肢静脉曲张的患者比例均高于非下肢深静脉血栓组,差异均有统计学意义(P <0.05)。多因素Logistic回归分析结果显示,年龄> 60岁及合并高血压、脑血栓、下肢静脉曲张均为脑胶质瘤患者术后发生下肢深静脉血栓的独立危险因素(P<0.01)。结论年龄>60岁及合并高血压、脑血栓、下肢静脉曲张均为脑胶质瘤患者术后发生下肢深静脉血栓的独立危险因素,可针对上述因素制订相关临床措施,预防脑胶质瘤患者术后发生下肢深静脉血栓。     

气压治疗联合利伐沙班对结直肠癌术后下肢深静脉血栓的防治作用

目的 探讨气压治疗联合利伐沙班对结直肠癌术后下肢深静脉血栓的防治作用.方法 选取2018年2月至2019年5月间武汉市第一医院收治的82例手术治疗的结直肠癌患者.根据治疗方法 不同进行分组,采用利伐沙班治疗的41例患者纳入对照组,采用气压治疗联合利伐沙班治疗的41例患者纳入观察组.比较两组患者下肢深静脉血栓发生情况、血...     

分层次个性化健康指导对宫颈癌患者术后自我效能感、自我护理能力及功能锻炼效果的影响

目的 探讨分层次个性化健康指导对宫颈癌患者术后自我效能感、自我护理能力及功能锻炼效果的影响.方法 采用随机数字表法将110例接受宫颈癌根治术的宫颈癌患者分为对照组(n=55)和观察组(n=55),对照组患者予以常规健康指导,观察组患者予以分层次个性化健康指导,两组患者均干预2周.分别采用一般自我效能感量表(GSES)、...     

老年肺癌胸腔镜手术后下肢深静脉血栓的危险因素分析及预测模型的建立和验证

目的分析老年肺癌胸腔镜手术后下肢深静脉血栓的危险因素, 建立列线图预测模型并进行内部验证。方法选择2018年2月至2022年2月在南充市中心医院行胸腔镜根治术治疗的183例老年肺癌患者作为研究对象。根据术后1个月内有无下肢深静脉血栓将患者分为下肢深静脉血栓组(n=61)和非下肢深静脉血栓组(n=122)。对老年肺癌胸腔镜手术后下肢深静脉血栓形成进行单因素及多因素分析, 根据多因素分析结果构建列线图预测模型, 并对模型进行验证。结果下肢深静脉血栓组与非下肢深静脉血栓组患者吸烟史(χ2=13.40, P<0.001)、术前化疗(χ2=8.79, P=0.003)、手术方式(χ2=7.97, P=0.005)、手术时间(t=7.23, P<0.001)、术后卧床时间(t=10.40, P<0.001)、合并糖尿病(χ2=6.37, P=0.012)、合并高脂血症(χ2=9.58, P=0.002)、术前D-二聚体(t=13.08, P<0.001)、术前纤维蛋白原(t=5.84, P<0.001)、术前血小板计数(t=7.01, P<0.001)差异均具有...     

胸部肿瘤患者开胸术后下肢深静脉血栓形成的预见性护理

目的 探讨预见性护理在预防胸部肿瘤患者开胸术后下肢深静脉血栓形成中的应用效果。 方法 采用随机数字表法将232例行开胸手术治疗的胸部肿瘤患者分为观察组与对照组,每组116例。对照组给予常规护理,观察组在常规护理基础上给予预见性护理,比较两组患者下肢深静脉血栓发生率、静脉通畅评分和下肢静脉血流速度。 结果 观察组发生下肢深静脉血栓3例,术后下肢深静脉血栓发生时间为（9.0±1.3） d,住院时间为（36.7±3.5） d。对照组发生下肢深静脉血栓11例,发生时间为（5.2±0.9） d,住院时间为（46.0±5.9） d,两组比较差异均有统计学意义（P均＜0.05）。观察组静脉通畅评分和下肢静脉血流速度分别为（5.2±1.2）分、（18.3±4.1）cm/s,对照组分别为（9.0±2.3）分和（14.0±3.3） cm/s,两组比较差异均有统计学意义（P均＜0.05）。结论 采用预见性护理可促进胸部肿瘤开胸术后患者深静脉血流通畅,对预防下肢深静脉血栓形成及减轻患者经济负担具有积极作用。     

巴曲亭在NSCLC手术低分子肝素抗凝中的应用研究

目的 探讨肺癌患者术中配合低分子肝素抗凝时加用巴曲亭对预防下肢静脉血栓形成的临床疗效.方法 选取137例行肺叶或全肺切除术治疗的非小细胞肺癌患者,随机分为观察组和对照组.观察组术中注射巴曲亭,对照组给予相同剂量的安慰剂,两组患者均在术后12小时内开始预防性使用低分子肝素.观察比较两组患者术中出血量、术后总引流量、血液凝固水平及下肢静脉血流情况.结果 观察组患者的术中出血量、术后总引流量分别为(354.32±75.20) mL、(211.52±72.16) mL,与对照组比较差异有统计学意义(P＜0.05).手术前后血液凝固水平两组差异不明显(P＞0.05).术后5天下肢深静脉彩色多普勒超声检查示,观察组2例发生下肢深静脉血栓,对照组1例,其余患者的下肢深静脉回流速度和回流血量差异不明显(P＞0.05).结论 术中应用巴曲亭能够明显减少应用低分子肝素抗凝的肺癌术后患者的出血量,且不会增加下肢静脉血栓的发生率,具有一定的临床推广价值.     

34例恶性肿瘤并发急性下肢深静脉血栓形成临床分析

[目的]探讨溶栓、抗凝等常规方法对恶性肿瘤并发的急性下肢深静脉血栓形成(DVT)的疗效。[方法]34例恶性肿瘤并发的DVT患者为观察组,选择34例创伤或手术后并发的DVT患者为对照组,两组均给予溶栓、抗凝等常规治疗,比较两组下肢深静脉再通情况和疗效。[结果]观察组下肢深静脉再通率、有效率均低于对照组(χ2=7.731,P=0.021;χ2=6.969,P=0.031)。[结论]常规方法对恶性肿瘤并发的急性下肢深静脉血栓形成的疗效较差。     

新辅助化疗在局部晚期宫颈癌患者中的疗效观察

目的 探讨新辅助化疗在局部晚期宫颈癌患者中的疗效.方法 根据术前是否接受新辅助化疗将108例局部晚期宫颈癌患者分为对照组(n=53)和观察组(n=55),对照组患者不给予新辅助化疗而直接进行开腹根治性手术治疗,观察组患者术前给予新辅助化疗.比较两组患者一般手术指标、血清肿瘤标志物[血管内皮生长因子(VEGF)、癌胚抗原(CEA)、鳞状细胞癌抗原(SCC-Ag)]水平、病理学结果、生命质量和观察组不良反应发生情况.结果 观察组患者手术时间明显短于对照组(P﹤0.01),术中出血量明显低于对照组(P﹤0.01).术后,两组患者血清VEGF、CEA、SCC-Ag水平均低于本组术前(P﹤0.05),且观察组患者血清VEGF、CEA、SCC-Ag水平均低于对照组(P﹤0.05).观察组患者淋巴结转移阳性率、阴道切缘阳性率和宫旁累及阳性率均明显低于对照组(P﹤0.01).术后,两组患者欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)评分均高于本组术前(P﹤0.05),且观察组患者EORTC QLQ-C30评分高于对照组(P﹤0.05).观察组新辅助化疗过程中发生胃肠道反应9例、轻度骨髓抑制1例、皮疹2例,不良反应总发生率为21.82％(12/55),对症治疗后均好转,未影响正常手术时间.结论 术前进行新辅助化疗有助于缩短手术时间,减少术中出血量,降低血清肿瘤标志物水平,有效控制肿瘤转移,提高术后生活质量.     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

Second-line chemotherapy with cisplatin-ifosfamide in patients with ovarian cancer previously treated with carboplatin-cyclophosphamide.

In an effort to use antineoplastic drug combinations which are active in platinum resistant ovarian cancer or which can induce a second response after a platinum first-line treatment, we conducted a study on 30 ovarian cancer patients previously treated with carboplatin plus cyclophosphamide who were given ifosfamide 5 g/m2 i.v. divided over days 1 to 3 plus mesma combined with cisplatin 100 mg/m2 i.v. divided over days 1 to 3 every 4 weeks as second-line treatment. Eight patients had never entered remission with first-line chemotherapy while 22 patients had tumor recurrence within 6 to 18 months after the end of chemotherapy and their tumors were considered potentially platinum sensitive. Responding patients received 6 courses while palliative treatment for nonresponders was provided. Of the 22 patients with tumor recurrence, 8 patients responded with one partial response (PR) and 7 complete clinical responses (CCR). Two out of the 8 patients with platinum resistant disease demonstrated short lasting PR. Seven patients with CCR underwent second-look operation and in two a pathological CR was documented. Median time to progression was 6 mo (4-12). The median overall survival was 12 mo (4-20). Myelotoxicity despite G-CSF administration was significant with grade 4 leukopenia in 40% and grade 3 thrombocytopenia in 20% of patients. Central nervous system (CNS) toxicity was significant with 30% somnolence, 20% disorientation and an episode of grand-mal epilepsy ascribed to ifosfamide. With a 33% response rate the combination is as effective as new agents employed in relapsed ovarian cancer. Platinum-refractory disease may respond to a lesser degree. The most important determinant of response was the progression-free interval from first-line chemotherapy. Whether patients recurring after carboplatin plus cyclophosphamide have a greater chance to respond to cisplatin plus ifosfamide or vice-versa cannot be supported by the current data and therefore randomized studies should be performed to this end.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs