药物配合神经阻滞治疗带状疱疹神经痛的效果观察

目的：探讨药物配合神经阻滞治疗PHN的疗效.方法：选择我院60例PHN住院患者进行药物配合神经阻滞治疗,评估患者入院、出院时的疼痛程度及治疗效果。结果：60例PHN患者临床治愈34例(57.5%),好转21例(35%),无效4例(7.5%),总有效率92.5%。无1例患者出现神经根损伤及全脊麻危象,安全性高。结论：本研究应用无创疗法和微创疗法对PHN进行综合治疗,疗效可靠,安全性高、副作用少,可明显改善患者生活质量。     

疼痛护理和临终关怀对改善胃癌晚期患者生活质量的效果探讨

目的:探讨疼痛护理和临终关怀对改善胃癌晚期患者生活质量的效果。方法:选择我院2016年2月至2017年11月期间收治的胃癌晚期患者64例,随机分为对照组和观察组,各32例,对照组患者给予常规护理,观察组患者在对照组基础上给予疼痛护理和临终关怀护理,观察比较两组患者护理满意度及其生活质量。结果:护理后,观察组患者护理满意度为96.88%,明显优于对照组(P0.05);观察组患者在食欲、精神、疼痛、睡眠、自身对癌症的认识、治疗的不良反应等方面评分均显著高于对照组(P0.05)。结论:胃癌晚期患者护理过程中,给予疼痛护理和临终关怀护理能够有效提高患者护理满意度,从而提高患者生活质量,值得临床推广。     

盐酸羟考酮缓释片治疗晚期肿瘤中重度疼痛的临床观察

目的 观察盐酸羟考酮缓释片(奥施康定)在晚期肿瘤中重度疼痛的治疗效果、不良反应及生活质量改善情况.方法 应用盐酸羟考酮缓释片治疗80例晚期肿瘤患者的中重度疼痛,全面评估患者疼痛,确定好初始剂量,根据患者疼痛控制情况调整患者用药剂量,从而达到有效的镇痛效果,并观察患者用药前后生活质量改善情况及用药后患者不良反应的情况.结果 80例晚期肿瘤中重度疼痛患者,最终滴定剂量60-480mg/天,治疗后疼痛评分在3分以下(疼痛达满意控制)的患者71例,占88.7%,经镇痛治疗后患者食欲增加,睡眠明显改善,生活质量提高.在所有不良反应中,便秘最常见(发生率为15.0%),其次是恶心、呕吐、头晕,无呼吸抑制及"成瘾"的发生.结论 盐酸羟考酮缓释片在治疗晚期肿瘤中重度疼痛方面安全有效,副作用小,生活质量明显提高,适合慢性癌痛患者长期使用.     

疼痛护理联合临终关怀对晚期胃癌患者的影响

目的探讨疼痛护理联合临终关怀对晚期胃癌患者的影响。方法选择2016年1月-2018年12月期间广东省肇庆市四会市人民医院162例晚期胃癌患者,根据入院顺序分为观察组80例和对照组82例,对照组患者给予常规治疗及常规护理,观察组在对照组的基础上给予临终关怀,比较两组的疼痛评分、生活质量评分及护理满意度。结果两组患者经护理后的疼痛评分均降低,且观察组的降低情况优于对照组,差异有统计学意义(P0.05)。观察组的生活质量评分优于对照组,差异有统计学意义(P0.05)。观察组的满意度为98.8%,高于对照组的89.0%,差异有统计学意义(P0.05)。结论疼痛护理联合临终关怀有助于改善晚期胃癌患者的生活质量,提高患者对护理的满意度,值得应用推广。     

心理咨询技能在肿瘤晚期患者疼痛护理中的应用分析

目的:观察心理咨询技能在临床上对于肿瘤晚期患者疼痛护理中的应用效果。方法:随机将96例肿瘤晚期患者分为观察组和对照组,每组48例。对照组采用常规治疗护理,观察组在常规治疗护理的基础上,采取心理咨询技能对患者进行干预。结果:采用心理咨询技能干预后,观察组患者疼痛缓解效果显著优于对照组,差异有统计学意义(P<0.05)。结论:对肿瘤晚期患者采用心理咨询技能,有利于患者主动配合治疗,显著改善患者的疼痛,提高患者治疗依从性,明显促进了临床护理质量和效率,保障了患者的生活质量。     

优质护理在晚期胃癌患者疼痛护理中的应用

目的：探讨优质护理在晚期胃癌患者疼痛护理管理中的应用效果。方法：60例晚期胃癌患者,随机分为观察组和对照组,各30例。观察组采取优质护理模式,对照组采取常规疼痛护理,比较两组患者的疼痛程度及护理服务满意度。结果：观察组患者的疼痛情况明显优于对照组,差异有统计学意义（P<0.05）;观察组患者护理服务满意率为96.7%（满意29例,不满意1例）,明显高于对照组的86.7%（满意26例,不满意4例）,差异有统计学意义（P<0.05）。结论：优质护理应用于晚期胃癌患者的疼痛护理管理中可明显缓解患者疼痛症状,改善患者预后,有利于提高患者生活质量,值得在临床推广应用。     

晚期癌痛患者接受宁养服务的观察与护理

目的评价宁养服务在提高晚期癌痛患者的生命质量中的作用.方法自制问卷对101例接受宁养服务的各类晚期癌痛患者进行生活质量测评,通过比较宁养服务前后患者常见症状改善情况,经过宁养服务后疼痛缓解率,评价宁养服务对晚期癌痛患者生命质量的影响.结果经过宁养服务,患者的疼痛得到不同程度缓解,疼痛缓解70%患者占24.75%;疼痛缓解80%患者占28.71%.常见临床症状有不同程度的改善,生活质量明显提高.结论晚期癌痛患者采用药物三阶梯止痛为重点,控制患者症状,给患者以心理疏导、心理治疗、护理指导及家属支持为主要手段的综合支持治疗的宁养服务,可明显提高患者的生命质量.     

临终关怀对晚期化疗患者不良情绪及生活质量的影响

目的 探讨临终关怀应用于晚期化疗患者中对其不良情绪及生活质量的影响.方法 64例住院化疗的老年晚期肿瘤患者分为对照组和观察组各32例,分别接受常规护理和临终关怀;评价两组患者干预前后抑郁和焦虑及自尊心理状态,问卷调查患者干预后的生活质量、治疗依从性及护理满意度.结果 干预后,两组患者的焦虑、抑郁、自尊心理得分均较干预前改善,且观察组患者焦虑、抑郁得分低于对照组,自尊心理得分高于对照组,差异均有统计学意义(P＜0.05);经干预后,观察组患者治疗依从性、生活质量改善、护理满意度均显著优于对照组(P＜0.05).结论 临终关怀有利于改善老年晚期肿瘤化疗患者的不良情绪,增强其自尊心,改善其生活质量.     

黄芪注射液配合化疗对晚期非小细胞肺癌患者生存质量的影响

目的：：观察黄芪配合化疗对晚期非小细胞肺癌(NSCLC)患者生存质量的影响。方法：选取60例NSCLC晚期患者随机分组：对照组（单纯化疗组）和治疗组（黄芪注射液配合化疗）各30例。两组均采用TP化疗方案,两组治疗组同时辅以黄芪注射液30ml/d静滴。1周期为21～28d,治疗2～3周期观察治疗结果。结果：对照组为36.7%,治疗组有效率为40.0%;两组平均缓解期分别为5.4个月和3.3个月;中位生存期分别为11个月和7个月,;1年生存率分别为46.7%和30.0%,均有显著性差异(P<0.05);观察组的临床症状改善率为80.4%,生存质量提高阳性率43.3%,明显高于对照组(临床症状改善率为50.0%,生存质量提高阳性率为23.3%)(P<0.01)。结论：黄芪注射液配合化疗对晚期非小细胞肺癌患者生存质量具有显著改善的作用。     

PKRP术联合内分泌疗法治疗晚期前列腺癌合并膀胱出口梗阻的短期疗效分析

目的：研究经尿道前列腺等离子电切术（PKRP）结合内分泌疗法治疗晚期前列腺癌（PCa）合并膀胱出口梗阻的短期效果。方法：根据乱数表法将本院2017年8月至2020年8月收治的100例晚期PCa合并膀胱出口梗阻患者分为常规组49例,给予内分泌疗法治疗;观察组51例在常规组基础上给予PKRP术治疗,观察两组尿流动力学指标、临床症状、生活质量和并发症发生情况。结果：治疗后,观察组最大尿流率、平均尿流率均高于常规组,残余尿量低于常规组（P<0.05）;观察组每日排尿次数、憋尿困难、尿不尽感评分均低于常规组（P<0.05）;观察组社会功能、心理功能、物质功能以及躯体功能评分均高于常规组（P<0.05）;观察组并发症发生率（9.80%）与常规组（6.12%）相比无统计学差异（P>0.05）。结论：PKRP术联合内分泌疗法可改善晚期PCa合并膀胱出口梗阻患者减轻尿道梗阻状况,调节尿流动力学指标,缓解排尿障碍等相关临床症状,提高生活质量,且不会增加并发症。     

Perspectives on the Pain of the Hospice Patient

Behind the physical disfigurement and emotional ravages of advanced malignancy, it is the pain of cancer that is most dreaded. Severe biological pain is experienced by fewer than half of patients dying from cancer. Hospice physicians have the expertise to control the pain of those cancer patients who do experience it. The cancer patient may experience other forms of pain that can be equally devastating: pain of isolation, pain of abandonment, and pain of loss of role. It is important for the occupational therapist working in a hospice setting to understand all aspects of pain management, and the occupational therapy treatment strategies which can improve the quality of life and perception of pain for the hospice patient. Through presentation of case studies, the authors illustrate applications of occupational therapy assessments and interventions in respect to two hospice patients. The occupational therapy treatment strategies effected an improvement in the quality of life for these patients and consequently their perception of pain of loss of role. Occupational therapists, as part of the hospice team, play an important part in giving patients an opportunity to live out their lives in as dignified and purposeful a manner as their disease permits.     

芬太尼透皮贴剂治疗晚期肺癌中重度疼痛120例护理观察

目的观察缓释芬太尼透皮贴剂（多瑞吉）治疗晚期肺癌中重度疼痛的疗效及不良反应,提出合理的治疗及护理措施。方法应用芬太尼透皮贴剂治疗肺癌晚期中重度癌痛患者120例,按照主诉疼痛的程度分级法（VRS法）判断疼痛缓解程度,按生活质量评分标准（QOL）评定生活质量等指标,每24小时评定一次,并观察不良反应。结果患者疼痛缓解率为93.75%,其中完全缓解59例（49%）,明显缓解46例（38%）,生活质量明显改善（P〈0.05）。不良反应主要为恶心、呕吐、便秘、嗜睡、头晕。结论缓释芬太尼透皮贴剂治疗肺癌晚期中重度疼痛效果良好,不良反应轻,应用方便;采取恰当的护理措施可提高疗效,减轻或避免不良反应的发生。     

The relationship between cancer pain and quality of life in patients newly admitted to Wuhan Hospice Center of China

To evaluate the relationship between pain and quality of life (QoL) in patients newly admitted to Wuhan Hospice Center, China. A total of 1,634 patients were analyzed in this retrospective study. A Numerical Rating Scale and Chinese-QoL instrument were used to assess pain score and QoL, respectively. Most patients experienced moderate to severe pain, which significantly impaired QoL. The pain was significantly correlated with appetite, mood, sleep, fatigue, pain intensity, daily activity, side effect, general appearance, and support from family. But there was no correlation with support from society, understanding of cancer, or attitude toward treatment. In our study, the relationship between pain and QoL was found to be reciprocal. The staff can offer a multidisciplinary care perspective for improving hospice care for this special group of population.     

Multidimensional continuous pain assessment chart (MCPAC) for terminal cancer patients: a preliminary report

Current use of pain measures is limited in clinical practice. The common pain measures neither target nor monitor the changes that occur with time with regard to the effect of other parameters associated with pain control. Changes in parameters, such as pain type, various pharmacological and nonpharmacological interventions, dosage of medications, and use of rescue doses, usually complicate pain control in terminal cancer patients. The authors propose use of a multidimensional, continuous pain chart that permits better assessment and control of pain. The chart integrates visual analogue pain assessment, special treatment techniques, regular medications and rescue doses, co-analgesics, pain categories, parameters relating to quality of life, sleep, and mobility. A total of 1,178 assessments were performed in 100 consecutive patients with full compliance. The chart permitted a continuous monitoring of patients 'most important needs concerned with pain control and was easily integrated into the hospice daily routines. We conclude that the chart represents an effective and friendly graphic tool to monitor pain and associated parameters that relate to the quality of the broad spectrum of pain control. The hope is that this tool may improve pain control by hospice professionals and facilitate communication between patients and the interdisciplinary team members.     

高压氧治疗对老年性骨质疏松症疼痛的疗效研究

目的　观察高压氧在治疗老年骨质疏松症疼痛及提高生存质量中的疗效。方法　 45例老年性骨质疏松症患者 ,均有自发性疼痛 ,随机分两组 ,Ⅰ组为对照组用钙剂治疗 ,Ⅱ组为治疗组 ,用钙剂加高压氧治疗。二组在治疗前均测股骨颈及腰椎骨密度 (BMD)无明显差异。结果　治疗组在用高压氧治疗二疗程 ( 2 0次 )后疼痛明显减轻 ,生存质量明显提高 ,与对照组相比P <0 0 5。结论　药物配合高压氧治疗在缓解骨质疏松症疼痛及提高生存质量方面比单纯药物治疗具有更好疗效     

Hospice Family Members' Perceptions of and Experiences With End-of-Life Care in the Nursing Home

Objective

Even though more than 25% of Americans die in nursing homes, end-of-life care has consistently been found to be less than adequate in this setting. Even for those residents on hospice, end-of-life care has been found to be problematic. This study had 2 research questions; (1) How do family members of hospice nursing home residents differ in their anxiety, depression, quality of life, social networks, perceptions of pain medication, and health compared with family members of community dwelling hospice patients? (2) What are family members’ perceptions of and experiences with end-of-life care in the nursing home setting?

Methods

This study is a secondary mixed methods analysis of interviews with family members of hospice nursing home residents and a comparative statistical analysis of standard outcome measures between family members of hospice patients in the nursing home and family members of hospice patients residing in the community.

Results

Outcome measures for family members of nursing home residents were compared (n = 176) with family members of community-dwelling hospice patients (n = 267). The family members of nursing home residents reported higher quality of life; however, levels of anxiety, depression, perceptions of pain medicine, and health were similar for hospice family members in the nursing home and in the community. Lending an understanding to the stress for hospice family members of nursing home residents, concerns were found with collaboration between the nursing home and the hospice, nursing home care that did not meet family expectations, communication problems, and resident care concerns including pain management. Some family members reported positive end-of-life care experiences in the nursing home setting.

Conclusion

These interviews identify a multitude of barriers to quality end-of-life care in the nursing home setting, and demonstrate that support for family members is an essential part of quality end-of-life care for residents. This study suggests that nursing homes should embrace the opportunity to demonstrate the value of family participation in the care-planning process.     

晚期肿瘤患者及家属的心理干预对患者生活质量的影响分析

目的 分析与探讨心理干预对于晚期肿瘤患者的生活质量的影响.方法 对本科室2008~2011年收治的170例晚期肿瘤患者的心理进行分析,按照患者的需求,给予其以临终关怀为中心的心理干预护理,帮助患者能够得到家庭的支持,使得患者身心平衡,最终有尊严地安详地步入死亡.结果 通过对170例晚期肿瘤患者及其家属进行有效的心理干预后,总体的不良心理得到明显的改善,相应的症状和痛苦有所减轻.结论 对于晚期肿瘤患者及其家属,采用适宜的心理干预对于提高患者的生存质量,尽量延长患者的生命有着重要的帮助.本文的结果显示,心理干预在临床对晚期肿瘤患者的治疗与护理过程中值得推广与应用.     

Spiritual pain: a comparison of findings from survivors and hospice patients

The article presents comparative research findings on the notion of "spiritual pain." The findings from interviews with hospice patients affirm the previously published, preliminary conceptualization of spiritual pain from interviews with survivors. However, while the survivor findings highlight the potential for spiritual pain associated with life after high-tech curative treatment, the hospice patient data emphasize the protectiveness of the hospice experience for deflecting the possibility of spiritual pain. It is anticipated the discussion of comparative findings will affirm the importance of researching this "ignored dimension" and, in so doing, will enrich our understanding of the spiritual dimension of healthcare. The work is part of a program presently developing a language of spirituality through research.     

疼痛工作站激光治疗带状疱疹后遗神经痛的护理

目的:观察疼痛工作站激光治疗带状疱疹后遗神经痛(PHN)的效果,总结护理体会。方法:疼痛工作站激光疗法治疗带状疱疹后遗神经痛30例,观察其治疗前后的疼痛情况。通过适当的护理及心理指导,30例患者完成了治疗,疼痛状况明显较前改善,生活质量有所提高。结果:经过合理规范的激光治疗,在患者治疗过程中未出现任何不良反应,在镇痛效果上取得一定疗效,通过治疗前的心理护理,治疗中规范的护理操作,治疗后的护理健康教育,有效降低患者痛阈,镇静药物使用明显减少,提高了患者的生活质量。结论:疼痛工作站激光治疗带状疱疹后遗神经痛使患者疼痛得到有效缓解,是治疗带状疱疹后遗神经痛的一种理想理疗方法。     

Operative treatment of painful neuromas

3-5% of patients with traumatic or iatrogenic peripheral nerve injury develop a painful neuroma, especially following trauma of small cutaneous sensory nerve branches. Neuroma pain is difficult to treat and often leads to loss of function and reduction of quality of life. Patients with a painful neuroma present with spontaneous electric, shooting or burning pain, allodynia, hyperalgesia and cold intolerance. The diagnosis is based on the medical history and physical examination, supplemented by Tinel's test and a diagnostic nerve blockade. Lasting pain relief is possible by means of surgical neuroma treatment performed by a plastic surgeon. Surgical treatment consists of repair or denervation of the nerve with relocation of the nerve stump in bone or muscle tissue or a vein. Referral of neuroma patients without delay to a plastic surgeon or multidisciplinary consultation is important, because the symptoms become increasingly difficult to treat over time. 3-5% of patients with traumatic or iatrogenic peripheral nerve injury develop a painful neuroma, especially following trauma of small cutaneous sensory nerve branches. Neuroma pain is difficult to treat and often leads to loss of function and reduction of quality of life. Patients with a painful neuroma present with spontaneous electric, shooting or burning pain, allodynia, hyperalgesia and cold intolerance. The diagnosis is based on the medical history and physical examination, supplemented by Tinel's test and a diagnostic nerve blockade. Lasting pain relief is possible by means of surgical neuroma treatment performed by a plastic surgeon. Surgical treatment consists of repair or denervation of the nerve with relocation of the nerve stump in bone or muscle tissue or a vein. Referral of neuroma patients without delay to a plastic surgeon or multidisciplinary consultation is important, because the symptoms become increasingly difficult to treat over time.