晚期恶性肿瘤患者169例死亡时间分析

目的 探讨晚期恶性肿瘤临终患者死亡时间的规律.方法 对我院2008年1月-2009年12月安宁病房169例晚期恶性肿瘤死亡患者的病史资料进行分析.结果 169例死亡病例中,与节气有关者102例,占60.4%.一天24小时中,死亡高峰在上午和上半夜,其次为下半夜,分别占26.63%,26.63%和23.67%,但具体时间以子时死亡人数为最多.一年四季中以冬季死亡率最高,月份中以12月死亡率最高.结论 晚期恶性肿瘤临终患者死亡与现代生物钟理论基本相符.应在死亡高发季节、时间共同做好濒死及死亡护理,及时与家属告知、沟通.     

五省市注册临终关怀机构晚期恶性肿瘤患者的医疗费用调查

目的 了解五省市临终关怀机构晚期恶性肿瘤患者的医疗费用情况,并分析其影响因素,为临终关怀政策的制定提供数据和参考.方法 采用问卷调查的方法,对北京、上海、四川、云南、浙江5省市登记注册的6所临终关怀机构的晚期恶性肿瘤住院患者的医疗费用进行调查与分析.结果 被调查临终关怀机构晚期恶性肿瘤住院患者的平均住院日为33.45 d,平均每人出院医疗费用为12 870.33元,日均医疗费用为359.92元,其中床位费占11.81%,药品费占45.40%,诊疗费占2.80%,检查费占14.18%,护理费占5.22%,治疗费占8.39%,材料费占6.86%;享有基本医疗保险的占78.10%,劳保医疗占3.94%,合作医疗占2.57%,自费占23.48%;医疗费用自付比例<5%占3.12%,5%～9%占6.14%,≥10%占90.74%.结论 晚期恶性肿瘤患者的医疗费用过高,在临终阶段晚期恶性肿瘤患者中还存在过度医疗现象.应积极推广WHO所提倡的临终关怀服务理念,探索具有中国特色的临终关怀服务模式与运作机制.     

恶性肿瘤晚期患者需要认知差异引发的护患冲突与对策

我国恶性肿瘤的年发病例数约为160万人，死亡约130万人，现患癌症病人200多万。平均每死亡5个人中，就有1人死于恶性肿瘤。由于我国社区护理处于起步阶段，大部分临终的恶性肿瘤晚期患者将在医院度过。肿瘤晚期患者护理量大，护理人员做了大量工作，却得不到患者家属的认可。为此，笔者采用问卷调查法进行了调查，现报告如下：     

晚期肿瘤病人临终关怀的护理体会

晚期肿瘤患者随着病情的加重 ,病人日渐衰竭 ,伴发许多并发症 ,面临死亡 ,在躯体、心灵上都十分痛苦 ,进入临终末期主要以护理为主 ,如何能更好地实施临终关怀 ,是肿瘤科护士面临的重要职责。为了更好地解除病人的痛苦 ,维护人的至死尊严 ,增强晚期肿瘤病人生理、心理的适应能力 ,提高临终病人的生活质量 ,有效地对病人实施临终关怀[1] ,现将护理要点进行探讨分析。1　临床资料2 0 0 3年 1～ 7月我科收治的晚期肿瘤患者 12 0例 ,其中男 72例 ,平均年龄 6 1岁 ,女 48例 ,平均年龄 5 7岁。原发性肝癌 38例 (占 31 6 7%) ,这些肝癌患者有不同程…     

重型颅脑损伤患者早期肠内营养的临床效果观察

目的探讨重型颅脑损伤患者进行早期肠内营养的效果方法将80例重型颅脑损伤患者随机分为观察组和对照组各40例,观察组术后48-72小时开始肠内营养,对照组常规治疗。分别观察两组腹泻、应激性溃疡等并发症的发生率结果观察组出现腹泻2例,占5%,应激性溃疡4例,占10%。对照组出现腹泻10例占25%,应激性溃疡13例占32%。结论重型颅脑损伤患者进行早期肠内营养,不但能增强机体免疫功能,改善机体营养状况,还能减少腹泻、应激性溃疡的发生。     

应激性消化道出血12例分析

目的探讨引起应激性消化道出血的常见原因及应对措施。方法对我院2010年1—12月发生应激性消化道出血患者的资料进行回顾性分析。结果发生应激性消化道出血12例,其中5例治愈,7例死亡。结论引起应激性消化道出血的原因较多,常见疾病为脑创伤、脑出血、恶性肿瘤晚期多器官衰竭和重度感染（败血症）,对此类患者进行预防性抑胃酸治疗,可防止或减少应激性消化道出血。     

22年来延边大学教职工恶性肿瘤发病情况报告

对1971～1992年间,延边大学教职工恶性肿瘤发病情况做了回顾性调查.调查教职工人次总数17244人次,发生恶性肿瘤32例.发病率185.57/10~5.前11年,发生恶性肿瘤8例,发病率136.12/10~5,后11年发生恶性肿瘤24例发病率211.11/10~5,说明恶性肿瘤发病率后11年比前11年明显上升.恶性肿瘤的发病率和死亡率在61～80岁年龄组最高.恶性肿瘤死亡26例,其死亡率150.78/10~5.肝癌在恶性肿瘤死亡中占首位.肝癌发病率最高.其次、肺癌、胃癌.     

恶性肿瘤晚期患者临终关怀重要性分析

目的:观察分析恶性肿瘤晚期患者临终关怀的重要性。方法:对395例恶性肿瘤晚期患者进行行为言语评估记录,经医院医护人员对患者实施临终关怀(主要包括临终心理关怀、临终生理关怀、临终生命伦理关怀)后,在患者最终去世后由管床护士再次按如下评估表对患者进行行为言语总结,对以上数据进行回顾性分析。结果:入院后情绪可控患者有361例,占总人数的91.4%,入院时总体得分80分,人均得分只有0.2分,入院后总体得分为504分,人均得分1.3分,入院前后比较,差异有统计学意义(P<0.05)。结论:对恶性肿瘤晚期患者进行临终关怀能够极大改观患者的生活态度,很好地安抚患者心情,也体现了临终关怀的重要意义。     

上海市18所社区临终关怀试点机构晚期恶性肿瘤临终患者居家医疗费用的调查与分析

目的评价2012年上海市政府实施临终关怀项目试点机构居家晚期恶性肿瘤临终患者医疗费用的经济效益,为社区临终关怀政策提供参考。方法采用问卷调查的方法对2013年18所社区试点机构居家临终关怀服务的医疗费用进行调查与分析。结果居家晚期恶性肿瘤临终病人平均住床日69.95天,医疗费用人均1610.82元,日均25.04元。费用占比:查床费21.56%,药品费31.44%,检查费8.43%,治疗费11.75%,材料费9.86%。结论目前晚期恶性肿瘤临终患者医疗费用昂贵,其中无效医疗费用尤高,居家临终患者医疗费用不高,开展居家临终关怀具有经济、方便、适宜和公平性,值得进一步发展。但居家临终关怀服务收费项目需要进一步完善。     

选择性动脉灌注化疗晚期头颈部恶性肿瘤的疗效观察

目的 观察动脉灌注顺铂DDP、5-Fu、BLM、治疗晚期头颈恶性肿瘤的疗效.方法 80例晚期头颈恶性肿瘤病人随机分为动脉灌注治疗组(A组)40例,静脉注射治疗组(B组)40例.结果 A组缓解率77.5%,中位缓解期7个月,中位生存期10个月,生存1年以上患者占52.5%;B组缓解率45%,中位缓解期5个月,中位生存期6个月,生存1年以上患者占22.5%.结论 动脉灌注治疗晚期头颈恶性肿瘤的临床疗效优于静脉滴注.     

晚期消化道恶性肿瘤并发难治性肠梗阻的人性化护理研究

目的 探讨晚期消化道恶性肿瘤并发难治性肠梗阻的人性化护理研究.方法 选取2010年1月至2011年1月我院收治的晚期消化道恶性肿瘤并发难治性肠梗阻患者共100例,随机分为干预组和对照组,其中干预组采用人性化护理,对照组采用常规的护理措施.结果 护理后干预组患者的护理评估量表评分明显低于护理前（P〈0.05）,且明显低于护理后的对照组（P〈0.05）.结论 对晚期消化道恶性肿瘤并发难治性肠梗阻患者进行人性化护理,可提高其生活质量,值得在临床上推广应用.     

新型冠状病毒疫情期间不同治疗阶段肿瘤患者心理相关状态及原因研究

  目的  探讨新型冠状病毒疫情期间早期诊断、治疗期间、后期康复、定期复查4个阶段肿瘤患者心理状态及相关原因。  方法  采用自行设计新型冠状病毒肺炎期间不同治疗阶段肿瘤患者的心理卫生调查问卷,通过互联网进行问卷发放,严格筛选填写规范的问卷进行整理、统计分析。  结果  不同阶段肿瘤患者在疫情中共性的问题是较多患者睡眠被不同程度的影响。早期诊断阶段患者在“担心疫情会影响手术”(72.22%)方面比其他阶段患者受影响更大;治疗期间患者因为病情处于较重状态,所以受疫情影响最大,“在疫情后,肿瘤对心理困扰的因素”(84.13%)、“是否会感到病情严重了”(75.93%)等方面受影响程度比其他阶段患者更大;后期康复阶段患者在“是否会感到病情严重了”(68.52%)方面影响程度较大;定期复查阶段患者受疫情影响的项目较少,但在“会推迟复查”(61.31%)方面受到影响。  结论  新冠疫情下,不同阶段肿瘤患者会在不同方面受到不同程度的影响,应针对不同阶段患者特点采取针对的干预方式。      

肌层浸润性膀胱癌保留膀胱手术后不同辅助化疗方法的效果比较

目的探讨浸润性膀胱癌行保留膀胱手术后髂内动脉灌注化疗与膀胱灌注化疗的治疗效果比较.方法选择T2-3N0M0期膀胱癌患者56名,手术方式为经尿道膀胱肿瘤电切术（TURBT）和膀胱部分切除术,术后1周开始进行化疗.其中24名术后采用髂内动脉灌注化疗,同一时期的其他32名患者则在术后采用膀胱灌注化疗.化疗期间观察患者的副反应,每3个月复查一次膀胱镜和尿细胞学.结果 56名患者共随访18～60个月,平均32个月.髂内灌注组化疗副反应主要为胃肠道反应,恶心呕吐发生率75.0%,此外有部分骨髓抑制表现,有29.2%白细胞下降.膀胱灌注组主要副反应为膀胱刺激症状,发生率为37.5%.观察期内肿瘤复发率髂内化疗组为25.0%,而膀胱灌注组复发率为56.3%（P〈0.05）.观察期间内,56名患者均未发生死亡.结论浸润性膀胱癌行保留膀胱手术后配合髂内动脉灌注化疗可以降低肿瘤复发率,无明显化疗副作用,对于某些不适宜或不愿意行根治性膀胱切除术的患者是一种理想的选择.     

Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older

CONTEXT: Postmenopausal women aged 55 years and older have 66% of incident breast tumors and experience 77% of breast cancer mortality, but other age-related health problems may affect tumor prognosis and treatment decisions. OBJECTIVE: To document the comorbidity burden of postmenopausal breast cancer patients and evaluate its relationship with age on disease stage, treatment, and early mortality. DESIGN AND SETTING: Data were collected on breast cancer patients' comorbidities by retrospective hospital medical records review and merged with information on patients' tumor characteristics collected from 6 regional National Cancer Institute Surveillance, Epidemiology, and End Results cancer registries. Patients were followed up until death or for 30 months from breast cancer diagnosis. PARTICIPANTS: Population-based random sample of 1800 postmenopausal breast cancer patients diagnosed in 1992 stratified by 3 age groups: 55 to 64 years, 65 to 74 years, and 75 years and older. MAIN OUTCOME MEASURES: Extent of disease, therapy received, comorbidity, cause of death, and survival. RESULTS: Seventy-three percent (1312 of 1800) of the sample was diagnosed with stage I and II breast cancer, 10% (n = 188) with stage III and IV breast cancer, and 17% (n = 300) did not have a stage assignment. Of the 1017 patients with stage I and stage II node-negative breast cancer, 95% received therapy in agreement with the National Institutes of Health consensus statement recommendation for early-stage breast cancer. Patients in older age groups were less likely to receive therapy consistent with the consensus statement (P<.001), and women aged 70 years and older were significantly less likely to receive axillary lymph node dissection as determined by logistic regression analysis (P<.01). Diabetes, renal failure, stroke, liver disease, a previous malignant tumor, and smoking were significant in predicting early mortality in a statistical model that included age and disease stage. Breast cancer was the underlying cause of death for 135 decedents (51.3%). Heart disease (n = 45, 17.1%) and previous cancers (n = 22, 8.4%) were the next major underlying causes. In the 30-month follow-up period, 263 patients (15%) died. CONCLUSION: Patient care decisions occur in the context of breast cancer and other age-related conditions. Comorbidity in older patients may limit the ability to obtain prognostic information (ie, axillary lymph node dissection), tends to minimize treatment options (eg, breast-conserving therapy), and increases the risk of death from causes other than breast cancer.     

恶性肿瘤患者抗氧化能力分析

目的：对101例原发性肝癌、肺癌、胃癌、乳腺癌、大肠癌、甲状腺癌等恶性肿瘤患者血液抗氧化能力进行观察研究。方法：以30例正常体检者为对照组，各种恶性肿瘤101例，测定其SOD、GSH-Px的活性及LPO的含量。结果：各种恶性肿瘤的SOD、GSH-Px的活性均显著低于正常对照组，而LPO的含量则明显高于对照组。结论：提示恶性肿瘤患者抗氧化能力降低，机体受自由基的损伤，进一步加重恶性肿瘤对生命的威胁。     

胃癌急性穿孔的外科诊治探讨

目的探讨胃癌穿孔患者的临床诊断及外科手术治疗方式的选择。方法回顾性分析38例胃癌急性穿孔患者的临床病理、手术方式及生存期资料。结果患者平均年龄65岁。病理分期Ⅱ期9例,Ⅲ期19例,Ⅳ期10例。13例作急诊胃切除术,手术病死率2．6％;10例先作穿孔修补术,术后3周作胃切除术,无手术死亡;15例行穿孔修补或加作胃空肠吻合术,无手术死亡;胃切赊术后中位存活期23个月（10～50个月）,胃穿孔修补者中位存活期6．3个月（3～12个月）。结论术中常规取标本活检可避免胃癌漏诊。早期诊断及正确术式可以降低病死率,单纯修补近期并发症多生存期短,强调尽可能施行I期胃癌根治术或姑息性胃切除,可延长生存期。     

The final illness in cancer: the widow''s perspective.

Widows of cancer patients were compared with other widows in general and with widows of men with chronic cardiovascular disease in particular, special attention being given to the vicissitudes of the final illness. Despite the recent emphasis on the need for open communication about the impending death between the dying patient and his family, interviews with 73 women whose husbands had died of cancer revealed that 40% of those who had been told their husband was dying refused to accept the warning. Only 29% of the couples openly discussed the possibility of the husband dying of his disease. More than half of those who did not talk with their husband about the impending death reported that this made no difference to their initial adjustment to bereavement. The stress for a woman of her husband's final illness leads to an especially difficult bereavement period; for example, significantly more widows of cancer patients than of patients with other illnesses perceived themselves to be in poor health during the initial bereavement period. Some of the problems specific to cancer patients and their families are described, along with recommendations for their alleviation.     

Causes of death and long-term prognosis after myocardial infarction in patients with diabetes mellitus.

The long-term prognosis and causes of death of myocardial infarction (MI) in 62 diabetics were studied. The mean follow-up time was 6.2 years, 11 patients died in the acute stage of MI, 9 of them (81.8%) had anterior infarction and their major causes of death were ventricular fibrillation and cardiogenic shock (72.2%). 19 died in the follow-up period, 14 of them (73.68%) had inferior and anterior septal infarction; and most died of reinfarction and sudden death. The cumulative survival rate 1, 2 and 5 years after MI was 80.7%, 71.9% and 57.9%, respectively. The results suggest that treatment and prevention of MI in patients with diabetes be more attentive to prevent ventricular fibrillation and cardiogenic shock during the acute stage and in the later stage more attention should be paid to preventing reinfarction. At any stage of the disease, strict diabetic control is of vital importance.

     

复方苦参注射液联合帕米膦酸二钠治疗恶性肿瘤骨转移疼痛

目的观察复方苦参注射液联合帕米膦酸二钠治疗恶性肿瘤骨转移疼痛的临床疗效。方法将64例恶性肿瘤骨转移疼痛的患者随机分为2组,对照组32例,单纯应用帕米膦酸二钠治疗;治疗组32例,在对照组基础上联合复方苦参注射液治疗。结果治疗组与对照组的总有效率分别为62．5％（20／32）和34．4％（11／32）,2组比较有统计学意义（P〈0．05）。结论复方苦参注射液联合帕米膦酸二钠治疗恶性肿瘤骨转移疼痛,有明显的协同作用,能提高近期疗效,明显改善患者疼痛症状。     

新兵应力骨折X线动态观察

目的：观察应力骨折不同时期X线特征，提高临床型应力骨折诊断的灵敏性和准确性。方法：拍摄早、中、晚期患正侧位或切线位X线片，动态分析比较。结果：早期X线对应力骨折灵敏度为28．9％，准确性100％；中期灵敏度为92％，准确性为100％；晚期灵敏度和准确性均为100％。结论：临床医师掌握了应力骨折X线特征，X线仍是部队医疗单位现有条件下，诊断应力骨折重要辅助手段。