帕洛诺司琼与昂丹司琼预防腹腔镜胆囊切除术后恶心、呕吐效果分析

目的探讨腹腔镜胆囊切除术后使用帕洛诺司琼与昂丹司琼对恶心、呕吐的预防效果。方法选取抚顺市中心医院自2017年4月至2019年4月收治的90例腹腔镜胆囊切除术患者为研究对象,采用随机数字表法将所有患者分为A、B两组,每组各45例。A组给予昂丹司琼治疗,B组给予帕洛诺司琼治疗。比较两组患者心率(HR)、平均动脉压(MAP)、术后恶心呕吐(PONV)分级、不良反应、饮食恢复正常时间、住院时间。结果 B组HR、MAP均显著低于A组,两组比较,差异均有统计学意义(P<0.05)。A组PONV总发生率为82.2%(37/45),显著高于B组的60.0%(27/45),两组比较,差异有统计学意义(P<0.05)。B组不良反应发生率为4.4%(2/45),显著低于A组的20.0%(9/45),两组比较,差异有统计学意义(P<0.05)。B组饮食恢复正常时间、住院时间均显著短于A组,两组比较,差异有统计学意义(P<0.05)。结论帕洛诺司琼应用于腹腔镜胆囊切除术后,可有效降低患者恶心、呕吐发生率,维持生命体征稳定,有助于患者早日进食,且不良反应较少。     

昂丹司琼预防和治疗腹腔镜胆囊切除术后恶心呕吐的疗效观察

目的：观察并分析昂丹司琼预防和治疗腹腔镜胆囊切除术后恶心、呕吐反应的临床效果。方法86例慢性结石性胆囊炎患者在全麻下接受常规腹腔镜胆囊切除术。将其分为术前用药组36例、术后用药组25例和对照组25例。术前用药组于麻醉前30分钟通过静脉注射盐酸昂丹司琼8 mg、术后用药组麻醉清醒后立即给予静脉注射盐酸昂丹司琼8 mg,对照组不给予任何止吐药物。观察至术后48小时,统计各组中恶心、呕吐反应的发生例数和药物不良反应情况。结果86例患者共有25例发生恶心、呕吐反应。术前用药组、术后用药组和对照组的恶心、呕吐发生率分别为27.8%、12.0%和48.0%。术后用药组与对照组相比有统计学意义（χ^2=7.71,P＜0.05）,说明术后用药可减少术后恶心、呕吐的发生;术前用药组与对照组比较无统计学意义（χ^2=2.61,P＞0.05）,说明术前用药不能预防术后恶心、呕吐的发生。25例患者术后发生恶心、呕吐,给予经静脉注射盐酸昂丹司琼8 mg,有21例患者缓解,缓解率为84.0%,用药过程中未发生药物不良反应。结论盐酸昂丹司琼预防和治疗LC术后恶心、呕吐是安全、有效的,预防性用药最佳时机应该为麻醉清醒时。     

格拉司琼预防全麻后恶心呕吐症状的临床研究

手术后的恶心呕吐 (Postoperativenauseaandvomiting,PONV)是麻醉和外科手术后最常见的并发症 ,全麻后PONV发生率更高 ,可达 70 %～ 80 % ,其可延长离开恢复室的时间 ,甚至引起严重的并发症 ,如误吸、吸入性肺炎、窒息等[1,2 ] 。本研究预防性给予高选择性 5 -羟色胺 (5 -HT3 )受体拮抗药格拉司琼以预防全麻拔管后PONV ,取得良好的效果。1　对象和方法1.1　对象　随机选择择期手术患者 112例 ,ASAⅠ～Ⅱ ,男5 3例 ,女 5 9例 ,年龄 16～ 74岁。手术种类包括胆囊切除术、胆道探查术、胃大部切除术、胆肠吻合术、肠部分切除术、肠粘连…     

盐酸昂丹司琼注射液与氟脲嘧啶存在配伍禁忌

<正>病人,男,39岁。胃癌术后进行化疗(氟脲嘧啶0.5 g,亚叶酸钙0.2 g),化疗时遵医嘱将氟脲嘧啶0.5 g加到0.9%生理盐水500 ml中静脉输入,并静脉推注盐酸昂丹司琼注射液8 mg。当两种液体接触时,即出现白色絮状混浊,立即更换输液器,并暂停静脉推注昂丹司琼。待氟脲嘧啶输     

氟哌利多或托烷司琼复合地塞米松预防妇科腹腔镜术后恶心呕吐临床疗效

目的比较氟哌利多或托烷司琼复合地塞米松两种方案对预防妇科腹腔镜手术患者术后恶心呕吐(PONV)的效果。方法选择2013年8月至2014年6月在海南省屯昌县人民医院择期行妇科腹腔镜手术的60例患者为研究对象。随机将患者分为氟哌利多复合地塞米松组(F组)与托烷司琼复合地塞米松组(T组),每组各30例。F组患者于诱导前静脉给予地塞米松10.0 mg,手术结束前30 min给予氟哌利多2.5 mg。T组患者除给予地塞米松外,在手术结束前30 min给予托烷司琼4.0 mg。盲法观察术后2、6、24 h内两组患者的PONV发生情况。结果 F组患者术后24 h PONV发生率为40.0%(12/30),显著低于T组的70.0%(21/30)。F组术后恶心呕吐总次数,以及术后2、6、24 h PONV疼痛VAS评分均低于T组(P<0.05)。结论氟哌利多复合地塞米松较托烷司琼复合地塞米松能更好的预防PONV。     

昂丹司琼、长托宁单次注射用于预防腹腔镜胆囊切除术后恶心呕吐的对照研究

尽管麻醉药品不断更新和麻醉技术也在进展,术后恶心呕吐（postoperative nausea and vomiting,PONV）仍然是常见的术后并发症,据报道平均发生率为20%～30%[1]。腹腔镜胆囊切除术后PONV的发生率在53%～72%[2,3]。     

老年乳腺癌术后不同化疗方案疗效及安全性比较

目的探讨老年乳腺癌患者应用不同辅助化疗方案治疗的有效性和安全性。方法回顾性分析辽宁省肿瘤医院2003-2010年收治的Ⅰ~Ⅲ期可手术治疗的老年(≥65岁)女性乳腺癌患者的临床资料及术后5年随访资料。按不同治疗方法分为FEC组、TC组和X组,对3组患者的临床疗效和生存率进行对照分析。结果本研究患者共466例,其中,术后接受FEC方案者145例,TC方案者192例,X方案者129例。3组患者的5年无复发生存率(RFS)分别为51%、60.4%、35.7%;总生存率(OS)分别为63.4%、64.1%、51.9%。TC组患者的PFS明显高于FEC组及X组,差异均有统计学意义(P<0.05);FEC组患者的PFS也高于X组(P<0.05)。TC组和FEC组患者的OS明显高于X组,差异均有统计学意义(P<0.05);而TC组与FEC组间比较,差异无统计学意义(P>0.05)。中性粒细胞减少更多发生在TC组(66.1%)和FEC组(51.7%),明显高于X组的1.6%(P<0.05);且TC组与FEC组间比较,差异也有统计学意义(P<0.05)。呕吐和心功能减退在FEC组患者中较多见,而手足综合征在X组中较多见。结论对于老年乳腺癌患者的术后辅助化疗,FEC方案与TC方案治疗效果相当,均优于X方案。3种方案的化疗均存在一定的不良反应。     

非小细胞肺癌术后单纯辅助化疗与联合恩度进行术后辅助化疗的疗效比较

目的探究非小细胞肺癌（non small cell lung cancer,NSCLC）术后单纯辅助化疗与联合恩度（重组人血管内皮抑制素注射液）进行术后辅助化疗的疗效差异。方法121例Ⅱb、Ⅲa期NSCLC术后患者随机分为对照组58例、观察组63例两组,对照组给予单纯化疗,包括多西他赛+顺铂/卡铂方案、长春瑞滨+顺铂方案、吉西他滨+顺铂/卡铂方案;观察组在此基础上增加恩度治疗;每个治疗周期均评价药物不良反应情况;治疗进行4个周期,并于术后3、6、9、12个月分别评价患者生存情况。结果观察组患者术后12个月时出现病情复发的比例为95%,明显低于对照组的259%（P<005）;观察组每个治疗周期的各类药物不良反应发生率与对照组发生率的差异比较无统计学意义(P>005)。结论非小细胞肺癌患者术后给予恩度联合化疗治疗,临床效果确切,术后1年复发率明显降低,药物不良反应无明显增加。     

经导管动脉化疗栓塞术治疗局部复发乳腺癌的疗效与安全性

目的探讨经导管动脉化疗栓塞术治疗局部复发乳腺癌的疗效与安全性。方法 回顾性分析2018年1月至2020年12月复发乳腺癌患者57例,接受经导管动脉化疗栓塞术治疗24例为A组,化疗药物为多柔比星12 mg/m2、紫杉醇45 mg/m2,化疗药物采用微导管于肿瘤靶血管局部灌注方式完成,靶血管栓塞材料为Embosphere栓塞微球,栓塞终点为肿瘤靶血管主干闭塞。选择同时段全身化疗患者33例为B组,化疗药物为多柔比星40 mg/m2、紫杉醇135 mg/m2,比较两组间6个月疾病控制率、无进展生存时间、总体生存时间差异。结果 A组24例患者均成功实施经导管动脉化疗栓塞术,技术成功率100%,6个月疾病控制率87.50%,中位无疾病进展生存期（PFS）12个月,中位总生存期（OS）22个月;B组6个月疾病控制率63.63%,PFS 9个月,中位OS 20个月;两组间6个月疾病控制率、中位无疾病进展生存期差异有统计学意义（P=0.04,P=0.03）,两组间中位总生存期差异无统计学意义（P=0.21）;A组患者栓塞术后综合征发生率为75%(18/24),胸壁疼痛、低热经止痛、退热等对症治疗3d后症...     

香菊胶囊与盐酸氨溴索片联合鼓室注射地塞米松治疗分泌性中耳炎患者的疗效观察

目的 探讨香菊胶囊与盐酸氨溴索片联合鼓室注射地塞米松治疗分泌性中耳炎(Secretory otitis media,SOM)患者的效果.方法 选取SOM患者96例(2019年1月～2020年4月),依据随机数字表法分组,各48例.单药组予以鼓室注射地塞米松治疗,联合组在单药组基础上予以香菊胶囊与盐酸氨溴索片治疗.比较两...     

Palmatine hydrochloride mediated photodynamic inactivation of breast cancer MCF-7 cells: Effectiveness and mechanism of action

Breast cancer is one of the commonest malignant tumors threatening to women. The present study aims to investigate the effect of photodynamic action of palmatine hydrochloride (PaH), a naturally occurring photosensitizer isolated from traditional Chinese medicine (TCM), on apoptosis of breast cancer cells. Firstly, cellular uptake of PaH in MCF-7 cells was measured and the cytotoxicity of PaH itself on breast cancer MCF-7 cells was estimated using the 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. Subcellular localization of PaH in MCF-7 cells was observed using confocal laser scanning microscopy (CLSM). For photodynamic treatment, MCF-7 cells were incubated with PaH and then irradiated by visible light (470 nm) from a LED light source. Photocytotoxicity was investigated 24 h after photodynamic treatment using MTT assay. Cell apoptosis was analyzed 18 h after photodynamic treatment using flow cytometry with Annexin V/PI staining. Nuclear was stained using Hoechst 33342 and observed under a fluorescence microscope. Intracellular production of reactive oxygen species (ROS) was studied by measuring the fluorescence of 2, 7-dichlorofluorescein (DCF) using a flow cytometry. Results showed that PaH treatment alone had no or minimum cytotoxicity to MCF-7 cells after incubation for 24 h in the dark. After incubation for 40 min, the cellular uptake of PaH reached to the maximum, and PaH mainly located in mitochondria and endoplasmic reticulum of MCF-7 cells. Photodynamic treatment of PaH demonstrated a significant photocytotoxicity on MCF-7 cells, induced remarkable cell apoptosis and significantly increased intracellular ROS level. Our findings demonstrated that PaH as a naturally occurring photosensitizer induced cell apoptosis and significantly killed MCF-7 cells.     

Locally advanced breast cancer: comparison of mammography,sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy

The accuracy of mammography, sonography and magnetic resonance imaging (MRI) in identifying residual disease after neoadjuvant chemotherapy is evaluated and imaging findings are correlated with pathologic findings. Fifteen patients enrolled in an experimental protocol of preoperative neoadjuvant chemotherapy underwent clinical examination, mammography, sonography and dynamic MRI, performed in this order, before and respectively after 2 and 4 cycles of neoadjuvant chemotherapy. Four radiologists, two for mammography, one for sonography and one for MR, examined the images, blinded to the results of the other examinations. All patients underwent radical or conservative surgery, and imaging findings were compared with pathologic findings. MRI identified 2/15 (13.3.%) clinically complete response (CR), 9/15 (60%) partial response (PR), 3/15 (20%) stable disease (SD) and 1/15 (6.7%) progressive disease. Mammography identified 1/15 (6.7%) clinically CR, 8/15 (53.3%) PR and 4/15 (27%) SD, and was not able to evaluate the disease in 2/15 (13%) cases. Sonography presented the same results as MRI. Therefore, MRI and sonography compared to mammography correctly identified residual disease in 100 vs. 86%. MRI resulted in two false-negative results because of the presence of microfoci of in situ ductal carcinoma (DCIS) and invasive lobular carcinoma (LCI). MRI was superior to mammography in cases of multifocal or multicentric disease (83 vs. 33%). Sonography performed after MRI improves the accuracy in evaluation of uncertain foci of multifocal disease seen on MR images with an increase of diagnostic accuracy from 73 to 84.5%. MRI assesses response to neoadjuvant chemotherapy better than traditional methods of physical examination and mammography.     

乳腺癌术后放疗与全身系统治疗的顺序选择

乳腺癌术后辅助治疗的作用是毋庸置疑的,合理布局术后放疗与辅助系统治疗既可以降低局部区域复发率,又可以提高患者生存率。部分系统治疗与放疗的最佳时序已经证实,但仍有方案需要进一步明确。特别是新辅助化疗者术后巩固化疗与术后放疗同步治疗的安全性、HER-2阳性患者术后双靶治疗与术后放疗同步治疗的安全性、小分子酪氨酸激酶抑制剂同步放疗的安全性等有待于进一步明确。本文对乳腺癌术后放疗与术后辅助系统治疗的顺序选择相关文献进行了综述。     

乳腺癌患者新辅助化疗的MRI研究

乳腺癌新辅助化疗(亦称初始化疗或术前化疗)最初是指对局部晚期乳腺癌患者手术治疗之前所进行的辅助化疗,目前己将该治疗扩展至肿瘤较大的可手术的乳腺癌患者,以使肿瘤降期,进而达到保乳手术治疗的目的。随着新辅助化疗在乳腺癌患者中不断推广应用,临床实践中迫切需要一种能准确评价化疗后肿瘤变化的检查方法,本文对RI(magnetic resonance imaging)在乳腺癌新辅助化疗中的研究进行综述。     

术前两种化疗方式对晚期乳腺癌微血管及微淋巴管密度影响的比较

 目的 探讨术前区域动脉灌注化疗及全身静脉化疗对晚期乳腺癌微血管密度(Microvessel demity,MVD)、微淋巴管密度(Microlymphtic vessel density,MLVD)的影响.方法 76例晚期乳腺癌患者随机分为2组,术前动脉灌注化疗组35例、术前全身静脉化疗组41例,选其中25例未行化疗前的乳腺癌组织作对照组.采用免疫组化SP法,用CD34、VEGFR3抗体检测3组乳腺癌组织标本MVD、MLVD.结果 MVD术前动脉灌注化疗组为(36.05±13.64),术前全身静脉化疗组为(49.92±12.90),对照组为(60.38±13.54),各组间比较差异有统计学意义(P＜0.01);MLVD术前动脉灌注化疗组为(6.62±3.70),术前全身静脉化疗组为(9.96±4.57),对照组为(11.30±5.32),动脉灌注化疗组与对照组比较显著下降(P＜0.01),与静脉化疗组比较差异有统计学意义(P＜0.05),静脉化疗组与对照组比较差异无统计学意义(P＞0.05).结论 术前区域性动脉灌注化疗比全身静脉化疗更能有效降低肿瘤组织及其周边组织内MVD和MLVD,从而抑制肿瘤细胞生长,减少肿瘤转移的机会.     

超声对恩度联合新辅助化疗治疗乳腺癌的疗效观察

目的：探讨彩色多普勒超声检查在恩度联合新辅助化疗治疗乳腺癌疗效评估中的价值。方法：分别于治疗前后应用彩色多普勒超声对38例乳腺癌的40个乳腺病灶及腋窝淋巴结进行观察及分析。结果：40个病灶中34个治疗有效,病灶内血流信号分级降低或血流消失;Vm ax值明显降低（P〈0.05）;化疗前发现异常淋巴结共32个,治疗后有28个缩小或消失,30个血流信号明显减少。超声评估原发肿瘤缓解的总有效率为85%（34/40）。结论：超声检查可为恩度联合新辅助化疗治疗乳腺癌提供简便、安全的疗效观察手段。     

The effect of chemotherapy on the uptake of technetium-99m sestamibi in breast cancer

Technetium-99m sestamibi scintimammography has been used primarily in the diagnosis of breast cancer. It has also been suggested that this technique could be used to monitor response to chemotherapy and possibly to predict those patients in whom no response can be expected. An initial study was performed in nine patients with primary breast cancer. All patients underwent prone lateral and anterior^99mTc-sestamibi imaging at diagnosis and 4–7 months later, after they had received cytotoxic chemotherapy. The uptake of^99mTc-sestamibi in the breast was compared with that in normal surrounding breast tissue and this ratio was expressed as the target to background ratio. In all patients treated there was a reduction in uptake of^99mTc-sestamibi after treatment, such that whilst all the tumours could be seen before treatment, only three were visible following chemotherapy. There was a significant fall in the mean target to background ratio of the patients undergoing chemotherapy: the tumour to background ratio was 2.48 before chemotherapy and 1.40 after treatment (P<0.001, paired Student'st test). This fall in tumour activity was observed both in those patients in whom a clinical response was seen and in the two patients in whom the tumour enlarged despite chemotherapy. It appears that the reduced uptake of^99mTc-sestamibi seen after chemotherapy may be a non-specific change and therefore may not be predictive of the clinical response to treatment.     

Breast tomosynthesis and digital mammography: a comparison of breast cancer visibility and BIRADS classification in a population of cancers with subtle mammographic findings

The main purpose was to compare breast cancer visibility in one-view breast tomosynthesis (BT) to cancer visibility in one- or two-view digital mammography (DM). Thirty-six patients were selected on the basis of subtle signs of breast cancer on DM. One-view BT was performed with the same compression angle as the DM image in which the finding was least/not visible. On BT, 25 projections images were acquired over an angular range of 50 degrees, with double the dose of one-view DM. Two expert breast imagers classified one- and two-view DM, and BT findings for cancer visibility and BIRADS cancer probability in a non-blinded consensus study. Forty breast cancers were found in 37 breasts. The cancers were rated more visible on BT compared to one-view and two-view DM in 22 and 11 cases, respectively, (p < 0.01 for both comparisons). Comparing one-view DM to one-view BT, 21 patients were upgraded on BIRADS classification (p < 0.01). Comparing two-view DM to one-view BT, 12 patients were upgraded on BIRADS classification (p < 0.01). The results indicate that the cancer visibility on BT is superior to DM, which suggests that BT may have a higher sensitivity for breast cancer detection.     

Diffusion weighted imaging in early prediction of neoadjuvant chemotherapy response in breast cancer

Background

Neoadjuvant chemotherapy (NAC) has clinically important outcome. Early evaluation of the treatment response is important to avoid unnecessary therapy in non-responders. MRI is the most sensitive imaging for monitoring NAC response.

Follow-up of women with breast cancer: comparison between MRI and FDG PET

The aim of this study was to compare MRI of the breast with ¹⁸F-fluoro-deoxy-glucose (FDG) positron emission tomography (PET) in patients with suspected local or regional breast cancer recurrence or suspected contralateral breast cancer. Thirty-two patients (mean age 57.2 years, age range 32–76 years) with suspected loco-regional recurrence (n=19), chest wall recurrence (n=5), and suspected secondary tumor of the contralateral breast (n=8) underwent MRI of the breast and FDG PET of the whole body and breast region. Cytology/histology (n=17) or a clinical follow-up examination (n=15) with additional imaging served as the standard of reference. A McNemar test was performed to compare PET and MRI, and kappa was determined to quantify agreement of both methods. Sensitivity was 79 and 100%, specificity was 94 and 72%, and accuracy was 88 and 84% for MRI and PET, respectively. Additional metastases outside the field of view of MRI were found in PET in 5 patients. In this study both imaging methods had comparable accuracy. The detection of distant metastases with whole-body PET imaging can influence patient management.