肺癌化疗患者癌因性疲乏及其对生活质量的影响分析

目的 了解肺癌化疗患者癌因性疲乏的发生率和严重程度,分析肺癌化疗患者癌囚性疲乏与生活质量的相关性.方法 采用横断面调查研究方法,应用Piper疲乏量表和简明健康测量量表(SF-36)对72例肺癌化疗患者进行问卷调查.结果 肺癌化疗患者疲乏的发生率为76.4%,整体疲乏和行为/严重性、情感、感觉等维度的中重度疲乏发生率分别为68.1%、63.9%、76.4%、65.3%,认知/情绪维度的轻中度疲乏发生率为41.7%,疲乏得分排序为情感维度＞行为俨重性维度＞感觉维度＞认知/情绪维度.肺癌化疗患者的癌因性疲乏与生活质量在多个维度上呈显著负相关.结论 肺癌化疗患者癌因性疲乏的发生率较高、程度较重,疲乏与生活质量两者相互影响,应采取减轻疲乏的干预措施,以提高肺癌化疗患者的生活质量.     

肺癌化疗患者癌因性疲乏及其与抑郁的相关性

目的探讨肺癌化疗患者癌因性疲乏特征及其与抑郁的相关性。方法 2008年1-7月应用Piper疲乏量表和抑郁自评量表对某医院72例肺癌化疗患者进行问卷调查。结果肺癌化疗患者疲乏的发生率为76.4%,其中中重度疲乏占68.1%;各维度疲乏得分排序为情感维度〉行为/严重性维度〉感觉维度〉认知/情绪维度疲乏;整体疲乏和各维度疲乏得分均与抑郁得分呈正相关（P〈0.01）。结论肺癌化疗患者癌因性疲乏的发生率较高,程度较严重,且与抑郁密切相关,护理人员应提高对该问题的关注度。     

血液肿瘤化疗患者癌因性疲乏状况及相关因素研究

目的探讨血液肿瘤化疗患者的癌因性疲乏水平及相关因素,为制定有效的疲乏干预措施提供依据。方法选取2012年3—7月收治于同济大学附属同济医院的血液肿瘤化疗患者99例,采用自制调查表和Piper疲乏修正量表进行问卷调查。结果存在疲乏症状的患者78例,发生率为78.8%,且整体疲乏程度及行为/严重性维度、情感维度和感官维度得分均达中重度水平;患者的疲乏程度与化疗次数、病程时间呈正相关,与血红蛋白、白蛋白指数呈负相关;年龄介于40~60岁间的患者疲乏程度明显高于其他年龄段患者,男性患者疲乏程度高于女性患者。结论癌因性疲乏在血液肿瘤化疗患者中发生率高,程度重,持续时间长,临床护理人员应重视对癌因性疲乏状况的评估和干预,针对其主要影响因素,做好癌因性疲乏的护理干预,改善患者生存质量。     

肺癌术后化疗病人癌因性疲乏相关因素调查分析

[目的]探讨肺癌术后化疗病人癌因性疲乏的影响因素。[方法]采用Piper疲乏修订量表对100例肺癌术后化疗病人进行调查。[结果]癌因性疲乏在肺癌术后化疗病人中普遍存在,其中86％是中重度疲乏;化疗副反应、化疗方案、疼痛、经济状况等是癌因性疲乏的主要影响因素。[结论]肺癌术后化疗病人癌因性疲乏的发生率较高,应采取相应的干预措施,降低病人癌因性疲乏的程度。     

妇科恶性肿瘤患者癌因性疲乏状况调查及对策

目的 了解妇科恶性肿瘤患者癌因性疲乏的发生率及发生程度,分析其原因.提出护理对策.方法 用简明乏力量表及自制调查表,调查96例妇科恶性肿瘤患者,评估乏力程度,分析其影响因素.结果 本组癌因性疲乏发生率93%,其中中重度癌因性疲乏66%,癌因性疲乏评分(5.08±0.61)分.多因素分析结果显示:化疗、贫血、白细胞计数低于正常值、抑郁、睡眠紊乱5个因素对癌因性疲乏有影响(P＜0.01).结论 加强心理疏导、做有氧运动、改善睡眠、纠正贫血、提高机体免疫功能,能有效缓解妇科恶性肿瘤患者的癌因性疲乏状况.     

肺癌化疗患者癌因性疲乏变化轨迹及其影响因素的纵向研究

目的 探讨肺癌化疗患者癌因性疲乏变化轨迹及其影响因素。方法 采用前瞻性研究方法,选择2020年12月至2021年12月在复旦大学附属中山医院首次接受化疗的肺癌患者250例,收集患者前6次化疗的化疗前、化疗结束时、化疗结束后1周的癌因性疲乏情况。采用混合增长模型识别患者疲乏轨迹类型,采用logistic回归分析癌因性疲乏的影响因素。结果 共识别出6种肺癌患者癌因性疲乏变化轨迹,分别为轻度疲乏稳定型（114例,45.78%）、轻度疲乏缓慢增长型（32例,12.85%）、轻度疲乏高增长型（13例,5.22%）、中度疲乏缓慢增长型（49例,19.68%）、中度疲乏缓解型（17例,6.83%）及高度疲乏缓解型（24例,9.64%）。Logistic回归分析显示,职业、居住方式、家庭人均月收入、医疗负担、咳嗽、吸烟状况、体质指数、呕吐、是否患有合并症、红细胞计数为癌因性疲乏的影响因素（P<0.05）。结论 肺癌化疗患者从首次化疗至6次化疗结束,癌因性疲乏呈现6种发展轨迹,存在个体差异,不同阶段影响因素不同,建议医护人员根据患者不同发展特点及影响因素提供个性化干预措施。     

血清C反应蛋白及皮质醇水平与康复期肺癌患者癌因疲乏的相关性分析

目的探讨血清C反应蛋白(CRP)及皮质醇水平与康复期肺癌患者癌因疲乏(CRF)的相关性。方法将我院收治69例康复期肺癌患者进行癌因性疲乏调查,按是否具有癌因疲乏,分为CRF组和非CRF组,对比两组血清CRP和皮质醇水平,分析其与患者癌因性疲乏的相关性,并分析影响康复期肺癌患者发生癌因性疲乏的危险因素。结果 69例康复期肺癌患者中癌因疲乏者39例(56. 52%),CRF组身体疲乏、情感疲乏、认知疲乏和CFS总分均高于非CRF组,血清CRP水平高于非CRF组,血清皮质醇含量低于非CRF组(P 0. 05),两组性别、年龄、化疗治疗方式和是否放疗等差异无统计学意义(P0. 05)。血清CRP与CFS各维度得分、CFS总分呈正相关,皮质醇和CFS各维度得分、CFS总分呈负相关(P 0. 05);血清CRP 10 mg/L和皮质醇166 nmol/L是影响康复期肺癌患者癌因疲乏的独立危险因素。结论血清CRP及皮质醇水平与康复期肺癌患者癌因疲乏显著相关。     

非小细胞肺癌脑转移化疗患者癌因性疲乏现状及影响因素分析

目的探讨非小细胞肺癌脑转移化疗患者癌因性疲乏现状及其影响因素。方法采用便利抽样法, 选取2020年3月—2021年9月商丘市第一人民医院的280例非小细胞肺癌脑转移化疗患者为研究对象。采用一般资料调查表、癌症疲乏量表和Herth希望量表对其进行调查。采用Pearson相关分析探讨癌因性疲乏和希望水平的相关性。采用多重线性回归分析探讨非小细胞肺癌脑转移化疗患者癌因性疲乏的影响因素。本研究共发放问卷280份, 回收有效问卷276份, 有效回收率为98.57%。结果非小细胞肺癌脑转移化疗患者的癌因性疲乏得分为(44.59±10.36)分, 希望水平得分为(36.64±6.37)分。Pearson相关分析结果显示, 非小细胞肺癌脑转移化疗患者的希望水平与癌因性疲乏呈负相关(r=-0.261, P<0.05)。临床首次分期、癌痛程度、希望水平是癌因性疲乏的影响因素(P<0.01)。结论非小细胞肺癌脑转移化疗患者的癌因性疲乏有待改善。临床首次分期、癌痛程度、希望水平是癌因性疲乏的影响因素。护理工作者可基于癌因性疲乏的影响因素制订有针对性的护理措施, 帮助患者提高生活质量。     

乳腺癌术后辅助化疗患者癌因性疲乏与社会支持相关性的研究

目的调查乳腺癌术后辅助化疗患者癌因性疲乏的状况,并分析乳腺癌术后辅助化疗患者癌因性疲乏与社会支持的相关性。方法采用Piper疲乏量表和社会支持评定量表对某市3所三级甲等医院的203例乳腺癌术后辅助化疗患者进行问卷调查。结果 95.57%的患者存在癌因性疲乏,处于中度疲乏程度;社会支持及主观支持、对社会支持的利用度与整体疲乏及各维度呈负相关,客观支持与情感维度呈负相关(P<0.01或P<0.05)。结论乳腺癌术后辅助化疗患者癌因性疲乏的发生率较高,应提高对癌因性疲乏的重视,加强社会支持,提高患者的生活质量。     

肺癌化疗期患者癌因性疲乏与希望水平的相关性及其它影响因素研究

目的探讨肺癌化疗患者癌因性疲乏与希望水平现状及其影响因素。方法采用方便抽样的方法,选择2017年7月-2018年6月入住我院的236例肺癌患者为研究对象。采用一般情况调查表、Piper疲乏评估修订量表、Herth希望量表对患者进行调查。结果肺癌化疗期患者癌因性疲乏得分为(123.41±21.61)分;希望水平得分为(35.88±6.12)分;二者得分呈负相关(P<0.05);肺癌化疗期患者的疾病临床分期、癌因性疲乏、睡眠状况是希望水平的主要影响因素(P<0.01)。结论肺癌化疗期患者的癌因性疲乏处于中等水平,希望水平较低,临床护理工作中,应当重视对患者的心理疏导和干预,缓解癌因性疲乏,提升患者的希望水平。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.