围术期护理对老年卵巢癌患者的效果观察

目的探讨160例老年卵巢癌患者围术期护理效果。方法选取2014年1月至2015年12月间哈尔滨医科大学附属临床第一医院收治的160例老年卵巢癌患者,采用随机数字表法分为观察组与对照组,每组80例。观察组患者采用围术期护理,对照组患者采用常规护理,观察两组患者护理前后焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、生存质量评分(心理领域、生理领域、环境领域和社会领域)及不良反应情况。结果护理后,观察组患者SAS和SDS评分与对照组比较为(36.70±6.39)分vs(42.32±7.20)分和(38.92±7.81)分vs(44.38±6.29)分,差异均有统计学意义(均P<0.05)。观察组患者心理领域、生理领域、环境领域和社会领域各评分与对照组比较为(14.94±3.27)分vs(11.29±3.11)分、(15.37±4.01)分vs(12.23±3.87)分、(15.29±4.21)分vs(12.63±3.81)分、(16.39±4.12)分vs(13.28±3.92)分,差异均有统计学意义(均P<0.05)。观察组患者不良反应总发生率为6.3%(5/80),小于对照组患者的31.3%(25/80),差异有统计学意义(P<0.05)。结论 80例老年卵巢癌患者采用围术期护理,能够有效减少并发症,提高治疗疗效。     

个性化优质护理对甲状腺癌切除术患者围术期的影响

目的 探讨个性化优质护理对甲状腺癌切除术患者围术期的影响。方法 选取2019年3月至2021年3月间上海中医药大学附属曙光医院收治的113例甲状腺癌切除术患者,采用抛硬币随机法分为观察组57例和对照组56例。对照组患者采用常规护理干预,观察组患者采用个性化优质护理干预,比较两组患者干预前后对疾病知识的了解程度、负性情绪、疼痛、并发症和生存质量。结果 观察组患者甲状腺癌知识了解程度为96.5%,高于对照组的82.1%,差异有统计学意义(P<0.05)。治疗后,两组患者SAS评分均降低,且观察组低于对照组,差异均有统计学意义(均P<0.05)。术后12h后各时点,两组患者NRS评分均低于术后即刻,且观察组均低于对照组,差异均有统计学意义(均P<0.05)。观察组患者术后并发症总发生率为5.3%,低于对照组的17.9%,差异有统计学意义(P<0.05)。治疗后,观察组患者角色功能、整体功能、认知功能、躯体功能、情感功能评分均高于对照组,差异均有统计学意义(均P<0.05)。结论 甲状腺癌切除术围术期采用个性化优质护理,可有效提高患者对甲状腺癌知识的了解程度,缓解...     

Gd-DTPA在脑转移瘤诊断中的应用及护理体会

目的:评价Gd-DTPA增强扫描在正确诊断不同表现的脑转移瘤中的作用,以及进一步探讨MRI增强前后的准备与护理方法。方法:对96例使用Gd-DTPA患者,增强前后病变MR表现进行分析比较。结果:96例中共检出瘤体灶148个,强化扫描比平扫多发现68个,在148个病灶中,呈弥散快速强化的93个,呈环状结节状强化的有55个,均为明显强化。结论:Gd-DTPA强化扫描对脑转移瘤的诊断价值是肯定的,在区别瘤体与水肿,坏死、囊变及显示微小病灶方面作用显著。加强扫描前后的护理,对保证受检者的安全及增强效果具有重要作用。     

乳腺癌围术期护理

乳腺癌是女性最常见的一种恶性肿瘤,在我国女性所患癌症中其患病率居首位,且每年以3%～4%的速度递增,发病日趋年轻化[1],大多数乳腺癌在被发现时,已有区域淋巴结和远处转移,其病死率高达5%[2].     

颈动脉体瘤围手术期的护理

目的：探讨颈动脉体瘤（CBT）患者围手术期的护理方法及注意事项。方法：对23例手术治疗的颈动脉体瘤病例的手术方式、围手术期护理方法、术后并发症进行回顾性分析。结果：本组患者肿瘤全部手术切除成功,5例有术后并发症发生,其中1例与围手术期的护理缺陷相关。结论：CBT手术治疗需要较长时间的术前准备和不同的手术方式。良好的围手术期护理,包括术前的心理护理、颈动脉压迫训练、术后生命体征观察与护理指导,是减少手术并发症、提高患者康复水平的重要保证。     

快速康复护理在颈椎转移癌围术期护理中的应用

目的 探究快速康复护理应用于行手术治疗颈椎转移癌患者的效果。方法 选取郑州市骨科医院2019年1月至2021年1月期间收治的行颈椎转移癌减压内固定术患者76例,随机均分为对照组和观察组,每组38例。对照组患者采用采用常规护理,观察组患者采用快速康复护理。比较观察2组患者的视觉模拟评分法(VAS)疼痛评分、颈椎功能障碍(NDI)指数、患者术后首次下床时间、住院时长、满意度及并发症发生率,分析2组患者护理效果。结果 结果 护理后,观察组患者VAS评分[(1.10±0.41)分]明显低于对照组[(1.72±0.80)分],差异有统计学意义(t=3.415,P=0.001)。护理后,观察组患者NDI指数[(10.09±3.52)%]明显低于对照组[(14.52±6.82)%],差异有统计学意义(t=3.553,P=0.001)。与对照组比较,观察组患者术后首次下床早、住院时间短、并发症发生率低,且护理满意度高,差异均有统计学意义(t=3.670,P<0.001;t=2.951,P=0.004;χ²=5.208,P=0.023;t=2.966,P=0.004)。结论 ...     

X—刀治疗脑转移瘤的术后处理

以BrainScanⅡ型X-刀，治疗脑转移瘤患者23例，共38个病灶。其中17例加作了全脑放射治疗。病灶经X-刀治疗后完全消失为14个（36．84％），明显缩小20个（52．63％），体积稍减或无明显变化但密度降低者为4个（10．52％），局部控制率为89．47％。患者因脑转移癌而产生的症状均明显改善或消失，其平均生存时间为7．88±3．24月，加作全脑放疗者的平均生存时间明显技单纯X-刀治疗为长。未发现放射性水肿、坏死及自发性瘤内出血等严重的并发症。X-刀或其他立体定向放射神经外科是治疗脑转移瘤的良好方法，应慎重选择适应症，加强术后处理。     

脑转移瘤的放射治疗

目的　探讨脑转移瘤的治疗。方法　 1990年 10月～ 1999年 1月我科共收治脑转移瘤 36例 ,2 6例采用60 Co外照射 ,先予常规分割全颅放疗中平面剂量 35～ 40Gy ,后缩野针对病灶 ,常规分割放疗 15～ 2 0Gy ,多发病灶不缩野。放疗时给予脱水治疗。结果　 2 6例完成放疗者 2 4例 ,其中半年生存率 5 4% ,1年生存率为 13 %。结论　对恶性肿瘤出现脑转移病人 ,积极治疗仍可取得较满意疗效。     

Retrospective analysis of the efficacy and tolerability of levetiracetam in patients with metastatic brain tumors

Seizures are a common complication of metastatic brain tumors (MBT), affecting approximately 27–50% of all patients during the course of their illness. Treatment of tumor-induced seizures is often inadequate with traditional antiepileptic drugs (AED) due to a variety of factors, including activation of glutamatergic NMDA receptors, alterations of neuronal input pathways, and tumor growth. Levetiracetam (LEV) is a 2nd generation non-enzyme inducing AED with a novel mechanism of action, binding to neuronal synaptic vesicle protein SV2A, that has been previously shown to reduce seizure activity in patients with primary brain tumors. Due to its unique mechanism of action, it has been postulated that LEV may also be effective in controlling seizures from MBT. A retrospective chart review was performed of all Neuro-Oncology Center patients with MBT who had received LEV for seizure control. Thirteen patients were reviewed with a median age of 55.1 years (range: 34–70). Six patients had breast cancer, five had lung cancer, and two had melanoma. LEV was used as an add-on AED in seven patients (54%) and as monotherapy in six patients (46%), with a median dose of 1,000 mg/day (range: 500–3,000). The baseline median seizure frequency was one ictal event every other day. After the addition of LEV, the median seizure frequency was reduced to 0 per week. The seizure frequency was reduced to less than 50% of the pre-LEV baseline in 100% of patients (P = 0.0002, Sign test), with 10 patients (77%; confidence interval: 46–95%) noting complete seizure control. The most common adverse event was somnolence and headache, noted in 3 of 13 patients (23%). LEV was very effective and well tolerated in MBT patients with seizures and should be considered for add-on therapy or as a substitute AED for monotherapy.     

Characteristics and immunologic changes in patients with malignant brain tumors

The investigation was concerned with assaying immunity and evaluating the role played by monocytes and tumor cells in the formation of T-cell dysfunction in malignant glioma (MG). The study group included 28 patients with anaplastic astrocytomas (n = 18) and glioblastomas (n = 10). MG patients showed significant changes in the numbers of CD16+ NK-cells and HLA-DR monocytes as well as lowered levels of HLA-DR expression on monocytes and proliferative response of T-lymphocytes as compared with both standard and alternative pathways of activation. Monocytes and macrophages suppressed T-cell activity due to production of prostaglandins E2 in such patients. Enhanced immunosuppression was also reported in 24-hour supernatants of tumor cells. Immune disorders were shown to involve apoptosis-independent mechanisms. Hence, despite the immune privilege of the brain, immunocompetent cells crossed blood-brain barrier and counteracted with tumor cells. As a consequence, monocyte function and cellular cooperation dropped while production of immunosuppressive factors rose, and T-cell dysfunction was brought about through apoptosis-independent mechanisms.     

Therapeutic cranial irradiation in patients with metastatic brain tumors from pulmonary carcinoma

Fifty-three patients with intracranial metastases from pulmonary carcinoma were treated with cranial irradiation between 1976 and 1983. There was improvement in neurologic symptoms in 80%, and the one and two-year survival rates for the entire group of patients were 21% and 4%. Those or patients without metastasis tumor in other organs were 38% and 9%, respectively. It was suggested that the total dose should be in excess of 40 Gy. Histologically, adenocarcinoma and epidermoid carcinoma showed better prognosis than other types of cancer.     

Leukocyte alkaline phosphatase score in patients with cerebrovascular disease and in patients with primary and metastatic brain tumors

Leukocyte alkaline phosphatase (LAP) activity in peripheral blood was determined in 54 patients with cerebrovascular disease (CVD), 11 patients with primary brain tumor, and 23 patients with metastatic brain tumor. The LAP score of the primary brain tumor patients (155 +/- 40) was significantly higher (P less than 0.03) than the LAP score for cerebrovascular disease patients (96 +/- 87). The LAP score levels of the metastatic brain tumor patients (251 +/- 55) was significantly higher as compared with both the cerebrovascular disease (P less than 0.001) and primary brain tumor groups (P less than 0.001). The LAP score could serve as an additional, although non-specific, marker to assist in the differentiation between cerebrovascular disease and brain tumors.     

Radiotherapy of metastatic brain tumors

In order to evaluate the role of radiotherapy cases of brain metastases, we retrospectively have analyzed the results of treatment in 89 patients with brain metastases, who had completed a course radiotherapy at the Jichi Medical School Hospital from August, 1973 to October, 1986. Cases analyzed included 60 patients with lung cancers, 6 with breast cancers, 6 with gastric cancers, 10 with other types, and 7 with unknown primary sites. The over-all median survival time was 4.7 months. Crude survival rates were 38.2% at 6 months, and 11.2% at one year, respectively. Two patients survived more than 3 years. The over-all rate of improvement of neurologic function (NF) were 75.3% of NF III patients, and 58% of NF II patients. There was, however, no significant difference in survival rates between the patients with and without NF improvement. Prognostic factors were investigated by a statistical method of a proportional hazard model. Age, the combined treatment with surgery and irradiation, and the neurologic standard dose (Neuret) were found to be factors which influenced the survival rate with a fair statistical significance. Survival rate increased with a decrease in age, an increase in the thoroughness of the surgical excision, and an increase in the Neuret dose. These data suggest that an aggressive approach to brain metastases in younger patients, so far as clinical judgements permit, may indeed improve survival.     

快速康复外科理念在颅内肿瘤患者围手术期护理中的应用效果

目的探讨快速康复外科理念在颅内肿瘤患者围手术期护理中的应用效果。方法选取2016年2月至2018年2月间山东省立第三医院收治的64例行超声引导下颅内肿瘤切除术患者,采用随机数表法将患者分为研究组与对照组,每组32例。对照组患者采用常规围术期护理措施,研究组患者采用快速康复外科理念进行围术期护理。观察比较两组患者的手术时间、术中出血量、首次排便时间、首次下床活动时间、住院时间及术后并发症情况。结果两组患者的手术时间和术中出血量比较,差异无统计学意义(P> 0. 05)。研究组患者首次排便时间、首次下床活动时间和住院时间均低于对照组,差异均有统计学意义(均P <0. 05)。研究组患者术后并发症发生率为6. 3%,低于对照组患者的25. 0%,差异有统计学意义(P <0. 05)。结论快速康复外科理念在颅内肿瘤围手术期护理中具有显著的应用效果,可以加快患者的康复速度,降低术后并发症发生率,适于临床推广。     

Distribution of cis-diamminedichloroplatinum in patients with metastatic brain tumors after intravenous or intracarotid administration

The distribution of cis-diamminedichloroplatinum (CDDP) was studied in 21 patients with intracerebral metastatic brain tumors from lung cancer after CDDP 100 mg/sq m i.v. or i.a. administration for 20 minutes using an infusion pump during surgery. Surgical tissue specimens of tumor and edematous brain tissue adjacent to tumor were obtained with whole blood soon after CDDP administration and assayed for total platinum using an atomic absorption spectrophotometer. The pharmacological distribution rates were represented as the brain/plasma, tumor/plasma and tumor/brain ratios. No statistical differences in the CDDP concentrations in the plasma were found between i.a. and i.v. administrations. The platinum concentration in edematous brain tissue adjacent to the tumor was always lower than the platinum concentration in the metastatic intracerebral tumor. No differences were noted for the brain/plasma ratio in the brain tissue adjacent to the tumor between the two administration methods (i.a.: 0.38 +/- 0.09, n = 8; i.v.: 0.43 +/- 0.13, n = 11, M +/- S.E.). However, two cases who each underwent two different administration courses showed i.a. to be pharmacologically advantageous since it resulted in a 2-to-7 times higher concentration in the brain tissue adjacent to the tumor. The tumor/plasma and tumor/brain ratios for i.a. administration (1.72 +/- 0.26, 6.09 +/- 1.30, n = 8, M +/- S.E.) were two times higher than those for i.v. administration 0.90 +/- 0.23, n = 12, 3.40 = 0.59, n = 10, M +/- S.E. (p less than 0.05, p = 0.061, unpaired t-test). Toxic side effects were moderate, especially decreased creatinine clearance, but tolerable. Our preliminary results demonstrated the pharmacologic advantage of i.a. CDDP chemotherapy in the treatment of metastatic brain tumor patients.     

Radiosurgery for metastatic brain tumors

Stereotactic radiosurgery (SRS) precisely delivers high-dose radiation to a small target (usually less than 3–4 cm in diameter), in a single session with steep dose-fall, employing various radiation methods. SRS provides good tumor control for small brain metastases from various primary cancers, with minimal untoward effects on surrounding normal brain. This excellent tumor control prevents neurological death and maintains good activity of daily life. Although surgery with whole-brain radiation therapy (WBRT) remains an important option for patients with a solitary brain metastasis, SRS with or without WBRT should be considered in patients with a limited number of small tumors and a good prognosis. Many reports, as well as both retrospective and prospective reviews, have shown WBRT before or after SRS to improve local control and reduce new distant lesion emergence. However, upfront WBRT does not improve survival. There are two major delivery techniques, Gamma Knife (GK; Elekta AB, Stockholm, Sweden) SRS and linear accelerator (LINIAC)-based SRS. They are based on quite different concepts, and have different techniques and clinical applications. These differences complicate the discussion of the limitations of and indications for SRS and the necessity for prophylactic WBRT. This review discusses numerous aspects of SRS, its value as compared with other treatment modalities, the necessity for prophylactic WBRT with SRS, the limitations of and indications for SRS, and the difference between GK and LINIAC SRS, based on the literature and our experience, and proposes a new strategy for the treatment of brain metastases in view of the available clinical data and experience.     

多学科护理照顾模式在脑膜瘤围术期患者护理中的应用

目的探讨多学科护理照顾模式在脑膜瘤围术期患者护理中的应用。方法选取2016年2月至2019年5月间汉中市中心医院收治的行脑膜瘤手术治疗的172例患者为研究对象。根据采用的护理方法不同进行分组,采用多学科护理照顾模式护理干预的86例患者纳入研究组,采用常规护理干预的86例患者纳入对照组。比较两组患者护理后的卡氏(KPS)评分、围术期各项康复指标及术后康复情况;评估多学科护理照顾模式干预对围术期患者的护理价值。结果研究组患者护理后的总有效率为90. 7%,高于对照组患者的73. 3%,差异有统计学意义(P <0. 05)。研究组患者围术期间术后监护室停留时间、住院时间和24h神经功能评分均低于对照组患者,差异均有统计学意义(均P <0. 05)。两组患者12h神经功能评分比较,差异无统计学意义(P> 0. 05)。两组患者术后1、2和3个月的KPS评分均高于术前,差异均有统计学意义(均P <0. 05),且研究组术后1、2和3个月的KPS评分均高于对照组,差异均有统计学意义(均P <0. 05)。两组患者术后均伴有颅内出血、颅内感染、颅内血肿及发热等症状出现,研究组术后并发症的总发生率低于对照组,差异有统计学意义(P <0. 05)。结论多学科护理照顾模式能够有效减少患者围术期的不适症状,促进围术期患者各项康复指标的恢复,降低术后并发症情况,提高其临床疗效。