食管下段癌根治术后并发胃食管吻合口瘘的护理

护士长食管下段癌根治术后并发胃食管吻合口瘘,近年来在本病房偶有发生,一旦发生,护理十分复杂,死亡率很高。为提高我科护理质量,护理部副主任一起参加查房指导。现对胃食管吻合口瘘的观察,护理重点以及从护理的角度出发如何预防吻合口瘘和降低死亡率等方面进行分析讨论。先请实习护士介绍病人情况。实习护士甲:患者陈×,男,59岁。半年前开始有轻微吞咽不适感和胸骨后烧灼感,近期症状日趋加重,呈进行性吞咽困难,进半流质常致梗噎,偶     

非小细胞肺癌患者肿瘤组织乳腺癌易感基因1和β微管蛋白Ⅲ表达及其与化疗疗效的关系

目的 观察肿瘤组织乳腺癌易感基因1(BRCA1)、β微管蛋白Ⅲ表达与ⅢB和(或)Ⅳ期非小细胞肺癌(NSCLC)采用紫杉醇联合顺铂(TP)方案化疗疗效的相关性.方法 入选初治、NSCLC临床TNM分期为ⅢB和(或)Ⅳ期、体能状态(PS)评分0～2分、预计生存期≥3个月的患者入选本研究.入选者均进行TP方案化疗,每3周重复,每2个周期评价1次疗效,共4～6个周期,无效者更换二线化疗方案.免疫组化检测肿瘤组织中BRCA1、β微管蛋白Ⅲ表达.根据BRCA1、β微管蛋白Ⅲ表达高低分为A组(BRCA1、β微管蛋白Ⅲ低表达)、B组(BRCA1、β微管蛋白Ⅲ高表达)、C组(BRCA1高表达,β微管蛋白Ⅲ低表达),D组(BRCA1低表达,B微管蛋白Ⅲ高表达).评价疗效指标:客观反应率(RR)、总生存时间(OS)、至肿瘤进展时间(TTP).结果 (1)人组87例ⅢB/Ⅳ期NSCLC患者,BRCA1、β微管蛋白Ⅲ表达阳性率分别为57.5%(50/87)、48.3%(42/87),BRCA1、β微管蛋白Ⅲ不同表达的NSCLC患者间临床特征比较差异无统计学意义.(2)87例患者中A组28例,B组23例,C组19例,D组17例.化疗前4组患者间的临床特征比较差异无统计学意义.4组患者RR分别为60.7%、34.8%、9/19、6/17;OS分别为(539.4±17.6)d、(267.2±20.5)d、(325.6±24.1)d、(283.7±26.2)d;TTP分别为(256.9±28.4)d、(143.8±17.6)d、(179.3±19.8)d、(152.6±23.5)d.方差分析显示,A组的RR、OS、TTP均优于其他3组,差异有统计学意义(P值分别为0.039、0.000和0.000).结论 BRCA1、β微管蛋白Ⅲ可作为TP方案疗效的预测分子;仅BRCA1、β微管蛋白Ⅲ低表达的NSCLC患者,可能是TP化疗方案的优势人群.

Abstract：

Objective To investigate the predictive value of breast cancer susceptibility gene 1 (BRCA1) and class Ⅲβ-tubulin protein expression in tumor tissue for the efficacy of taxol and cisplatin combined chemotherapy (TP) in stage Ⅲβ/Ⅳ non-small cell lung cancer(NSCLC) patients. Methods A total of 92 stage Ⅲβ/Ⅳ NSCLC patients were recruited with 87 patients evaluated. Bronchoscopy or lung puncture tumor biopsy samples were obtained with BRCA1 and class Ⅲβ-tubulin protein expression examined immunohistochemically before chemotherapy. The patients were randomly assigned to be received 4 to 6 cycles of TP chemotherapy regiments and followed up until death or lost. Response rate (RR) , overall survival (OS) and time to tumor progression (TTP) were assessed. Results Among the 87 evaluated patients, the positive expression rates of BRCA1 and class Ⅲβ-tubulin were 57. 5% (50/87) and 48. 3%(42/87) respectively. There was no significant difference in clinical characteristics among patients with different positive expression rate. According to different expression of BRCA1 and class Ⅲβ-tubulin, the patients were divided into four groups: group A (low expression of both BRCA1 and class 1 p-tubulin) ,group B (high expression of both BRCA1 and class Ⅲβ-tubulin) , group C (high expression of only BRCA1) and group D (high expression of only class Ⅲβ-tubulin). The RR was higher in group A than other three groups (60. 7% , 34. 8% , 9/19 and 6/17 respectively). The OS and TTP were longer in group A than other three groups [OS: (539. 4 ± 17. 6) days, (267. 2 ± 20. 5) days, (325. 6 ± 24. 1) days and (283.7±26.2) days respectively ; TTP: (256. 9 ± 28. 4) days, (143.8±17.6) days, (179. 3 ± 19. 8)days and (152. 6 ±23. 5) days respectively]. There were no significant differences among the other three groups. Conclusions The expression level of BRCA1 and class Ⅲβ-tubulin in tumor tissue is probably a predictor for the efficacy of TP chemotherapy in NSCLC patients. TP chemotherapy is more suitable for the NSCLC patients with lower expression of both BRCA1 and class Ⅲβ-tubulin. Our study may provide a new sight for tailored chemotherapy in NSCLC patients.     

封堵治疗卵圆孔未闭并发不同类型偏头痛47例

目的 探讨封堵治疗卵圆孔未闭(PFO)并发不同类型偏头痛病人的临床疗效及安全性。方法 选取2013年1月至2016年1月在广西壮族自治区9家医院收治的PFO合并偏头痛病人47例,经PFO封堵治疗后,观察术前及术后头痛症状改变情况,C反应蛋白(CRP)、血浆一氧化氮(NO)水平及血液流变学指标血浆黏度(PV)、红细胞比容(Hct)的变化情况。结果 47例病人术后头痛影响测定-6(HIT-6)评分较术前有明显下降(P＜0.05),经颅多谱勒超声发泡试验(c-TCD)声学造影检查仅2例存在Ⅱ级右向左分流;术后CRP、血浆NO水平及PV、Hct较术前有明显改善。结论 经导管封堵PFO是一种安全有效的治疗方法,可有效减少偏头痛的再发生。