肾上腺素对颅内微创血肿清除术患者的影响

目的探讨肾上腺素对颅内微创血肿清除术后的影响。方法对86例基底节区脑出血行微创血肿清除术,术后随机分成两组。A组使用尿激酶加肾上腺素液化血肿,B组予常规尿激酶液化血肿。将两组治疗结果进行临床对比。结果 A组43例中,恢复良好生活能自理27例(62.79%),部分生活自理中残10例(23.26%),重残4例(9.30%),死亡2例(4.65%)。B组43例中恢复良好生活能自理的22例(51.16%),部分生活自理中残12例(27.91%),重残5例(11.63%),死亡4例(9.30%)。术后第1天复查头颅CT,血肿体积A组明显比B组小;两组术后血肿体积及神经功能评分存在显著性差异(P<0.05)。结论颅内微创血肿清除术后尿激酶加肾上腺素液化血肿,治疗效果明显优于常规尿激酶液化血肿。肾上腺素对于颅内血肿有明显收缩血管、止血、防止血肿因尿激酶溶解血块后继发性出血作用。     

Validation and reliability of distress thermometer in Chinese cancer patients

Objective:To examine the validation and reliability of the distress thermometer(DT) recommended by National Comprehensive Cancer Network(NCCN) in Chinese cancer patients.Methods:A total of 574 Chinese cancer patients from Beijing Cancer Hospital completed the detection of DT,the Hospital Anxiety and Depression Scale(HADS) and Symptom Checklist 90(SCL-90),Receiver Operating Characteristic(ROC) curve and Area Under the Curve(AUC) were used to analyze the validation relative to HADS and SCL-90.The patients with DT≥4 and whose distress caused by emotional problems were interviewed with the MiNi International Neuro-psychiatric Interview(MINI)(Chinese Version 5.0).This version was used to analyze cancer patients’ psychological and Psychiatric symptoms during the cancer process;3.Another 106 cancer patients in rehabilitation stage and stable condition were asked to fill in DT two times,at the base time and after 7-10 days.Results:Data of ROC indicates that a DT cutoff score of 4 yielded AUC of 0.80 with a optimal sensitivity(0.80) and specificity(0.70) relative to HADS,and AUC of 0.83 with the greatest sensitivity(0.87) and specificity(0.72) against SCL-90.The DT also has acceptable test-retest reliability(r=0.800,P=0.000);According to the interview results,the most common psychiatric problems cancer patients have adjustment disorder,depression,and anxiety.Conclusion:The data suggest that DT has acceptable overall accuracy and reliability as a screening tool for testing distress severity and specific problems causing distress in Chinese cancer patients.It is worth being used in oncology clinic,the rapid screening and interview could help caregivers to identify psychological and psychiatric problems of cancer patients and provide useful information for further treatment.     

Trends in Various Types of Surgery for Hysterectomy and Distribution by Patient Age,Surgeon Age,and Hospital Accreditation: 10-Year Population-Based Study in Taiwan

Study ObjectiveTo estimate the trends in various types of hysterectomy (abdominal, vaginal, laparoscopic, and subtotal) and their distribution according to patient age, surgeon age, and hospital accreditation in Taiwan.DesignRetrospective cohort study (Canadian Task Force classification II-2).SettingPopulation-based National Health Insurance (NHI) database.PatientsWomen with NHI in Taiwan undergoing various types of hysterectomy to treat noncancerous lesions.InterventionsData for this study were obtained from the Inpatient Expenditures by Admissions files of the NHI research database, released by the NHI program in Taiwan for 1996–2005.Measurements and Main ResultsA total of 234 939 women who underwent various types of hysterectomy were identified for analysis. The number of hysterectomies performed annually remained stationary during the 10-year study. Total abdominal hysterectomies decreased significantly (77.33% in 1996 vs 45.68% in 2005), laparoscopic hysterectomies increased significantly (5.20% vs 40.40%), vaginal hysterectomies decreased (14.70% vs 8.86%), and subtotal abdominal hysterectomies increased (2.76% vs 5.06%). Laparoscopic hysterectomy was more commonly performed in middle-aged women; vaginal hysterectomy was more common in older women; and subtotal abdominal hysterectomy was more common in younger women. Laparoscopic hysterectomy was performed more commonly in regional hospitals (33.11%), followed by medical centers (30.17%) and local hospitals (17.78%). Laparoscopic hysterectomy was performed more commonly in not-for-profit hospitals (30.25%), followed by private hospitals (29.32%) and government-owned hospitals (25.91%).ConclusionThere has been considerable change in the types of surgery used for hysterectomy in Taiwan over the past 10 years. As a minimally invasive approach, laparoscopic hysterectomy represents a profound change for both patients and surgeons.