影响晚期癌症病人生活质量因素的探讨

为了解晚期癌症病人的心理社会需求 ,探讨影响晚期癌症病人生活质量的因素 ,以控制疼痛为核心 ,配合心理辅导及护理指导 ,对 2 68例晚期癌症患者及家属进行全方位的系统干预 ,并对病人整体生活质量进行评估。结果 :病人的生活质量明显提高 ,但 7%病人癌痛没有获得有效的控制。此外乏力、恶心、呕吐及便秘是常见的躯体症状 ;不了解自己真实病情的人负性情绪的比率高于知情者。提示 :系统干预提高了癌症病人的生活质量 ,但目前癌痛控制不尽如人意 ,癌痛及其他躯体症状是影响病人情绪的主要问题之一。医护人员要多方面地衡量和评估病人及其家人的需求 ,使宁养服务更加完善     

关于修订培养计划的建议及措施

修订培养计划是高校教学管理中的一项重要工作,直接体现着学校教育管理水平的高低,因此各院校都高度重视.结合天津中医药大学培养计划的修订工作,从修订指导思想、人才培养着力点、保障措施建设3个方面提出了建议,并介绍了天津中医药大学所制定并采取的相应措施.     

Envoy DA导管治疗合并颈动脉迂曲前循环动脉瘤的临床体会

目的 评价使用Envoy DA导管治疗合并颈动脉迂曲前循环动脉瘤的通过性、支撑性和安全性。方法 分析2017年1月—2020年12月在泾县医院收治合并颈动脉迂曲前循环动脉瘤使用DA导管的患者共49例,分析患者临床资料、导管到位时间、使用同轴技术数量、动脉瘤介入治疗前和结束时导管头端的位置、导管相关并发症、动脉瘤栓塞程度以及患者预后。结果 所有患者DA导管均顺利到位,导管平均到位时间（9.2±5.6）min,其中10例（20.4%）应用同轴技术将DA导管超选至颈内动脉。治疗前DA导管到位颈内动脉海绵窦段8例,岩骨水平段15例,岩骨垂直段26例,治疗结束时造影示有9例（18.4%）导管头端下移,其中有2例（4.1%）因导管下移至颈内动脉颈段,更换长鞘+DA导管的同轴双导管系统。3例（6.1%）导管到位后出现血管痉挛,给予动脉泵入尼膜同痉挛缓解。其他病例未出现导管相关性并发症。3个月随访时mRS评分,0分33例,1分10例,2分6例。结论 Envoy DA导管在合并迂曲颈动脉的前循环动脉瘤栓塞过程中,具有良好通过性且能提供足够支撑力。[国际神经病学神经外科学杂志, 2022, 49(6):5...     

Transfemoral subclavian artery stenting through a shaped guiding catheter without pull-through technique: A case report

Transfemoral subclavian artery stenting can be challenging unless the placement of the guiding catheter is secured. Herein, we present a patient with subclavian artery stenosis treated with endovascular stenting using a shaped guiding catheter. A 79-year-old woman was admitted to our department because of a cold sensation and numbness of her left arm. Computed tomography revealed stenosis of the left subclavian artery (SA), located just proximal to the ostium of the left vertebral artery (VA). Doppler ultrasound showed reverse flow in the left VA. We planned to stent for the SA stenosis under the balloon protection of the left VA. The balloon protection device was easily navigated into the left VA through brachial access. After that, a self-expandable stent was successfully placed from just proximal to the VA origin to the ostium of the SA using a highly stable shaped guiding catheter. The patient recovered from the symptoms and was discharged 4 days after the procedure. The high stability of the shaped guiding catheter is advantageous during endovascular treatment of the subclavian artery.     

战创伤急救中快速建立气道的新型气管切开装置

目的探索并研发一项可用于战创伤紧急救治的新型气管切开装置及其使用方法。方法分别对6只杂种犬（10～20kg）和6只小型猪（15-30kg）实施环甲膜穿刺反向引导气管切开术,并建立气道。结果从插入穿刺管到完成气管插管,杂种犬用时（153．83±32．90）s,小型猪用时（173．83±34．07）s。所有实验动物均成功建立通畅的呼吸通道,无严重出血和其他并发症,通过纤维支气管镜也未观察到气管壁损伤。结论此方法快速、简单、安全,所有操作可由一人完成,大大提高了建立紧急呼吸通道的速度,有望在完善后应用于战创伤急救中建立快速气道。     

Ⅱ型糖尿病社区健康指导效果评价

目的：评价社区健康指导措施对糖尿病患者自我管理能力的改善。方法：对50例糖尿病患者健康教育前及健康教育实施6个月后，进行自我管理能力问卷调查。结果：患者按时服药、血糖监测、饮食控制、加强运动、定期复查等各项结果均有统计学差异。表明健康教育后糖尿病患者的自我管理能力明显高于健康教育前。结论：有针对性的社区健康指导对糖尿患者自我管理能力的提高具有明显的积极作用。     

New method to increase a backup support of a 6 French guiding coronary catheter.

A 6 Fr guiding catheter is commonly used in the percutaneous coronary intervention (PCI). However, one of the limitations of the 6 Fr guiding catheter is its weak backup support compared to a 7 or an 8 Fr guiding catheter. In this article, we present a new system for PCI called the five-in-six system. Between March 2003 and September 2003, this system was tried on eight chronic total occlusion cases. The advantage of the five-in-six system is that it increases backup support of a 6 Fr guiding catheter.     

Angioplasty of a totally occluded right coronary artery

A new 6 French (F) guiding catheter with a large, teflon-coated internal lumen (4.2F) was developed, permitting use of the standard ultralow profile (< 3F) over-the-wire system. This small coronary angioplasty system (6F-PTCA) was evaluated in 48 lesions in 45 of 137 patients (33%) who underwent coronary angioplasty between September 1990 and January 1991. The mean age was 64 years (range 49 to 82); 37 (82%) were male. The procedure was via the brachial artery in 28 patients (62%). The overall primary success rate was 96%. It was 100% via the brachial artery and 90% via the femoral artery. There were no major complications. The puncture compression time with the 6F-PTCA via the brachial artery and via the femoral and with 8F-PTCA via the femoral was 3.8, 9.6, and 16.9 hr, respectively (P<0.001), although the procedure time of the 6F-PTCA via brachial and via femoral and of the 8F-PTCA was not significantly different. The mean hospital stay was 3.1, 4.5, and 5.5 days, respectively (P<0.01). A small hematoma occurred in 2 patients (4.4%) after the 6F-PTCA and in 3 (3.3%) after 8F-PTCA, and a large hematoma (>5 cm) was noted in 7 patients (7.6%) after 8F-PTCA. These results indicate that coronary angioplasty using the over-the-wire system through the new 6F guiding catheter is technically feasible. Moreover, this approach, especially when advanced via the brachial artery, could shorten the he-mostasis time and facilitate early ambulation. © 1992 Wiley-Liss, Inc.     

肝细胞癌四种临床分期系统预后判断和治疗指导价值的比较

Objective To compare the Barcelona clinic liver cancer staging classification (BCLC), the Japan integrated staging score (JIS), the cancer of the liver Italian program score (CLIP) and Chinese staging system in terms of their ability to predict outcomes and to guide option of therapy in patients with hepatocellular carcinoma (HCC) in China.Methods Clinical data of 861 HCC patients from Zhongshan Hospital between 2001 and 2002 were retrospectively analyzed. Patients were classified acccording to different staging systems. Survival for patients in different stages and the effects of therapeutic methods on survival time were compared. Results BCLC, JIS and Chinese staging system showed the ability in predicting survival for patients in different staging. CLIP failed to show significant difference in survival rates for each subgroup. There was no significant difference in survival rate between surgery and transarterial chemoembolization (TACE)/transarterial embolization (TAE) for patients classified as BCLC stage C, CLIP scores more than 3 or Chinese stage Ⅲ a.The survival rate, however, was higher in patients received operation than those received TACE/TAE if they were classified as earlier stages. Conclusions The BCLC, JIS and Chinese staging systems show prospective ability for Chinese HCC patients in prediction outcomes, whereas the BCLC and the Chinese staging systems are better at both predicting outcomes and guiding the option of treatment.     

ST段抬高型心肌梗死患者行经皮冠状动脉介入治疗时应用单根指引导管的有效性与安全性

目的评估急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者经桡动脉途径行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗中依据术前检查结果,直接使用单根指引导管的有效性与安全性。方法连续入选2017年1月至2019年1月于汕头市第二人民医院住院,诊断为STEMI且具有急诊冠状动脉造影及PCI治疗指征的患者120例。用随机数字表法以1∶1随机分为试验组与对照组。对比两组门-球囊(door-to-balloon,D2B)时间、穿刺至球囊时间、住院时间及半年主要不良心血管事件(major adverse cardiac event,MACE)发生率等。结果试验组中的D2B时间[(65±15)min vs.(73±19)min,P=0.01]和穿刺至球囊时间[(18±10)min vs.(28±13)min,P<0.001]比对照组更短,差异有统计学意义。在试验组中,使用指引导管的数量显著低于对照组,差异有统计学意义(P<0.05)。30 d随访过程中,两组均有2例MACE发生,两组MACE发生率比较,差异无统计学意义(P>0.05)。结论依据术前检查的结果,直接使用单个指引导管在STEMI患者中行急诊PCI治疗能有效缩减D2B时间。