基于前哨症状的耳穴贴压预防胃癌化疗患者症状群的效果

目的 对胃癌化疗患者进行预防性症状管理,降低症状群发生率及相关症状严重程度。方法 将肿瘤科收治的胃癌化疗患者120例按随机序列分为试验Ⅰ组40例、试验Ⅱ组40例、对照组40例。三组均在常规护理的基础上行耳穴贴压,试验Ⅰ组选取症状群相关穴位行耳穴贴压,试验Ⅱ组选取疼痛相关穴位行耳穴贴压,对照组选取假穴位贴压,连续干预1周。比较三组干预前后疼痛-疲乏-睡眠障碍症状群发生率、症状严重程度的差异。结果 干预后,试验Ⅰ组症状群发生率显著低于对照组(P<0.0125),试验Ⅰ组、试验Ⅱ组疼痛程度显著低于对照组,试验Ⅰ组疲乏得分、睡眠得分显著低于试验Ⅱ组与对照组(均P<0.05)。结论 基于前哨症状行耳穴贴压预见性干预胃癌化疗患者,可显著降低疼痛-疲乏-睡眠障碍症状群发生率,减轻患者症状困扰程度。     

Effects of obesity on lower urinary tract symptoms in Korean BPH patients

We analyzed the effects of obesity on lower urinary tract symptoms （LUTSs） in Korean benign prostatic hyperplasia （BPH） patients. This is a multicenter, cross-sectional, prospective study conducted in four centers in Korea. A total of 602 men with LUTSs secondary to BPH were included. BPH/LUTSs cases were men aged ≥ 40 years with intemational prostate symptom scores （IPSS） ≥ 8 points. Height, weight and waist circumference were measured. Among the 602 patients, 156 patients had a waist circumference above 90 cm, representing central obesity, and 215 patients had a body mass index above 25 kg m2. Waist circumference was positively correlated with prostate volume （P = 0.034）. Men with waist circumference 〉 90 cm experienced a 1.36-fold increased risk of severe LUTSs （95% CI 0.82-2.41） compared with men with waist circumference ≤ 90 cm. Prostate volume was positively correlated with urgency and nocturia in men with central obesity. In this population of Korean men diagnosed with BPH, central obesity rather than overall obesity seems to be the more important predictor of LUTSs correlated with BPH.     

症状评分、分度法诊断急性高原反应的应用与体会

本文报告应用症状评分、分度法对部队急进高原人群进行急性高原反应诊断的体会。现场调查结果;第1～3天发病率为18.5～37.9％,比临床症状学方法结果低。评分法具有量化、客观、简便等优点。对定量评价急性高原反应,指导临床与科研工作,使结果更具统一性和可比性,以及客观评价高原医学科研成果,具有理论和实际意义。     

Symptom burden, quality of life, advance care planning and the potential value of palliative care in severely ill haemodialysis patients.

BACKGROUND: There has been little research on the potential value of palliative care for dialysis patients. In this pilot study, we sought (i) to identify symptom burden, health-related quality of life (HRQoL) and advance directives in extremely ill haemodialysis patients to determine their suitability for palliative care and (ii) to determine the acceptability of palliative care to patients and nephrologists. METHODS: Nineteen haemodialysis patients with modified Charlson co-morbidity scores of > or =8 were recruited. Each completed surveys to assess symptom burden, HRQoL and prior advance care planning. Palliative care specialists then visited patients twice and generated recommendations. Patients again completed the surveys, and dialysis charts were reviewed to assess nephrologists' (i) compliance with recommendations and (ii) documentation of symptoms reported by patients on the symptom assessment survey. Patients and nephrologists then completed surveys assessing their satisfaction with palliative care. RESULTS: Patients reported 10.5 symptoms, 40% of which were noted by nephrologists in patients' charts. HRQoL was significantly impaired. Thirty-two percent of patients had living wills. No differences were observed in symptoms, HRQoL or number of patients establishing advance directives as a result of the intervention. Sixty-eight percent of patients and 76% of nephrologists rated the intervention worthwhile. CONCLUSIONS: Extremely ill dialysis patients have marked symptom burden, considerably impaired HRQoL and frequently lack advance directives, making them appropriate candidates for palliative care. Patients and nephrologists perceive palliative care favourably despite its lack of effect in this study. A more sustained palliative care intervention with a larger sample size should be attempted to determine its effect on the care of this population.     

阿米替林对非糜烂型胃食管反流病合并单纯抑郁症状的治疗效果分析

目的探讨非糜烂型胃食管反流病(non-erosive reflux disease,NERD)合并单纯抑郁症状的治疗效果。方法使用综合医院焦虑、抑郁量表(the Hospital anxiety and depressive scale HADS)对NERD患者进行心理测评,对合并单纯抑郁症状患者按轻度、中度、重度分层随机分为常规组、治疗组、对照组三组,每组90例。常规组:奥美拉唑20mg,2次/d,西沙比利10 mg,3次/d,口服;治疗组90例,给予阿米替林12.5 mg,3次/d,奥美拉唑20 mg,2次/d,西沙比利10 mg,3次/d,口服;对照组90例,安慰剂,半片,3次/d,奥美拉唑20 mg,2次/d,西沙比利10 mg,3次/d,口服。疗程为8周,并于治疗后2、4、6、8周观察反酸、烧心、反胃、胸骨后疼痛及抑郁症状的缓解情况。结果对照组和治疗组患者治疗8周后,精神、躯体症状均显著改善,与常规组有显著差异(P(0.01),相互间也有显著差异(P(0.01)。结论抗抑郁药治疗能显著改善合并有单纯抑郁症状的NERD患者的精神和躯体两方面症状。     

急性胰腺炎患者住院早期胃肠功能与病情进展的相关性研究

背景　肠道作为吸收营养、参与免疫调节的重要器官,其在急性胰腺炎患者的病情进展中起着重要作用,但目前关于住院早期胃肠功能在急性胰腺炎患者病情进展中的作用鲜见报道。目的　探讨轻度急性胰腺炎患者住院早期的胃肠功能与其病情进展之间的关系。方法　选取2017年12月-2018年5月在南京医科大学第一附属医院胰腺中心接受治疗的轻度急性胰腺炎患者为研究对象。参照2013年急性胰腺炎患者诊治指南,根据出院诊断中病情严重程度,将患者分为轻度急性胰腺炎组（n=58）、中度急性胰腺炎组（n=28）、重度急性胰腺炎组（n=14）。比较3组患者入院后首次大便时间、入院第1、2、3天修订版胃瘫主要症状指数（GCSI-R）量表评分,并探讨患者的病情严重程度与以上指标的相关性。结果　3组急性胰腺炎患者性别、年龄、体质指数（BMI）、吸烟情况、饮酒情况、入院24 h液体入量比较,差异无统计学意义（P>0.05）。3组患者首次大便时间及GCSI-R量表总分、早饱维度评分、腹胀维度评分比较,差异有统计学意义（P<0.05）;3组患者恶心/呕吐维度评分比较,差异无统计学意义（P>0.05）。急性胰腺炎患者的病情严重程度与其首次大便时间及入院第1、2、3天的GCSI-R量表总分、早饱维度及腹胀维度评分呈正相关（P<0.05）,与入院第1、2、3天恶心/呕吐维度评分无相关性（P>0.05）。结论　轻度急性胰腺炎患者入院早期的胃肠功能与其病情进展密切相关,反映了急性胰腺炎患者的病情严重程度,可作为预后评估指标之一。     

腹膜透析患者症状评估表的制订及信效度检验

目的探讨腹膜透析患者症状评估表的适用性,并检验其信效度。方法通过查阅国内外文献、结合对临床腹膜透析患者、临床医护人员的结构性访谈及医护专家函询的结果,对中文版腹膜透析患者症状评估表进行修订,最终删除6个条目,新增5个条目,形成腹膜透析患者症状评估表。对河南省3所腹膜透析中心330例腹膜透析患者进行调查,评价其信效度。结果腹膜透析患者症状评估表的内容效度为0.923;该量表共提取5个公因子,累积方差贡献率为64.153%;总Cronbach′sα系数为0.947,各维度Cronbach′sα系数0.795~0.904;各因子的重测信度系数r值>0.7。结论腹膜透析患者症状评估表具有良好的信效度,可用于我国腹膜透析患者症状的评估。     

老年男性下尿路症状伴逼尿肌过度活动患者临床及尿动力学特点分析

Objective To study the change of clinical and urodynamic parameters in the patients with lower urinary tract symptom (LUTS) caused by detrusor overactivity (DO). Methods Two hundred and twenty-seven patients with LUTS underwent clinical evaluation from October 2006 to December 2008, including Prostate Volume (PV), International Prostate Symptom Score (IPSS), Peak Flow rate (PF) and Residual Urine (RU) measurement. Pressure flow studies were performed. The detrusor overactivity was recorded to classify the patients into 2 groups, DO group and none DO group. The clinical and urodynamic parameters were compared between the two groups. Results Mean patient age was 70 years (range 52 to 89). According to the urodynamic results, there were 126 patients in DO group and 101 patients in none DO group. The mean patients age was older in DO group than the none DO group(P＜0.05). Adjusted by age, the PV, PF, and RU were no different between the two groups(P>0.05). The mean first sensation of bladder, bladder compliance, cystometric capacity, bladder outlet obstruction parameters, single voiding volume and max detrusor pressure during contraction were different between the two groups(P＜0.05). Conclusions The main risk factors of DO are the ageing and BOO. The non invasive parameters such as PV、 PF、 and RU could not be used to judge DO. The changes of urodynamic parameters caused by DO were hyperaesthesia of bladder、lower bladder compliance、 higher max detrusor pressure and lower max cystometric capacity. This study emphasis the importance of the urodynamic studies in the aged patients with LUTS.     

鼻咽癌出院5年患者症状群与生活质量的相关性研究

目的 调查鼻咽癌出院5年患者症状群的构成,分析症状群与生活质量的相关性.方法 采用一般资料表、M.D.Anderson症状调查表-头颈部、生活质量量表对131例患者进行调查,采用探索性因子方法提取症状群、Spearman分析症状群与生活质量的相关性.结果 鼻咽癌出院5年患者疲劳(99.2％)、口干(97.7％)、健忘(...     

甲基强的松龙在胸椎管狭窄症围手术期的应用

目的探讨甲基强的松龙(MP)在胸椎管狭窄症围手术期应用的价值.方法对82例胸椎管狭窄症采用单纯后路胸椎板切除术患者进行回顾性研究.所有患者手术减压前30min给予MP 1000mg冲击.76例减压术后第1日起每日200mg递减,术后第5d停药.术后出现脊髓缺血再灌注(IR)损伤6例,其中3例MP用法同上;另3例术后出现脊髓IR损伤时即刻按NASCIS-Ⅱ方案治疗.结果本组76例术后呈现不同程度的恢复.另6例术后出现脊髓IR损伤,其中术后MP每日200mg递减治疗的3例患者神经功能恢复较慢,1例于术后6个月恢复至正常,2例术后1年随访时肌力恢复满意但肢体仍有麻痛感;采用NASCIS-Ⅱ方案治疗的3例患者中,2例于治疗后48h神经功能基本恢复正常,1例于术后1个月双下肢功能完全恢复正常.发生应激性溃疡1例.结论胸椎管狭窄症手术减压患者围手术期应用MP,具有预防和治疗脊髓继发性损伤的作用.