晚期非小细胞肺癌维持治疗的研究进展

自1985年以来肺癌成为全世界常见的恶性肿瘤~([1]),2002年我国男性肺癌世界人口调整发病率为42.4/10万,女性肺癌世界人口调整发病率为19.0/10万~([2]).根据美国Surveillance Epidemiology and End Resuits(SEER)统计,肺癌患者5年生存率美国为15%,欧洲为10%,发展中国家为8.9%~([2]).非小细胞肺癌(non-small cell lung cancer,NSCLC)占所有肺癌病例的80%-85%.NSCLC早期症状多不明显,大多数患者确诊时已属局部晚期或发生远处转移,失去手术根治机会,化疗仍为晚期NSCLC的主要治疗手段之一.

Osteoarthritis, a nonspecific inflammatory lesion, is a commonly seen joint disease. Clinically, it is mainly characterized by arthralgia, swelling, and motor impairment. Since the knee joint is the load-bearing joint of the human body, and is susceptible to trauma, gonitis tends to have the highest morbidity in the four limbs, which manifests itself arthritis of patella and femur at the early stage; narrowness or disappearance of the medial joint space at the mid stage; and damage of the cartilage accompanied with flexion deformity at the late stage. In recent years, based on the experience of Prof. Cao Yiming, the author has treated 47 cases of gonitis by combined use of Chinese drugs and acupuncture, and obtained satisfactory therapeutic results as reported in the following.

Chronic renal insufficiency is the result of renal injuries and progressive deterioration caused by various reasons. At the late stage, i.e. the period of uremia, it may be complicated with abnormalities of various systems. Along with the development and popularization of hemodialysis, the survival time of uremic patients can be prolonged, but uremic pruritus affects greatly the quality of life of the patients. For this purpose, we have treated 68 cases of the patients with acupuncture and western medicine respectively, and made clinical observations on the therapeutic results. A report follows.

Since 1994, the Oncologic Department of the Henan Provincial TCM Hospital has used Chinese herbal enema for treatment of tumors at the middle and late stage with satisfactory therapeutic effects. The following are some examples.

妊娠末期急性胰腺炎并发门静脉系统血栓一例

病例报告:病人,女,28岁,因停经37周,阵发性腹痛1个月,引产后4 d,于2005年6月10日入院.入院前1个月曾患胰腺炎,当地医院治疗后症状缓解.5 d前腹痛症状加重,B超提示胎儿已死亡,并于次日自然娩出.因症状一直难以缓解而转入西安交通大学医学院第一附属医院.入院查体:生命体征平稳,心肺未见异常;腹平软,左上腹有压痛明显,无反跳痛,移动性浊音阴性.

神经源性肺水肿

Neurogenic pulmonary edema (NPE) is a type of pulmonary edema that occurs secondary to central nervous sytem (CNS) damage, namely centrogenic pulmonary edema or cerebrogenic pulmonary edema[1,2] NPE is clinically characterized by acute dyspnea and progressive hypoxemia, while tachycardia, hypertension and tachypnea are only nonspecific symptoms in early phase. Early diagnosis of NPE is difficult since chest X-ray shows no remarkable sign or only increased hazy lung markings in early stage[3]. Diagnosis can be made definitely in the late stage of NPE according to the following manifestation : paleness, clamminess, feeling of impending death, rales, frothy pink sputum, hypoxemia and bilateral widespread infiltration on chest roentgenography. However, successful rescue rate is very low and mortality rate could reach as high as 90% at this stage[4-6].

Objective. To study the redistribution of endothelin-1 (ET-1) receptors in two subcellular organelles , the sarcolemmal membrane and the light vesicle, of rat heart during the progression of sepsis. Methods. Sepsis was induced by cecal ligation and puncture (CLP). ET1 receptor was assayed by using [125I]-ET1 binding. Marker enzyme activities, protein yield, and dry-to-wet weight ratio of cardiac membranes were measured. Results. Septic rat heart exhibited two distinct phases: an initial hyperdynamic phase( 9h after CLP; early stage of sepsis) followed by a hypodynamic (18h after CLP, late stage of sepsis) phase. [125I]-ET1 binding study showed that during early stage of sepsis, the Bmax of ET1 receptors was increased by 30％ in sarcolemma but decreased by 19％ in light vesicles, while during late stage of sepsis, the Bmax was decreased by 24％ in sarcolemma but increased by 38％ in light vesicles.The total binding of sarcolemma and light vesicles was increased by 25％ during early stage of sepsis but decreased by 17％ during late stage of sepsis. Conclusions. These data indicated that ET1 receptors in the rat heart were externalized from light vesicles to sarcolemmal membranes during early hyperdynamic phase while internalized from surface membranes to intracellular compartment during late hypodynamic phase of sepsis.

胸大肌肌皮瓣修复晚期头颈癌瘤术后缺损病人的护理

晚期头颈癌瘤病人,特别是术后或放疗后复发的病人,常因肿瘤侵犯范围广,再次切除会带来组织广泛和复杂的缺损.术后修复是治疗的关键.

晚期乳腺癌的介入治疗及护理

晚期乳腺癌是指临床Ⅲ期癌,常因原发癌灶体积过大而丧失手术机会,治疗效果差.我院从1998年始,对26例晚期乳腺癌病人行术前介入治疗,使病人获得Ⅱ期手术机会,效果满意.

多瑞吉贴剂治疗晚期癌症病人疼痛的临床观察及护理

芬太尼透皮贴剂(多瑞吉)是强阿片类的非口服止痛药.主要用于晚期肿瘤中度以上疼痛、同时不能吞咽药物、口服给药的晚期病人.疼痛是影响晚期肿瘤病人生存质量的主要问题.因此,大限度地缓解癌症病人的疼痛,从而改善和提高癌症病人的生活质量是非常重要的[1].我院应用多瑞吉贴剂治疗 48例晚期癌痛病人,效果良好.现介绍如下.

夏季晚期食管癌病人的营养护理

合理的营养可提高病人机体的抗病能力,减少并发症[1].夏季是人体消耗大的季节,在高温环境中,人体对蛋白质、水、无机盐、维生素及微量元素的需求量均有所增加[2].

晚期周围神经损伤后感觉功能恢复中:脊髓后角P物质及降钙素基因相关肽的变化

背景:晚期周围神经损伤有无修复价值?如果脊髓神经元中P物质和降钙素基因相关肽的变化发生了不可逆的变化,其修复后也预示着感觉功能的缺失. 目的:定量研究周围神经损伤24周后,脊髓后角中P物质和降钙素基因相关肽的变化.设计:建立以大鼠坐骨神经损伤为研究对象的实验模型,损伤后24周为远期观察点,自身对照(对侧空白组),定量化研究.单位:第四军医大学骨科研究所.材料:实验于2002-10/2003-05在第四军医大学骨科研究所完成.SD大鼠55只,分成11组,即坐骨神经切断1,2,3,4,6,8,10,12,16,20,24周各组.干预:切断大鼠一侧坐骨神经并结扎其近端的方法建立周围神经损伤模型;另一侧为对照侧.应用计算机图像分析技术测试P物质和降钙素基因相关肽免疫反应区的面积.主要观察指标:各组大鼠脊髓后角中P物质和降钙素基因相关肽阳性纤维的终末分布面积的变化.结果:55只大鼠均进入结果分析.①P物质时间序列表示:周围神经损伤后2～6周,P物质在脊髓后角免疫反应区面积下降至低,随之回升,至16周恢复正常,20,24周无明显的进一步变化.②脊髓后角降钙素基因相关肽阳性纤维和终末分布面积损伤与自身对照侧的比值:1周时1.14,6周时1.13,24周时0.29,各时间点基本相似(P＞0.05)结论:周围神经损伤至晚期,脊髓后角及后根神经节细胞合成和分泌P物质及降钙素基因相关肽的功能尚未受到破坏,脊髓后角已处于一种稳定的平衡状态,仍有恢复感觉功能的神经学基础.

康复期癌症人的心理问题探讨

Background: The mental problems of the patients with malignant tumor are complex, and it is very important for rehabilitation of the patients to find the most common and prominent mental problems and perform effective mental care. Objective: To discuss the mental problems of the patients with malignant tumor in the recovery stage. Unit: the tumor department of Hospital of Heze City in Shandong Province. Subject: All cases in the research came from the patients with malignant tumor in our hospital durng the period of 1998～ 2000. We selected 100 cases who have reached fully clinical recovery or turned better and could take care of oneself by systemic therapy. In the group, there were 61 males and 39 females; 30 patients in 40～ 55 years old, 70 in 56～ 65; 39 cases who were illiterate, 36 who only accepted primary school education, 21 who accepted middle school education, 4 who reached the degree of university education; 63 farmers, 28 workers, 4 cadres, and 5 individual businessman. Intervention: During the days before leaving hospital, record the mental problems worried most of the patients by responsibility nurse' survey. In the course, only record whether there were the problems or not and the content of the problems, but never determine the degree of the problems. Result:(1) The problems most worried by 27 patients were there were no effective therapeutic methods (27％ ); (2) The problems most worried by 21 patients were the life would be terminal (21％ ); (3) The problems most worried by 12 patients were short of family income, decrease of labor ability and arrangement of the children (12％ ); (4) The problems most worried by 6 patients were unhappy relationship between man and wife (6％ ); (5) The problems most worried by 15 patients were parents or children would be encumbered (15％ ); (6) The problems most worried by 9 patients were radiological or chemical therapy would not be performed regularly (9％ ); (7) There were 10 patients who had no the special problems most worried (10％ ). By statistical analysis, there was obvious difference in sex between (2) and (3) (P< 0.01). The female worried (2) problems were more than the male, while the male worried (3) problems were more than the female. In addition by statistical disposal, we found the problems most worried were relative with sex,age,educational degree,job of the patients (P >0.05); and obviously relative with the progressive degree of tumor (P< 0.01), because the mental problems of the patients with early stage tumor were less than the patients with late stage tumor obviously. Conclusion: The mental problems of the patients with malignant tumor in the recovery stage should be paid attention to, and it's significant for rehabilitation of the patients to apply effective mental care.

药物三阶梯止痛治疗在癌性疼痛康复中的应用

Background: According to small scale of investigation, world health organization (WHO) infers that moderate and serious pain is observed in about 1/3 of patients receiving active anti cancer therapy and 60% in late stage. Cancer related pain is a threat to patients' living quality and confidence, so rehabilitation becomes an important part in treatment of cancer.

微粒皮移植治疗特大面积深度烧伤瘢痕挛缩畸形

Background:Contracture deformity of scar in late stage of extensive deep burn often needed repeated surgical plastics and no fitful auto skin or lacking were the common problems in clinic.

晚期癌症病人生活质量研究

1 重要性及必要性目前,大多数癌症治疗所关注的只是疾病本身,而不是患者本人及其主观感觉,如QOL.QOL评估已日益成为癌症治疗的一个有机组成部分.

流行性出血热多尿期肾小球毛细血管壁通透性的研究

本文对8例流行性出血热(EHF)及对照组测定了中性右旋醣酐-40(d)和内源性血浆β2微球蛋白(β2m),白蛋白(alb)和IgG的清除分数(θ).结果发现,在EHF多尿初期(Gla),其分子大于44 A的θd和θIgG均呈显著增高,而小分子的θd又低于正常,提示肾小球滤过膜"大孔"数的增多和负电荷的丢失.在多尿后期,大分子θd和θIgG已呈明显下降,提示滤过膜通透性已得到一定修复.

长春瑞滨治疗老年晚期非小细胞肺癌疗效观察

近年来,非小细胞肺癌的发病率持续升高,70岁及以上老年人患者也明显增多.晚期非小细胞肺癌化疗的目的在于延长生存和改善生活质量[1].化疗的毒副作用越发引起临床医师和患者的关注.

It is very difficult for doctor to treat patient with persistent hypotension in the late stage of shock. The aim of present study was to elucidate the reason for lower vasoreactivity in severe shock. Irreversible hemorrhagic shock of rat was reproduced and the vasoreactivity of arteriole in spinotrapezius muscle to norepinephrine (NE) was measured. The resting membrane potential of isolated arterial strips was detected with a microelectrode. The effect of NO on the membrane potential and intracellular ［Ca2＋］i level in isolated arteriolar smooth muscle cells (ASMCs) was determined with fluorescent probes under confocal microscope. KATP channel of ASMCs was measured with patch clamp method. It was shown that membrane hyperpolarization appeared in arteroles 2 h post hemorrhage, while the resting potential was increased from (-36.9±6.3) mV of control value to (-51.0±9.1) mV with the NE threshold increased to 15 times more than preshock value. The hyperpolarization of ASMCs was closely related to vascular hyporeactivity (correlation coefficient 0.96, P＜0.01). The hyperpolarization was enhanced by lack of ATP, increase in H＋，and OONO- in ASMCs. Single KATP channel conducatance, mean open time and open probability was increased in ASMCs, and the increased ［Ca2＋］i level of ASMCs stimulated by NE was reduced to 50% of normal value. The vasoreactivity, blood pressure and survival rate could be improved by the treatment of glybenclamide and NaHCO3. The study indicates that hyperpolarization of ASMCs is a major reason for lower vasoreactivity in severe shock, since it inhibits the voltage dependent Ca2＋ channel (POC) with the reduction of NE stimulated ［Ca2＋］i increase. The decrease in ATP and increase in H+, and OONO- in ASMCs involves in the activation of KATP channel, leading to the ASMCs hyperpolarization.