姑息关怀病房终末期癌症患者自杀的防治

终末期癌症是指肿瘤已经发展到各种已知的有效抗癌治疗措施均无反应或不能控制其生长,而且出现身体各部位转移与浸润,明显缩短患者的生存期,降低生命质量.姑息关怀是通过控制疼痛和治疗躯体的、社会心理和宗教困扰,来预防和缓解身心痛苦,从而改善病人的生命质量.     

北京肿瘤医院宁养院:关键词"力撑"与"推动"

宁养服务的涵义是专门收治晚期癌症患者,为晚期癌症患者进行各种姑息性治疗的一个概念。WHO对姑息治疗的解释是：肯定生命并把死亡视为一正常过程；既不加速也不延缓死亡；提供疼痛和其他痛苦症状的缓解；结合心理和精神方面的医疗照顾；提供一支持系统以帮助患者尽可能积极地生活直至死亡；提供一支持系统以帮助家属在患者患病期间和他们沮丧期间能应付面对的一切。宁养服务的目的是使患者获得最佳生活质量,“When day can not add to lift,add lift to day”。这一观念是否被接受,很大程度上取决于患者的生活方式、所受文化教育程度、信仰及价值观。     

晚期癌症患者居家宁养服务与住院姑息治疗成本-效益分析

目的:分析晚期癌症患者居家与住院姑息性治疗的疗效及医疗费用支出,为晚期癌症患者居家及住院治疗提供参考。方法:统计50位居家接受宁养服务和50位住院接受姑息治疗的患者的医疗费用并进行比较分析,通过问卷调查统计他们的生活质量并进行对比分析。结果:居家接受宁养服务的患者的医疗费用明显低于住院接受姑息治疗的患者(P<0.05),两组患者的生活质量无明显差异(P>0.05)。结论:晚期癌症患者居家接受宁养服务是一种较好的选择,且可避免医疗资源的浪费和过度治疗。     

500例晚期癌症患者宁养服务回顾性分析

目的探讨宁养服务对提高晚期癌症患者生存质量的作用。方法回顾性分析我院500例晚期癌症患者给予以控制疼痛为主的宁养服务后,患者生存质量改善的临床资料。结果晚期癌症患者接受宁养服务后疼痛得到不同程度缓解,症状有明显改变,明显的提高患者的生存质量。结论宁养服务能够提高晚期癌症患者的生存质量。     

音乐疗法对改善癌症病人疼痛及睡眠质量的效果评价

目的探讨不同类型的音乐对缓解恶性肿瘤晚期的疼痛效果及提高患者的睡眠质量。方法 2012年1月—2013年1月选取恶性肿瘤患者100例,随机分为2组各50例,干预1组患者接受莫扎特音乐疗法+常规治疗,干预2组患者接受梁祝音乐疗法+常规治疗,干预10 d后,通过分析疼痛评估量表及睡眠质量评估量表指标变化来评价不同类型音乐的治疗效果。计量资料采用t检验,组间比较采用方差分析,P0.05为差异有统计学意义。结果干预1组患者的疼痛得分和睡眠质量得分与干预前相比,得分明显下降,差异有统计学意义(P0.05);干预2组患者的疼痛得分与干预前相比,得分明显下降,差异有统计学意义(P0.05);但是其睡眠质量得分与干预前相比下降不明显,差异无统计学意义(P0.05)。结论莫扎特音乐能够缓解患者的疼痛,改善其睡眠质量,而梁祝音乐能够缓解癌痛但不能改善睡眠质量。     

姑息护理在晚期癌症患者中的应用

目的 探讨姑息护理在减轻晚期癌症患者疼痛,提高患者生存质量所起的作用.方法 将2008年1月～2010年10月入住笔者所在医院的124例晚期癌患者随机分为观察组和对照组,观察组除实施常规护理外,给予姑息护理干预,对照组仅实施常规护理;比较两组患者护理后焦虑情绪变化,以及精神面貌、心态、死亡恐惧感和临终前要求4项指标.结果 姑息护理后观察组患者的焦虑情绪得到明显改善,精神面貌、心态及死亡恐惧感、临终要求方面均优于对照组.结论 姑息护理能满足患者及亲属身心各方面需求,减轻疾病的痛苦,提高生存质量,平静接受死亡.     

晚期癌症患者实施人文关怀护理的临床效果分析

目的：探讨对晚期癌症患者采取人文关怀护理的临床效果。方法：将我社区收治的48例晚期癌症患者随机平均分为两组。对对照组24例患者采取常规护理,对观察组24例患者在此基础上再实施人文关怀护理,对两组患者的各项指标进行比较分析。结果：观察组患者的SAS评分为（43．5±3．6）分,SDS评分为（42．1±5．2）分;对照组患者SAS评分为（57．6±4．8）分,SDS评分为（58．6±4．7）分,两组患者的不良心理状态评分比较,差异有统计学意义（P〈0．05）。观察组患者的疼痛总缓解率为91．7％,对照组患者的疼痛总缓解率为66．7％,组间差异有统计学意义（P〈0．05）。结论：对晚期癌症患者采取人文关怀护理,能有效改善患者的不良情绪,大大降低患者的疼痛,提高患者的生存和生活质量,具有重要的临床意义。     

晚期癌痛患者接受宁养服务的观察与护理

目的评价宁养服务在提高晚期癌痛患者的生命质量中的作用.方法自制问卷对101例接受宁养服务的各类晚期癌痛患者进行生活质量测评,通过比较宁养服务前后患者常见症状改善情况,经过宁养服务后疼痛缓解率,评价宁养服务对晚期癌痛患者生命质量的影响.结果经过宁养服务,患者的疼痛得到不同程度缓解,疼痛缓解70%患者占24.75%;疼痛缓解80%患者占28.71%.常见临床症状有不同程度的改善,生活质量明显提高.结论晚期癌痛患者采用药物三阶梯止痛为重点,控制患者症状,给患者以心理疏导、心理治疗、护理指导及家属支持为主要手段的综合支持治疗的宁养服务,可明显提高患者的生命质量.     

晚期癌症疼痛的评估与护理

目的给予癌症晚期出现疼痛的患者相应的疼痛评估以及护理,探讨护理方法及治疗对策。方法选取癌症晚期出现疼痛的患者31例进行观察,首先对其疼痛情况进行评估,然后采取药物止痛的护理方法,并对癌痛患者进行心理支持,改善其生存质量。结果癌症患者经过护理,除了1例疼痛强烈而死亡,其余患者疼痛症状有所缓解,生命质量得到了一定的提高。结论临床上,给予癌症晚期出现疼痛的患者护理评估,并采取相应的药物进行止痛干预,辅助一定的心理护理和支持,能够有效减轻癌症患者疼痛感,提高其生活水平。     

康宁心理治疗对晚期癌症患者疼痛的疗效观察

目的：探讨康宁心理治疗对晚期癌症患者疼痛的疗效。方法：选择99例晚期癌症患者，随机分为实验组（50例），对照组（49例），实验组在常规治疗的基础上予护理专人康宁心理治疗，2次／日，连续7天，对照组仅予常规止痛治疗。结果：治疗组在临床疼痛症状消失、生活质量等方面均优于对照组，有效率显著提高，P〈0．01。结论：康宁心理治疗对晚期癌症患者疼痛的疗效显著，并改善其生活质量，无不良反应。     

医疗介护模式对晚期消化道肿瘤患者生活质量的影响

目的通过实施医疗介护模式,延伸医院的医护服务,提高晚期消化道肿瘤患者的生活质量。方法入选2010年5月至2011年5月我院肿瘤科病房出院的晚期消化道肿瘤患者162例,其中对照组78例,观察组84例,所有患者随访2个月。分别在出院时及出院后1个月、2个月,采用KPS量表、癌症疼痛综合治疗生存质量量表及巴氏指数量表对患者进行测评。结果出院后1个月及出院后2个月,观察组的KPS评分明显高于对照组(P<0.05),癌症疼痛综合治疗生存质量评分亦明显高于对照组(P<0.05);而观察组的ADL评分在出院后1个月及出院后2个月低于对照组(P>0.05)。结论实施医疗介护模式可以减轻晚期消化道肿瘤患者的疼痛,改善患者的体能状态,提高患者的生活质量。     

Quality of life at the end of life. Analysis of the quality of life of oncologic patients treated with palliative care. Results of a multicenter observational study (staging)

Outcome in palliative care can be defined as patients' quality of life, quality of death and satisfaction with care. In an Italian multicentre prospectic study ('Staging') the quality of life of 571 palliative care patients with advanced cancer disease was assessed since the beginning of palliative care till the end of the study. We analyzed the tissue of quality of life missing data and the possibility to input the missing quality of life evaluation through the quality of life evaluation made by a proxy (doctor, nurse). The greatest functional impairment and an increasing level of some symptoms (fatigue, general malaise, emotional status) were observed during the last two weeks of life, whereas for other symptoms (gastro-intestinal, pain) some degree of control was possible. The quality of life analysis for palliative care patients should consider the different response of different quality of life components to the palliative care intervention.     

舒适护理在普外科围手术期的应用探讨

目的探讨舒适护理在普外科患者围手术期护理中的应用效果。方法将142例普外科手术患者随机分为观察组和对照组各71例,对照组采用常规护理,观察组采用舒适护理,对比分析两组患者术后疼痛、心理状态及满意度情况。结果观察组患者术后12 h,24 h及48 h疼痛程度评分均明显低于对照组（2.81±0.21）vs（3.43±0.23）,（2.61±0.12）vs（3.22±0.20）,（2.50±0.14）vs（3.24±0.25）,护理满意度评分明显低于对照组（89.72±5.63）vs.（98.28±5.91）,术后人际关系、焦虑、抑郁、恐惧、强迫症状、敌对、躯体化评分均明显优于对照组（2.64±0.35）vs（1.10±0.27）,（1.22±0.32）vs（0.69±0.11）,（1.03±0.30）vs（1.64±0.46）,（0.29±0.08）vs（1.18±0.41）,（1.37±0.45）vs（1.90±0.46）,（1.10±0.37）vs（1.33±0.52）,（1.02±0.22）vs（1.17±0.37）,差异有统计学意义（P〈0.05或P〈0.01）。结论围手术期舒适护理可明显缓解患者术后疼痛,改善心理状态,提高护理服务满意度,护理效果优于常规护理,值得临床推广应用。     

综合护理干预对肺癌化疗患者生存质量的影响

目的 探讨健康教育及综合护理干预对肺癌化疗患者生存质量的影响.方法 2010年2月至2013年2月,选取在我院住院化疗的100例肺癌患者,按照随机数字法分为干预组及对照组,每组各50例,对照组患者在化疗过程中仅给予常规抗癌药物治疗及常规基础护理,干预组在常规化疗及护理的基础上对患者进行健康教育,实施综合护理干预.于入组当时及研究结束时分别采用Zung焦虑量表（SAS）、抑郁量表评分（SDS）、生活质量核心问卷（QLQ-C30）对患者的生活质量进行评价,分析综合护理干预对肺癌化疗患者生存质量的影响.治疗前后采用配对样本t检验,组间比较采用单因素方差分析,以P＜0.05差异有统计学意义.结果 两组患者入组时的年龄、性别、病程、SAS、SDS评分、QLQ-C30评分差异均无统计学意义,一般资料具有可比性（均P＞0.05）.干预后对照组SAS评分及SDS评分分别为（58.8±7.6）分、（49.5±10.1）分,干预组SAS评分及SDS评分分别为（46.5±7.8）分、（37.4±9.2）分,与对照组相比明显降低,差异有统计学意义（t=5.347、6.215,P＜0.05）.干预后对照组生活质量各项评分：一般情况、体力评分、情感情分、认知评分、社会角色评分、功能评分分别为（47.3±23.0）分、（54.9±26.6）分、（60.4±19.1）分、（66.2±25.8）分、（54.1±26.2）分、（49.4±21.5）分,干预组分别为（57.2±18.3）分、（63.0±25.9）分、（67.3±23.3）分、（75.4±28.2）分、（67.7±24.8）分、（58.5±22.3）分,与对照组相比明显提高,差异均有统计学意义（t=5.725、6.144、5.021、5.702、7.137、6.357,均P＜0.05）.结论 对肺癌患者进行健康教育及综合护理干预可减少患者的焦虑及抑郁症状,全面提高患者的生活质量.     

Palliative care provision for patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a major cause of disability, morbidity and mortality in old age. Patients with advanced stage COPD are most likely to be admitted three to four times per year with acute exacerbations of COPD (AECOPD) which are costly to manage. The adverse events of AECOPD are associated with poor quality of life, severe physical disability, loneliness, and depression and anxiety symptoms. Currently there is a lack of palliative care provision for patients with advanced stage COPD compared with cancer patients despite having poor prognosis, intolerable dyspnoea, lower levels of self efficacy, greater disability, poor quality of life and higher levels of anxiety and depression. These symptoms affect patients' quality of life and can be a source of concern for family and carers as most patients are likely to be housebound and may be in need of continuous support and care. Evidence of palliative care provision for cancer patients indicate that it improves quality of life and reduces health care costs. The reasons why COPD patients do not receive palliative care are complex. This partly may relate to prognostic accuracy of patients' survival which poses a challenge for healthcare professionals, including general practitioners for patients with advanced stage COPD, as they are less likely to engage in end-of-life care planning in contrast with terminal disease like cancer. Furthermore there is a lack of resources which constraints for the wider availability of the palliative care programmes in the health care system. Potential barriers may include unwillingness of patients to discuss advance care planning and end-of-life care with their general practitioners, lack of time, increased workload, and fear of uncertainty of the information to provide about the prognosis of the disease and also lack of appropriate tools to guide general practitioners when to refer patients for palliative care. COPD is a chronic incurable disease; those in an advanced stage of the disease pursuing intensive medical treatment may also benefit from the simultaneous holistic care approach of palliative care services, medical services and social services to improve quality of end of life care.     

延续护理对介入治疗中晚期肝癌患者自我护理能力和生活质量的影响

目的探讨延续护理对介入治疗中晚期肝癌患者自我护理能力和生活质量的影响。方法选择58例经皮导管肝动脉灌注化疗治疗中晚期肝癌病者,随机均分为研究组和对照组,对照组实施常规护理,研究组给予延续护理,出院前3d进行护理评估和出院指导,出院后4周进行电话随访和每隔2周的家庭访视。采用自我护理能力测定量表评定患者的自我护理能力、自我责任感和健康知识水平,采用SF-36评估患者的情感指数、健康指数和生活满意度。结果护理前,两组患者的自我护理能力和生活质量差异无统计学意义（P〉0．05）,护理后,研究组的自我护理能力、自我责任感和健康知识水平分别为（116．32±13．96）、（22．36±3．94）和（52．36±5．78）分,明显高于对照组的（102．24±12．30）、（19．72±3．21）和（48．16±4．02）分,差异均有统计学意义（均P〈0．05）;研究组的情感指数、健康指数和生活满意度分别为（6．76±1．79）,（8．24±1．88）和（9．72±1．97）,显著高于对照组的（5．64±1．52）,（7．08±1．96）和（8．16±1．37）,差异均有统计学意义（均P〈0．05）。结论延续护理显著提高介入治疗中晚期肝癌患者的自我护理能力和生活质量。     

食管癌/贲门癌病变患者生命质量随访研究

摘要:目的　评价食管癌/贲门癌病变患者治疗前后生命质量变化情况。方法　以河南林州经早诊早治项目筛查并经病理学确诊的食管癌/贲门癌癌前病变及以上患者为研究对象,运用EQ-5D量表,分别于治疗前、治疗后1、6、12个月进行生命质量评估。结果　共纳入73例癌前病变患者,88例早期癌患者,58例中晚期癌患者。治疗前3组得分分别为（0.90±0.05）、（0.87±0.09）、（0.81±0.17）分,中晚期癌组得分最低（P＜0.01）。治疗后1个月,癌前病变组得分明显降低［（0.85±0.09）分,P＜0.01）］,后逐渐恢复,12个月时超过治疗前［（0.91±0.03）分,P＜0.05）］。早期癌组得分变化趋势与癌前病变组相似,但12个月时仍低于治疗前水平［分别为（0.85±0.15）分和（0.87±0.09）分,P＝0.226）］。治疗后中晚期癌组得分持续下降,6个月时达最低［（0.74±0.28）分,P＜0.05）］,12个月时恢复到治疗前水平［（0.80±0.13）分,P＝0.624）］。结论　食管/贲门癌前病变和早期癌组生命质量始终高于中晚期癌组,提示食管/贲门癌早期识别与治疗有利于提高患者生命质量。     

Assessing quality of end-of-life hospital care in a southern European regional health service

OBJECTIVES: During the final period of life, patients with cancer in the Basque Country are given treatment in different types of hospital care. This study compared the quality of care according to the type of care in one of the autonomous communities in Spain. METHODS: A retrospective study was carried out of cancer patients who died in conventional hospital services, home hospitalization services, and palliative care units. In addition to hospital stay and readmission number, variables based on the recommendations of Spanish Society for Palliative Care were studied. RESULTS: End-of-life was diagnosed in 57 percent of a sample of 486 patients, 3 days before death (median). The use of symptom control scales was only documented in the clinical records of eight patients. Sociofamily evaluation was not found. Patients in conventional hospital services were less frequently diagnosed with end-of-life and agony and were significantly different from the rest in the reasons for admission, symptoms assessed, drugs used, administration routes, and dosage forms. Pain was evaluated in 50 percent of the patients and was better controlled in palliative care units. Patients not diagnosed with agony (52 percent) were more frequently not given specific treatment. CONCLUSIONS: End-of-life in cancer patients was diagnosed too late. The quality of care in palliative care units and by home hospitalization service was better than that in conventional hospitalization. Nevertheless, there were areas for improvement in the three modalities of care.     

综合护理干预对甲状腺肿瘤患者术后影响分析

目的：总结分析综合护理干预在甲状腺肿瘤患者术后中的积极影响。方法：选择2012年1-12月本院收治的60例甲状腺肿瘤手术治疗患者为研究对象,随机分为观察组和对照组各30例,对照组给予甲状腺肿瘤围手术期常规护理,观察组在常规护理基础上给予综合护理措施,比较两组患者术后1、24、48 h疼痛评分,住院时间以及SAS和HAMA评分的差异。结果：观察组患者术后1、24、48 h VAS评分分别为（3.6±0.8）分、（2.2±0.7）分、（1.9±0.5）分;均明显低于对照组的（4.7±1.0）分、（4.9±1.3）分、（5.3±0.6）分,差异具有统计学意义（P〈0.01）;观察组患者术后住院时间为（6.5±1.2）d,明显短于对照组的（8.6±1.7）d,差异有统计学意义（P〈0.01）。护理后,观察组SAS和HAMA评分分别为（45.18±3.06）分、（14.12±2.03）分,均显著低于对照组的（51.34±3.24）分、（17.45±2.82）分,差异有统计学意义（P〈0.01）。结论：在常规护理基础上采取综合护理干预能有效缓解甲状腺肿瘤患者术后疼痛和焦虑情绪,促进康复,缩短住院时间,值得推广使用。     

A study of quality of life in cancer patients receiving palliative chemotherapy.

Although primary treatment for cancer has been associated with psychosocial distress, less research has focused on patients with advanced disease. Traditionally, the outcomes of treatment have been assessed using biomedical criteria, including tumour regression, progression and survival. It is argued that these data are inadequate to understand the impact of cancer upon the patient. Instead, quality of life considerations are crucial when treatments are aversive, especially when the aims are palliative rather than curative. Fifty-three patients with advanced breast cancer or ovarian cancer were studied prospectively for 6 months to assess whether the site and method of chemotherapy administration influenced their quality of life. Patients received palliative chemotherapy either at home or in hospital. Quality of life was operationalized as measurement of anxiety, depression, self-esteem, health locus of control, physical performance and symptoms. In addition, semi-structured interviews explored social roles, relationships, and perceptions of treatment. Hospital administered chemotherapy was perceived to be most distressing. Regression analysis indicated that anxiety and depression accounted for most of the variance in quality of life. Patients who died during the study 13 (24%) experienced considerable psychological and physical morbidity. Women over 60 years, experienced less psychological and physical distress. Quality of life broadens the criteria by which cancer treatments are evaluated, to include the experience of the patient.