风险白皮书 第二部分输血治疗同意书

输血治疗是临床治疗中的重要措施。作为一种支持性与代偿性的治疗方法,输血在很多情况下是抢救危重患者生命行之有效的手段。输血包括输全血和成分血,成分血包括红细胞、血小板、血浆等,临床中要根据患者需求做出选择。我们知道,输血治疗是存在风险的,即使血源按国家规定采用合格试剂进行了严格检测,但受科技水平的限制及不可预知因素的影响,输血风险有时仍难以避免。这里主要是两个方面的问题:一是输血不良反应的发生;二是输血相关疾病的传播。因此,在输血前医生需按照《临床输血技术规范》向患者或其家属告知输血目的、可能发生的输血反应和经血传播疾     

国产吉西他滨（誉捷）联合铂类治疗非小细胞肺癌安全性及疗效的临床观察

目的评价国产吉西他滨（誉捷）联合铂类方案治疗非小细胞肺癌的安全性及短期疗效。方法61例非小细胞肺癌患者采用誉捷＋顺铂方案40例,誉捷＋卡铂方案21例;化疗使用常规剂量及用法,每3周循环,至少完成2周期。以0-Ⅳ级记录化疗期间不良反应,化疗前及2周期后分别进行生活质量（QOL）评分,同时评估非手术患者化疗前后肿瘤大小变化。结果本组患者化疗后最主要的不良反应为白细胞下降、中性粒细胞下降和恶心呕吐,发生率分别为59.0%、41.0%和41.0%,其余不良反应发生率较低;中重度不良反应（Ⅲ＋Ⅳ度）同样以白细胞下降、中性粒细胞下降和恶心呕吐为主,发生率分别为13.1%、14.8%和11.5%。全组患者化疗期间出现4例心脏相关事件,3例出血事件,1例患者出现中枢神经系统症状,经及时处理后患者均顺利出院。化疗后生活质量稳定和提高的患者占全组患者的68.9%;化疗前后患者生活质量分别为46.79±4.637和45.66±6.416,两者比较无统计学差异（P=0.312）。22例非手术患者化疗2周期后疗效为：10例SD,3例M R,8例PR,1例CR,治疗有效率（CR＋PR）为40.9%。结论国产吉西他滨（誉捷）与铂类联合方案治疗非小细胞肺癌在用药安全性及短期疗效上与国外文献报道无明显差异,绝大多数患者能够良好耐受。     

70岁以上老年肺癌手术并发症及相关因素分析

目的 探讨70岁以上老年肺癌病人手术治疗特点及影响术后并发症发生的危险因素.方法 回顾总结222例年龄≥70岁接受肺切除手术的老年肺癌病人临床资料.将术后出现严重并发症的病人纳入Ⅰ组,仅出现一般并发症的病人则纳入Ⅱ组,无并发症发生的病人纳入Ⅲ组.定义A1组=Ⅰ组+Ⅱ组,B1组=Ⅲ组,A2组=Ⅰ组、B2组=Ⅱ组+Ⅲ组.对可能影响术后并发症发生的危险因素分别在A1组与B1组间、A2组与B2组间进行单因素分析和二项logistic多因素回归分析.结果 术前161例病人合并其他疾病(72.5%).手术方式以单肺叶切除为主(64.9%),中位淋巴结清扫数为14个(0～57个).术后并发症总发生率63.5%,严重并发症发生率13.5%,围手术期死亡1.8%(4例).Logistic回归分析结果显示,影响术后总体并发症发生的独立危险因素为术前体重下降(P=0.020)、ASA分级(P＜0.001)、MVV(%预测值)(P=0.020)和淋巴结清扫数(P=0.004);影响术后严重并发症发生的独立危险因素为ASA分级(P=0.003)、MVV(%预测值)(P=0.018)和肿瘤位置(P=0.007).结论 重视术前体重下降及术中淋巴结清扫对70岁以上老年肺癌病人手术安全性的影响;对术前高ASA分级、低MVV(%预测值)水平以及肿瘤为中心型的70岁以上老年肺癌病人应特别加强围手术期管理以降低手术风险.

Abstract：

Objective This study is to analyse the clinical feature and risk factors of morbidity after pulmonary resection for lung cancer in patients older than 70 years. Methods The clinical records of 222 patients older than 70 years who had undergone pulmonary resection for their lung cancer was reviewed. The patients were divided into 3 groups: group Ⅰ including the patients who had severe postoperative complications, group Ⅱ including the patients who had mild complications and group Ⅲ including the patients who had no complications. Moreover, the definitions were made that group A1 = group Ⅰ+ Ⅱ , group B1 = group Ⅲ, group A2 = group Ⅰ and group B2 = group Ⅱ + Ⅲ. Univariate analyses and multivariate binary logistic regressions relating postoperative morbidity to risk factors were performed between the group Al and Bl, A2 and B2, resulting in the identification of the independent risk factors for overall morbidity and major morbidity. Results Preoperative comorbidity was recorded in 161 patients (72.5%). Lobectomy (64.9% ) was the predominant surgical procedure. The median number of dissected LN was 14, with the range of 0 to 57. The overall morbidity was 63.5% , including major morbidity of 13.5%. Perioperative mortality was 1.8% (4 cases). The results of binary logistic regression analyses indicated that the independent risk factors for overall morbidity were preoperative weight loss (P =0.020), ASA score (P＜0.001), MVV (% predicted) (P=0. 020 ) and the number of dissected LN ( P = 0.004 ). The independent risk factors for major morbidity were ASA score ( P =0.003), MVV (% predicted) (P= 0.018) and the location of tumor (P=0.007). Conclusion Preoperative weight loss and numbers of dissected mediastinal lymph nodes were risk factor for lung cancer patients older than 70 years, Proper perioperative management for the elderly patients with high ASA score, low MVV (% predicted) or central tumor, could reduce the major postoperative morbidity.     

Risk factors of morbidity after pulmonary resection for lung cancer in patients older than 70 years

<正>Objective To investigate the function and mechanism of embryonic stem cells again Lewis non-small cell lung cancer in vivo. Methods Based on the mouse Lewis non-small cell lung cancer model,we have tested some tumor growth indexes and investigated the immune response of embryonic stem cells against cancer cells. Results Compared with the mice in control group,mice in