疼痛的评估与心理护理措施

疼痛是临床上极为常见的症状和病人的主诉,是每一个医护人员都要面对和处理的问题。作为护理人员,我们首先要相信和理解病人的痛苦,掌握疼痛的性质和区域分布特点,除了知道痛觉的生理学知识外,还要懂得痛觉的心理知识,帮助患者尽可能减轻和解除疼痛。1护理评估1.1资料收集资料收集对护理评估至关重要,它包括主观和客观两个方面,即病人主诉、护理观察和查体等。具体内容包括:疼痛原因及发生背景;疼痛的部位、范围、程度、深度、持续时间及由此而带来的功能障碍及其程度;疼痛性质、强度以及伴随症状;疼痛初发时间及形式;以往疼痛发作时采用的…     

胸段食管癌三维适形放疗摆位误差研究

Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis.     

PAR-2基因沉默对食管癌EC109细胞增殖及侵袭转移的影响

目的:研究PAR-2基因沉默对食管癌EC109细胞增殖和侵袭迁移能力的影响。方法:运用MTT及流式细胞术法检测sh RNA-PAR-2 EC109细胞增殖能力及细胞周期的变化;Transwell小室法检测sh RNAPAR-2 EC109细胞侵袭和迁移能力的变化。结果:sh RNA-PAR-2 EC109细胞增殖低于正常对照组,24、48、72 h的细胞抑制率分别为15.92%、24.89%、32.28%,与正常对照组比较差异有显著性(P<0.05),而转染试剂组和阴性质粒转染组与正常对照组比较差异无显著性(P>0.05)。sh RNA-PAR-2 EC109细胞发生S期阻滞,转染24、48、72 h S期细胞比例分别为(32.79±4.06)%、(26.54±1.37)%和(33.45±2.46)%,与对照组相比差异有显著性(P<0.05)。在侵袭实验中,sh RNA-PAR-2 EC109细胞穿过聚碳酸酯膜的细胞数为19.6±2.11,与对照组比较差异有显著性(P<0.05)。在迁移实验中,sh RNA-PAR-2 EC109细胞穿过聚碳酸酯膜的细胞数为24.2±2.82,与对照组比较差异有显著性(P<0.01)。结论:sh RNA-PAR-2 EC109细胞的增殖减慢,侵袭及迁移能力降低。     

神经阻滞疗法控制带状疱疹疼痛的疗效观察

带状疱疹是一种以皮肤疱疹和局部剧烈疼痛为特征的病毒性疾患,多发生于中老年人及抵抗力低下的人群.皮肤损害一般在一月内康复,而疼痛可以持续数月到数年,形成后遗神经痛.大多数带状疱疹病人的日常生活、睡眠均受到疼痛的严重影响.     

手术室麻醉药品的管理

麻醉药品是指使用后易产生身体依赖性易成瘾的药品。麻醉药品具有双重性．合理使用和管理有利于疼痛的治疗，另一方面一旦流入社会也将给社会带来危害。手术室是医院内使用麻醉药品最多的科室，加强手术室麻醉药品的管理尤为重要。我科自2003年1月以来，平均每天手术约20台，麻醉药品用量较大，为确保麻醉药品的合理使用，我科制定了有效的麻醉药品管理制度，没有发生药品的流失，使麻醉药品的管理规范化、制度化取得了良好的效果，现介绍如下。     

戊四氮点燃模型大鼠海马苔藓纤维出芽与Cdk5/p35表达的动态变化

目的：动态观察细胞周期素依赖性激酶5（cyclin-dependent kinase5，Cdk5）和调节亚基p35在戊四氮（pentylenetetrazole，PTZ）致痫大鼠海马各区的表达变化，及其与苔藓纤维出芽（mossy fiber sprouting，MFS）的关系，以探讨其在癫痫发病机制中的作用。方法：SD雄性成年大鼠120只，随机分为PTZ组和对照组；PTZ组分为PTZ第1次注射后3d、1周、2周、4周、6周共5个亚组，每亚组12只，对照组随机分为5个亚组，与眦组各时间点对应。以上各亚组再分2个小组，每小组6只大鼠，分别进行（1）免疫组织化学和原位杂交，检测各时间点Cdk5与p35蛋白和mRNA在海马CA1和CA3区、齿状回颗粒细胞层和门区的表达；（2）Timm染色并评分。结果：PTZ组大鼠上述各区Cdk5和p35mRNA在第3天时表达即有明显上调（P＜0．01），第4周仍维持在较高水平，第6周时基本恢复到对照组水平；各区Cdk5和p35蛋白表达从第3天起即上调（P＜0．01），第2周时最强，其后下调，至第6周接近或达到对照组水平。PTZ组CA3区在点燃前MFS评分1～4分，点燃后MFS评分4～5分。MFS的变化趋势与Cdk5和p35的表达一致。结论：海马Cdk5／p35的表达变化可能参与苔藓纤维出芽，从而促进癫痫的发生。     

困难取环45例临床体会

目的探讨宫内节育器取出困难的原因及处理方法.方法总结2004年1月～2005年3月45例取器困难者的临床资料.结果45例取出困难者中,43例为绝经妇女(占96.7%),2例常规手术失败后,在B超引导下取出,8例绝经时间长(8～18年),阴道、宫颈及子宫萎缩,术前估计取器困难者,经用药后取出,其余均按常规手术顺利取出.结论①绝经后应尽早取出宫内节育器;②绝经时间长,阴道宫颈子宫萎缩者,用尼尔雌醇及米索待宫颈松弛后.再取宫内节育器,避免盲目操作.     

胸段食管癌三维适形放疗摆位误差研究

Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis.     

胸段食管癌三维适形放疗摆位误差研究

Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis.