以Peplau人际关系理论为基础的干预模式对肺癌化疗患者心理状态、主观幸福感及生活质量的影响

目的 探讨以Peplau人际关系理论为基础的干预模式对肺癌化疗患者心理状态、主观幸福感及生活质量的影响.方法 将136例肺癌患者根据不同干预方案分为对照组(n=71)和观察组(n=65),对照组患者给予常规干预,观察组患者给予常规干预+以Peplau人际关系理论为基础的干预模式.比较两组患者干预前后的心理状态、主观幸福感及生活质量改善情况.结果 观察组患者下床活动时间、肛门排气时间、肠鸣音恢复时间、住院时间均明显短于对照组(P﹤0.01).干预后,两组患者焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均明显低于本组干预前(P﹤0.01);且观察组患者SAS、SDS评分均明显低于对照组(P﹤0.01).干预后,两组患者主观幸福感各维度评分均明显高于本组干预前(P﹤0.01);且观察组患者主观幸福感各维度评分均明显高于对照组(P﹤0.01).干预后,两组患者生活质量(QOL)量表各维度评分均明显高于本组干预前(P﹤0.01);且观察组患者QOL量表各维度评分均明显高于对照组(P﹤0.01).对照组患者不良反应总发生率为63.38％(45/71),高于观察组的46.15％(30/65)(P﹤0.05).结论 对肺癌化疗患者实施以Peplau人际关系理论为基础的干预模式,可改善患者心理状态,提高主观幸福感及生活质量,临床应用前景广阔.     

临终关怀护理在原发性晚期肺癌患者疼痛管理中的应用效果

目的探讨临终关怀护理模式对改善晚期原发性肺癌患者疼痛和生活质量的作用。方法选取2015年1月至2017年6月间安康市中心医院收治的90例原发性晚期肺癌患者,采用随机数表法分为试验组和对照组,每组45例。试验组患者采用临终关怀护理模式,对照组患者采用常规护理模式,比较两组患者的疼痛情况、心理状况及生活质量。结果试验组患者护理后1个月、2个月和3个月视觉模拟评分量表(VAS)评分均低于对照组患者,差异均有统计学意义(均P<0.05)。护理前,两组患者焦虑自评量表(SAS)和抑郁自评量表(SDS)评分比较,差异无统计学意义(P>0.05)。护理后,两组患者SAS和SDS评分都明显降低,且试验组评分均低于对照组,差异均有统计学意义(均P<0.05)。护理前,两组患者生活质量综合评定问卷(GQOLI-74)评分比较,差异无统计学意义(P>0.05)。护理后,两组患者GQOLI-74评分均明显提高,且试验组评分明显高于对照组,差异均有统计学意义(均P<0.05)。结论在原发性晚期肺癌患者疼痛管理中采用临终关怀护理模式,能够显著减轻患者疼痛,缓解患者负性情绪,提高患者生活质量。     

不同疼痛护理方法对98例晚期肺癌患者疼痛控制的影响

目的 探索一种能够减轻晚期肺癌患者疼痛的方法.方法 选取晚期肺癌患者98例,将患者随机分为试验组与对照组,每组各49例.试验组采用综合疼痛控制措施进行护理,对照组采用常规疼痛控制措施进行护理.比较两组患者的疼痛控制情况、血压脉率情况及护理满意度情况.结果 治疗后,试验组的疼痛分级低于对照组(P﹤0.05);试验前、后,试验组患者的血压、脉率与对照组比较,差异均无统计学意义(P﹥0.05);试验组患者的护理满意度为96.0%,高于对照组的81.6%,差异有统计学意义(P﹤0.05).结论 采用综合疼痛控制措施的护理方法,可有效减轻患者的疼痛程度,提高患者对护理的满意度.     

术前IDEAS模式访视在腹腔镜下子宫内膜癌手术患者中的应用效果

目的 探讨术前IDEAS模式访视在腹腔镜下子宫内膜癌手术患者中的应用效果。方法 采用随机数字表法将136例腹腔镜下子宫内膜癌手术患者分为观察组和对照组,每组68例,对照组患者给予常规术前访视,观察组患者给予术前IDEAS模式访视。比较两组患者的手术时间、住院时间、不良反应发生情况、生理应激指标（脉率、舒张压和收缩压）、心理应激反应[焦虑自评量表（SAS）、抑郁自评量表（SDS）]、应对方式[中文版医学应对问卷（MCMQ）]及生活质量[欧洲癌症研究与治疗组织生命质量测定量表（EORTC QLQ-C30）]。结果 观察组患者的手术时间和住院时间均短于对照组,不良反应发生率低于对照组,差异均有统计学意义（P﹤0.05）。干预后,两组患者的脉率、舒张压和收缩压均高于本组干预前,观察组患者的脉率、舒张压和收缩压均低于对照组,差异均有统计学意义（P﹤0.05）。干预后,两组患者的SAS和SDS评分均低于本组干预前,观察组患者的SAS和SDS评分均低于对照组,差异均有统计学意义（P﹤0.05）。干预后,两组患者面对评分均高于本组干预前,回避和屈服评分均低于本组干预前,观察组患者面对评分高于对照组,回...     

安宁疗护改善重症监护病房晚期肺癌疼痛患者生存质量的效果观察

目的分析安宁疗护改善重症监护室(ICU)晚期肺癌疼痛患者生存质量的效果。方法随机数字表法将100例晚期肺癌患者随机分为对照组与干预组,每组50例,对照组患者接受常规干预措施,干预组患者在此基础上给予安宁疗护。干预前后,根据世界卫生组织(WHO)疼痛分级法比较两组患者的疼痛情况;采用患者尊严量表(PDI)比较两组患者的尊严水平;采用总体幸福感量表(GWB)比较两组患者的主观幸福感;采用欧洲癌症治疗研究组织的生活质量核心问卷(EORTC QLQ-C30)比较两组患者的生存质量。结果干预前,两组患者疼痛程度、PDI量表、GWB量表和EORTC QLQ-C30量表评分比较,差异均无统计学意义(P﹥0.05)。干预后,干预组患者疼痛程度弱于对照组患者,差异有统计学意义(P﹤0.05),干预组患者症状困扰、心理状况、依赖性、精神安宁和PDI量表总分均低于本组干预前和对照组患者(P﹤0.05),生活的满足和兴趣、对健康的担心、精力、抑郁或愉快的心境、对情感和行为的控制、松弛和紧张、幸福感总分均高于本组干预前和对照组患者(P﹤0.05),躯体功能、角色功能、情绪功能、认知功能和总分均高于本组干预前和对照组患者(P﹤0.05)。结论安宁疗护能够减轻ICU晚期肺癌疼痛患者疼痛程度,维护患者临终前尊严,提高其主观幸福感,并改善生存质量。     

多模式健康宣教在晚期肝癌患者中的应用效果

目的 探讨多模式健康宣教在晚期肝癌患者中的应用效果。方法 根据干预方法的不同将96例晚期肝癌患者分为对照组和观察组,每组48例,对照组患者采取常规干预,观察组患者采取多模式健康宣教。比较两组患者的治疗依从性、疼痛程度[视觉模拟评分法（VAS）]、疲乏程度、心理状况及生活质量。结果 观察组患者的治疗依从率明显高于对照组（P﹤0.01）。干预后,两组患者的VAS评分和疲乏程度评分均低于本组干预前,观察组患者的VAS评分和疲乏程度评分均低于对照组,差异均有统计学意义（P﹤0.05）。干预后,两组患者敌对、焦虑、敏感、抑郁评分均低于本组干预前,观察组患者敌对、焦虑、敏感、抑郁评分均低于对照组,差异均有统计学意义（P﹤0.05）。干预后,两组患者精神健康、生理功能、活力、情感职能评分均高于本组干预前,观察组患者精神健康、生理功能、活力、情感职能评分均高于对照组,差异均有统计学意义（P﹤0.05）。结论 多模式健康宣教可提高晚期肝癌患者的治疗依从性,缓解其疼痛和疲乏程度,改善其心理状况和生活质量,值得临床推广使用。     

以人际关系模式为指导进行乳腺癌患者健康教育的效果分析

目的探讨以人际关系模式为指导进行乳腺癌患者健康教育的临床效果。方法选取2011年1月至2014年1月广州市妇女儿童医疗中心收治的134例乳腺癌患者,采用随机分组方式将以上患者分为观察组和对照组,各67例。对照组采用常规护理措施,观察组则按照Peplau人际关系模式为指导进行护理,对两组患者的相关知识掌握程度、功能锻炼达标情况以及术后并发症情况进行统计对比。结果观察组患者在相关知识掌握程度、功能锻炼达标率以及术后并发症发生率上均明显优于对照组,差异均有统计学意义(均P<0.05)。结论 Peplau人际关系模式指导下的健康教育能够促进乳腺癌患者对于相关健康知识的掌握,提高从医性,加强功能锻炼效果,减少术后并发症的发生,相较于常规护理措施,有着明显的优势,值得在临床上推广和应用。     

疼痛管理在晚期肿瘤患者安宁疗护中的效果观察

目的探讨疼痛管理在晚期肿瘤患者安宁疗护中的效果。方法选取2015年1月至2016年12月间江苏省如皋市人民医院收治的120例晚期肿瘤患者,采用随机数表法分为观察组和对照组,每组60例。对照组患者采用常规护理,观察组患者在对照组护理基础上加强疼痛管理。比较两组患者护理前后疼痛程度、日常生活能力及疼痛缓解效果。结果护理前,两组患者视觉模拟评分比较,差异无统计学意义(P>0.05);护理后,两组患者疼痛评分均低于护理前,且观察组低于对照组,差异均有统计学意义(均P<0.05)。护理后,两组患者日常生活能力均优于护理前,且观察组优于对照组,差异均有统计学意义(均P<0.05)。护理后,观察组患者疼痛总缓解率为96.7%高于对照组的60.0%,差异有统计学意义(P<0.05)。结论在晚期肿瘤患者安宁疗护中加强疼痛管理,能有效减轻患者疼痛,增强日常生活能力,缓解疼痛,值得临床推广。     

生活质量评价在晚期肺癌患者中的临床应用

随着医学模式由传统的单纯生物医学模式向生物－心理－社会医学模式的转变和晚期肺癌患者生存时间的延长，生活质量已成为在晚期肺癌临床治疗和研究中独立的终末评价指标和目前所追求的治疗目的。就生活质量在临床应用中的意义和生活质量测量量表的选择进行综述。     

生活质量评价在晚期肺癌患者中的临床应用

随着医学模式由传统的单纯生物医学模式向生物-心理-社会医学模式的转变和晚期肺癌患者生存时间的延长，生活质量已成为在晚期肺癌临床治疗和研究中独立的终末评价指标和目前所追求的治疗目的。就生活质量在临床应用中的意义和生活质量测量量表的选择进行综述。     

Prevalence and management of pain in Italian patients with advanced non-small-cell lung cancer

Pain is a highly distressing symptom for patients with advanced cancer. WHO analgesic ladder is widely accepted as a guideline for its treatment. Our aim was to describe pain prevalence among patients diagnosed with advanced non-small-cell lung cancer (NSCLC), impact of pain on quality of life (QoL) and adequacy of pain management. Data of 1021 Italian patients enrolled in three randomised trials of chemotherapy for NSCLC were pooled. QoL was assessed by EORTC QLQ-C30 and LC-13. Analgesic consumption during the 3 weeks following QoL assessment was recorded. Adequacy of pain management was evaluated by the Pain Management Index (PMI). Some pain was reported by 74% of patients (42% mild, 24% moderate and 7% severe); 50% stated pain was affecting daily activities (30% a little, 16% quite a bit, 3% very much). Bone metastases strongly affected presence of pain. Mean global QoL linearly decreased from 64.9 to 36.4 from patients without pain to those with severe pain (P<0.001). According to PMI, 616 out of 752 patients reporting pain (82%) received inadequate analgesic treatment. Bone metastases were associated with improved adequacy and worst pain with reduced adequacy at multivariate analysis. In conclusion, pain is common in patients with advanced NSCLC, significantly affects QoL, and is frequently undertreated. We recommend that: (i). pain self-assessment should be part of oncological clinical practice; (ii). pain control should be a primary goal in clinical practice and in clinical trials; (iii). physicians should receive more training in pain management; (iv). analgesic treatment deserves greater attention in protocols of anticancer treatment.     

The therapeutic utility of lung irradiation for Hodgkin's disease patients with large mediastinal masses

Since Hodgkin's disease patients with large mediastinal masses frequently relapse in the intrathoracic area after regular mantle field irradiation, the feasibility and utility of low dose lung irradiation as an initial part of the supradiaphragmatic field was examined. Fifteen newly diagnosed patients with Hodgkin's disease and large mediastinal masses were treated with 1000–2000 rad to the lung as a part of extended field radiotherapy. All patients received radiotherapy aloe. Results of treatment were compared with those in 20 similar patients who were treated only with extended field irradiation. With a minimum follow-up of 24 months, only 2 patients (13%) who received lung irradiation have recurred and only one of these recurred in the Lung. In contrast 15 (79%) of the 19 complete responders who were treated without lung irradiation had relapsed by 24 months, 9 in the intrathoracic region. Recurrence-free survival was significantly longer in patients who received Lung irradiation. No increased frequency in serious complications has been experienced to date with low dose whole lung irradiation, compared with regular mantle field treatment. This study suggests that lung irradiation may be a feasible alternative to adjuvant combination chemotherapy when treating patients with Hodgkin's disease and large mediastinal masses.     

Variation in survival of patients with lung cancer in Europe, 1985–1989

In this study, we report on the variation in the prognosis for adult patients with lung cancer within Europe, by age, histology and country from 1985–1989. We considered trends in survival since 1978 for most countries. Survival analysis was carried out on 173 448 lung cancer cases diagnosed between 1985 and 1989 in 44 population-based cancer registries, participating in the EUROCARE study. Relative 1-year survival rates for patients with lung cancer varied from 24 to 40%, being highest in Finland, France, The Netherlands and Switzerland and lowest in Denmark, England, Poland and Scotland. Half of all patients under the age of 45 years died within 1 year of diagnosis, increasing to almost 80% for those aged 75 years or older. Whilst the prognosis for patients with non-small cell carcinoma remained more or less constant between 1978 and 1989 (25% in Denmark and 44% in Finland), that for patients with small cell carcinoma improved slightly, especially in The Netherlands (Eindhoven from 17 to 24%) and Switzerland (Geneva from 24 to 32%). In conclusion, a fairly large variation in lung cancer relative survival rates existed between European countries. The most likely explanation for the differences is the variation in access to specialised care. Except for a slight improvement in short-term survival for patients with small cell lung cancer, survival has remained poor since 1978.     

快速康复理念对肺癌手术患者住院费用的影响

目的:探讨快速康复理念对肺癌手术患者安全和有效性及住院费用的影响。方法:住院肺癌患者160例,分为实验组和对照组,各80例。对照组接受传统方法治疗,实验组按快速康复理念治疗。观察两组疗效,比较住院费用差异。结果:实验组住院时间、手术时间、术后并发症均明显小于对照组,治愈例数多于对照组,具有统计学意义（P<0.05）。两组服务、诊断及材料费用差异不大（P>0.05）,治疗、药品及总费用差异显著（P<0.05）。总住院费构成比例高的是治疗和药品。结论:快速康复理念应用于肺癌患者围手术期,能明显降低住院及手术时间和住院费用。     

Prognosis in HIV-infected patients with non-small cell lung cancer

Background:

We conducted a population-based study to evaluate whether non-small cell lung cancer (NSCLC) prognosis was worse in HIV-infected compared with HIV-uninfected patients.

Methods:

Using the Surveillance, Epidemiology and End Results (SEER) registry linked to Medicare claims, we identified 267 HIV-infected patients and 1428 similar controls with no evidence of HIV diagnosed with NSCLC between 1996 and 2007. We used conditional probability function (CPF) analyses to compare survival by HIV status accounting for an increased risk of non-lung cancer death (competing risks) in HIV-infected patients. We used multivariable CPF regression to evaluate lung cancer prognosis by HIV status adjusted for confounders.

Results:

Stage at presentation and use of stage-appropriate lung cancer treatment did not differ by HIV status. Median survival was 6 months (95% confidence interval (CI): 5–8 months) among HIV-infected NSCLC patients compared with 20 months (95% CI: 17–23 months) in patients without evidence of HIV. Multivariable CPF regression showed that HIV was associated with a greater risk of lung cancer-specific death after controlling for confounders and competing risks.

Conclusion:

NSCLC patients with HIV have a poorer prognosis than patients without evidence of HIV. NSCLC may exhibit more aggressive behaviour in the setting of HIV.     

支气管镜在肺癌诊断中的应用——1315例支气管镜检查结果分析

目的探讨支气管镜在肺癌诊断中的应用。方法回顾性分析我院1998-2005年1315例肺癌患者支气管镜检查结果,应用SPSS10．0医学软件进行统计学分析。结果本组患者男女比例2．5：1,60-69岁为发病年龄高峰占33．0％。其中31．08％（418／1315）为腺癌,其次为鳞癌和小细胞癌,分别占31．0％（408／1315）和25．0％（329／1315）。病变部位以中心型多见,占89．7％（1180／1315）,31．7％（417／1315）发生于上叶支气管（P〈0．001）,左右支气管发生率相似。60．8％（800／1315）镜下表现为增生型,其次为浸润型、外压型、正常型,分别占28．1％（370／1315）、2．8％（37／1315）和8．2％（108／1315）,增生型鳞癌多见（40．6％）（P〈0．001）,浸润型、外压型和正常型腺癌多见,分别为48．9％、51．4％和63．0％（P≤0．001）。78．6％（1034／1315）经支气管镜确诊,其中钳检阳性率83．4％（966／1158）,刷检阳性率14．0％（176／1257）,肺泡灌洗阳性率31．0％（26／84）,经支气管镜肺活检阳性率73．9％（17／23）,经支气管镜淋巴结针吸活检阳性率63．6％（14／22）,21．4％（281／1315）经其他方法确诊。鳞癌和小细胞癌钳检阳性率为81．6％和89．1％,均高于腺癌（P〈0．001和P=0．023）,鳞癌刷检阳性率为9．1％,低于腺癌（13．2％）（P=0．029）和小细胞癌（21．0％）（P=0．001）。中心型肺癌钳检阳性率（80．3％）和刷检阳性率（14．4％）均明显高于周围型（P〈0．001）。增生型肺癌钳检阳性率（88．4％）及刷检阳性率（15．6％）均明显高于其他镜下表型（P〈0．001）。正常型联合取材阳性率（23．1％）高于单纯钳检和刷检（P〈0．001）。结论经支气管镜确诊肺癌男性多于女性腺癌比例较前呈明显上升态势;经支气管镜确诊肺癌好发于段以上支气管;支气管镜确诊肺癌阳性率高;联合取材可明显提高正常型肺癌诊断阳性率;经支气管镜淋巴结针吸活检安全有效,有助于提高支气管镜诊断阳性率。     

Underutilization of radiotherapy for lung cancer in New South Wales,Australia

BACKGROUND:

Lung cancer is the leading cause of cancer death in most developed countries. Radiotherapy is important in its treatment, with an estimated optimal utilization rate between 45% and 68% at initial diagnosis. The objective of this study was to describe radiotherapy practice for lung cancer in New South Wales (NSW), Australia.

METHODS:

Patients with lung cancer were identified prospectively from the NSW Central Cancer Registry (CCR) from November 1, 2001 to December 31, 2002. Questionnaires were mailed to diagnosing and treating clinicians to obtain detailed information on diagnosis, staging, referrals, and treatment. The authors describe referral for and receipt of radiotherapy treatment.

RESULTS:

Of 1812 patients with lung cancer patients who were identified, 943 patients (52%) were referred for radiotherapy, 846 patients (47%) received a radiotherapy questionnaire, and 727 patients (40%) received radiotherapy. Compared with optimal radiotherapy, there was less curative radiotherapy to the primary site (20% actual vs 50% optimal), and there was more palliative radiotherapy to metastatic sites (36% actual vs 11% optimal). The greatest shortfall in radiotherapy use was observed in patients who had limited stage small cell lung cancer (46% actual vs 94% optimal). The use of combined‐modality treatment for stage III nonsmall cell lung cancer and for limited stage small cell lung cancer was uncommon.

CONCLUSIONS:

There is underutilization of radiotherapy for lung cancer in NSW, especially in small cell lung cancer. The use of combined‐modality treatment for potentially curable lung cancers is suboptimal. These issues have to be addressed to improve survival and quality of life for patients with lung cancer. Cancer 2010. © 2009 American Cancer Society.     

Radical radiation therapy in the treatment of laparotomy staged Hodgkin's disease patients

In 1970, a policy for the treatment of Stage IIIA Hodgkin's disease patients at the University of Minnesota, which included complete staging procedures and extended field or total nodal irradiation (TNI), was introduced. Evaluation of the results 4 years later indicated that certain patients, especially those with large mediastinal masses and/or hilar disease, or who were spleen positive, were having higher recurrence rates than patients without these characteristics. In 1974, a new approach to treatment for patients with large mediastinal masses or spleen positive disease was instituted which involved treating the whole lung or hemi lung in patients with large mediastinal masses and/or hilar disease, and the liver in patients who had positive spleens. The results of this treatment modification are reported in this study. Long term follow-up reveals that this approach has led to a recurrence free survival and overall survival similar to that noted in patients treated with combined modality treatment without the obvious risk of subsequent leukemia related to combination chemotherapy and radiotherapy. In addition, the complications of the treatment are tolerable and do not demonstrate an increase over patients not treated in this manner. Radical radiation therapy is recommended as a treatment of choice for Stage IA, IIA, and IIIA patients with or without splenic involvement, and with or without hilar disease and/or large mediastinal masses with appropriate radiation field modification to adjust for disease extent.