目的:观察等速肌力训练联合肌内效贴治疗对乳腺癌根治术后放疗患者上肢活动度、放射性皮肤损伤及上肢淋巴水肿的干预效果。方法:采用随机数字表法将64例乳腺癌根治术后序惯化、放疗患者分为观察组及对照组，每组32例。2组患者在放疗后均根据其肢体功能状况及身体耐受情况进行常规康复训练(包括手指爬墙、伸展运动、耸肩运动、扩胸运动、过顶触耳等)，观察组在此基础上辅以等速肌力训练及肌内效贴治疗，持续治疗5周。于放疗前、放疗结束时对比2组患者患侧肩关节活动度、肩臂手残疾问卷(DASH)评分、患侧上肢淋巴水肿发生率以及放射性皮肤损伤情况。结果:放疗结束时2组患者肩关节各方向活动度均较放疗前明显减小( P<0.05)，但观察组肩关节各方向活动度均明显大于对照组( P<0.05)，放疗后观察组DASH评分[(13.37±1.79)]及淋巴水肿发生率(18.8%)均明显低于对照组( P<0.05)，2组患者放射性皮肤损伤情况组间差异无统计学意义( P>0.05)。 结论:乳腺癌根治术后序惯放疗可导致患者上肢淋巴水肿、肩关节活动受限以及放射性皮肤损伤，而等速肌力训练联合肌内效贴治疗可降低乳腺癌患者上肢淋巴水肿发生率，改善上肢功能及肩关节活动度，该联合疗法值得临床推广、应用。

目的 探讨虚拟现实技术联合案例教学法在肿瘤康复治疗师教学中的应用效果.方法 选取2018年1—12月在华中科技大学同济医学院附属同济医院肿瘤科和康复医学科接受肿瘤康复培训的48名康复治疗师为对象,根据随机数字表法分为试验组(24例)和对照组(24例),试验组采用虚拟现实技术联合案例教学法进行教学,对照组采用传统讲授式教学.课程结束后,对两组学员进行理论考核和操作考核、问卷调查教学满意度,综合评价虚拟现实技术联合案例教学法在肿瘤临床康复治疗师教学中的应用效果.结果 试验组康复治疗师的理论考核成绩和操作考核成绩明显高于对照组[试验组理论基础知识(82.48±6.98)分,操作考核如运动治疗(16.62±2.89)分等](P<0.05).同时,试验组在教学满意度多维度调查评估表各项评分均明显高于对照组[试验组兴趣吸引力(4.28±0.62)分、理解记忆力(4.14±0.66)分、沟通能力培养(4.09±0.60)分等](P<0.05).结论 虚拟现实技术联合案例教学法在肿瘤康复治疗师教学中的应用能提升教学质量和教学满意度,培养全面的理论基础知识、操作实践能力和沟通能力.

目的:探讨基于MDT的对分课堂联合CBL教学模式在软组织肿瘤临床教学中的应用效果及学员对该教学模式的评价.方法:选取2017年1月至2019年10月在我科接受住院医师规范化培训的50名学员为研究对象.随机分为对照组和实验组,每组25人.对照组授课方式为传统教学法,实验组授课采用MDT联合对分课堂和CBL教学法.教学结束后,采用命题考试进行教学效果考核;采用问卷调查的方法评估学生对教学模式的满意度.结果:实验组的选择题、简答论述、病例分析和总成绩分别为26.36±2.75、18.24±2.40、30.76±3.09、75.36±5.96,而对照组分别为24.40±3.80、16.60±2.10、29.04±2.86、70.04±6.30,两组比较有统计学差异(P<0.05).在提高课堂学习效率、学习兴趣、自学能力、理论知识的理解和记忆能力,扩充专业知识,提高文献检索能力、分析问题和解决问题的能力、临床思维能力,这8个维度的赞成度调查中,实验组均优于对照组(P<0.05).实验组学员对本组教学模式的接受度更高(P<0.05),但也有更多的实验组学员认为本组教学模式增加了学习负担(P<0.05).结论:MDT联合对分课堂和CBL的教学模式应用于软组织肿瘤临床教学中,有利于提高教学效果,且接受度更高.

目的 探讨3D打印技术联合案例教学法在头颈肿瘤临床教学中的应用效果.方法 选取2016年1月-2017年12月在某大学附属医院肿瘤科接受住院医师规范化培训的60名学员为教学对象,随机分为实验组(30例)和对照组(30例),实验组采用3D打印技术联合案例教学法教学,对照组进行传统讲授式教学.课程结束后,对两组学员进行统一考试统计成绩,发放调查问卷评估教学满意度,综合评价3D打印技术联合案例教学法的教学应用效果.结果 实验组和对照组学员性别、年龄和全省规范化培训学员统一招录总成绩差异无统计学意义(P>0.05);实验组学员的理论基础知识、典型病例分析、临床操作技能和常见影像阅片成绩均明显高于对照组,差异有统计学意义(P<0.05).同时,实验组在兴趣吸引力、理解记忆力、培养临床思维、知识层面扩展、医患沟通能力培养等教学满意度调查评估表各项评分均明显高于对照组,差异有统计学意义(P<0.05).结论 3D打印技术联合案例教学法在头颈肿瘤临床教学中的应用,有益于提升头颈肿瘤教学课程的教学质量和教学满意度,培养良好的临床思维和临床实践能力.

目的 探讨培菲康联合复方小檗碱保留灌肠预防急性放射性直肠炎的临床疗效.方法 选择2016年1月—2017年12月我院收治的直肠癌根治术后行辅助放化疗的100例患者为研究对象,随机分为观察组(n=50)和对照组(n=50).两组患者均接受卡培他滨(825 mg·m-2,2次/天,口服)同期放疗(DT 45 Gy/25 F),观察组在此基础上采用培菲康口服(2包/次,3次/天)联合复方小檗碱保留灌肠(20 mL/次/天).比较两组患者急性放射性直肠炎的发生情况、卡氏功能状态(KPS)评分、乏力状况及生活质量(QOL)评分.结果 治疗4周时,观察组患者急性放射性直肠炎的发生率和级别均明显低于对照组(P<0.05);观察组患者KPS评分(80.02±7.34)显著高于对照组(76.64±7.08)(P<0.05);观察组患者中重度乏力的发生率(20％)显著低于对照组(48％)(P<0.05);观察组患者QOL评分(41.26±5.08)显著高于对照组(39.02±4.90)(P<0.05).观察组因放射性肠炎而减少口服化疗药物剂量或中断放疗的比例(4％)均显著低于对照组(18％)(P<0.05).结论 培菲康联合复方小檗碱保留灌肠对预防急性放射性直肠炎效果较好,患者依从性好,值得临床推广应用.

目的:观察奥氮平辅助治疗胃癌术后放化疗患者的临床疗效及其对生活质量影响.方法:将100例胃腺癌术后辅助放化疗患者随机分成观察组或对照组,观察组在同步放化疗期间接受奥氮平辅助治疗,对照组同步放化疗期间接受除了奥氮平之外的其他治疗.在同步放化疗开始前1d以及放疗4周时采用世界卫生组织(WHO)标准对患者恶心呕吐症状及程度进行评估,并用综合医院焦虑抑郁量表和WHO生存质量测定量表对患者治疗前后的心理状况和生活质量的变化进行评价.结果:放化疗4周时,观察组患者发生Ⅲ-Ⅳ级恶心呕吐反应和焦虑及抑郁评分明显低于对照组,差异具有统计学意义(P＜0.05);放化疗4周时观察组生存质量在生理、心理、社会关系等方面评分明显高于对照组,差异具有统计学意义(P＜0.05).结论:奥氮平辅助治疗可以有效改善胃腺癌术后放化疗患者的焦虑抑郁和恶心呕吐症状,从而改善患者的生存质量,值得在临床中推广应用.

目的:研究静态多叶准直器(MLC)调强和容积调强方式在脑转移癌全脑联合同期局部加量放疗的剂量学特点.方法:选择35例脑转移癌患者分别设计静态多子野(MSF)-MLC调强放疗(IMRT)和容积旋转调强放疗(VMAT)2种放疗计划,均采用全脑放疗联合同期局部加量放疗的放疗方案,处方剂量为全脑临床靶区(CTV) 30Gy/10 F、肿瘤靶区(GTV) 40 Gy/10 F,比较两者在靶区剂量分布、危及器官照射剂量和机器跳数上的差异.结果:两种技术均能满足临床放疗的基本要求.VMAT在左右眼球、左右视神经和垂体的最大剂量(Dmax)以及在右晶体、左右眼球、左右视神经和脑干的平均剂量上均较MSF有降低,机器跳数也较MSF明显下降.结论:VMAT可以作为脑转移癌全脑联合同期局部加量放疗中一个优化选择.

目的 探讨系统性康复训练联合迈之灵片治疗宫颈癌同步放化疗后下肢淋巴水肿的临床疗效.方法 61例接受同步放化疗治疗后发生下肢淋巴水肿的宫颈癌患者按接受治疗方式的不同分为治疗组和对照组,治疗组接受髋关节全范围运动训练和手法淋巴引流按摩为主的系统性康复训练并联合迈之灵片治疗,对照组接受肿瘤科常规护理和迈之灵片治疗,观察两组患者在治疗前和治疗3个月后下肢沉重感、疼痛、麻木和功能障碍等主观不适情况,下肢周径变化和淋巴水肿分级上的疗效差异.结果 两组患者接受治疗3个月后,治疗组和对照组的下肢深重感、疼痛、功能障碍评分分别为1.96 ±0.66和2.47±0.57、1.59 ±0.49和2.00±0.61、0.90±0.46和1.51±0.73,上述三个主观指标治疗组均优于对照组(P＜0.05),治疗组小腿周径(32.38±4.40)cm较对照组(34.78±5.19)em明显缩小(P＜0.05),但两组在麻木感、大腿周径和总体淋巴水肿分级上无明显差异.结论 系统性康复训练联合迈之灵片可以有效地治疗宫颈癌患者同步放化疗后的下肢淋巴水肿.

Objective:To observe the effect of physical therapy combined with compression massage on activity, pain,numbness and lymphedema of the impaired limb in breast cancer patients with sequential chemoradiotherapy after radical mastectomy.Methods:Sixty cases of breast cancer were randomly and equally divided into observation group and control group.All patients were treated with radical mastectomy and postoperative sequential chemora-diotherapy.The observation group was given the physical therapy combined with compression massage on the af-fected limb for 3 months after the start of radiotherapy.Before and after treatment,the activity,pain and numbness of the affected limb,and the perimeter difference between the affected limb and the healthy one were evaluated.Re-sults:After treatment for 3 months,range of shoulder motion in various directions was decreased as compared with that before treatment in both two groups(P<0.05).After treatment,VAS score and perimeter difference between the affected limb and the healthy one in both two groups were increased(P<0.05),and VAS score and perimeter difference between the affected limb and the healthy one in observation group were significantly reduced as compared with control group(P<0.05).After treatment,the numbness of the control group was significantly increased as compared with that before treatment(P<0.05),but there was no significant difference in the numbness of observa-tion group before and after radiotherapy(P>0.05),and the numbness was obviously lower in observation group than in control group(P<0.05).Conclusions:Radical mastectomy and postoperative sequential chemoradiotherapy could lead to limitation of motion,pain,numbness and edema of the affected limb.The physical therapy combined with compression massage can reduce edema of the affected limb,and improve motor function,symptoms of pain and numbness of the affected limb in patients with breast cancer.

Objective: To investigate the prescriptions of 1000 outpatients with hypertension in the university and staff & workers hospitals respectively, to know the classes of antihypertensive drugs in the daily use and the antihypertensive regimes in these two hospitals, and to assess whether they were in accordance with the international hypertension therapy guidelines. Method: The prescriptions of selected 1000 outpatients with hypertension visiting the above two hospitals respectively from August to December of 2004 were analyzed. Result:The use ratio of calcium channel blockers (CCB) in the university and staff & workers hospitals was 38. 5% versus 45.4% respectively, angiotensin-converting enzyme inhibitors (ACEI)24. 7% versus 16.6%, that of diuretics, 12.0% versus 5.6%, that of β-adrenergic receptor blockers (β-Blocker) , 18. 3% versus 26. 7% , that of angiotensin Ⅱ -receptor blockers(ARB) , 6. 3% versus 2.7% ,and that of α-ad-renergic receptor blockers(α Blocket) , 0. 3% versus 3. 0% . As compared with the patients (60.6% versus 57. 2%) receiving monotherapy, the rest (39.4% versus 43. 8%) took the combination of two or more than two classes of antihypertensive drugs. Conclusion:The classes of antihypertensive drugs prescribed to the outpatients with hypertension in the university and staff & workers hospitals were in accordance with the JNC-Ⅶ and 2003 European society of hypertension-European society of cardiology guidelines for the management of arterial hypertension in general, more with the antihypertensive regimes in the university hospital than those in the latter. But there were still some common problems in these two hospitals. For example, the application of diuretics was not as extensive as it could be. Possibly existing insufficient medication was another problem.

目的调查某院1000例高血压患者门诊处方,了解高血压病人常用降压药物的种类和降压治疗方案,评估它们是否符合国际高血压治疗指南.方法抽查2004年8～12月某院心内科专科1000例高血压病人门诊处方,详细地进行统计及分析.结果门诊高血压病人常用降压药物为:钙拮抗剂(CCB)38.5%,血管紧张素转换酶抑制剂(ACEI)24.8%、β受体阻滞剂(β-Blocker)18.3%、利尿剂12.0%和血管紧张素II受体拮抗剂(ARB)6.3%.其中CCB、利尿剂以国产为主,β受体阻滞剂、ACEI、ARB以进口居多.在1000例病人中,采用一种降压药物占60.6%,联合应用2种或2种以上降压药物占39.4%.结论门诊高血压病人降压药物应用种类及降压治疗方案基本符合2003年美国和欧洲高血压治疗指南,但也存在利尿剂应用偏少及可能存在降压药物用量不足等问题.