目的 探究失效模式与效应分析预防PICC置管后深静脉血栓价值.方法 选取2017年1月—2018年8月在本院进行PICC置管治疗的106例患者,将患者随机分为常规组及研究组,对常规组患者置管后行常规护理措施,对研究组患者实施以失效模式与效应分析为基础的护理干预模式,比较两组患者深静脉血栓发生几率及并发症发生总几率、RPN评分及血管损伤情况.结果 研究组患者治疗期间深静脉血栓发生率及并发症总发生率分别为3.77％及7.55％,均显著低于常规组(P<0.05),且研究组患者失效模式RPN评分均显著低于常规组(P<0.05).结论 对PICC置管患者实施以失效模式与效应分析为基础的护理干预模式,能够有效预防深静脉血栓等并发症的发生,同时有助于保护患者血管,值得推广.

目的 分析同伴支持教育联合思维导图护理对乳腺癌根治术患者病耻感及癌因性疲乏的影响.方法 选取2017年5月至2019年5月在本院行手术治疗的乳腺癌患者96例为研究对象,随机将其等分为对照组和观察组,对照组给予常规护理,观察组在对照组基础上给予同伴支持教育联合思维导图护理,比较干预前后两组患者病耻感与癌因性疲乏评分改变情况.结果 干预后两组患者癌因性疲乏和病耻感评分低于治疗前且观察组评分低于对照组,差异有统计学意义(P<0.05).结论 同伴支持教育联合思维导图护理可有效改善乳腺癌根治术患者病耻感及癌因性疲乏评分,提高患者心理健康水平,值得推广应用.

目的 观察早期阶段性康复锻炼应用于乳腺癌术后患者的临床效果.方法 选取62例乳腺癌术后患者为研究对象,随机分为两组,各31例.对照组术后按常规实施功能锻炼,观察组术后实施早期阶段性康复锻炼,比较两组患者肩关节活动度、运动耐力及并发症发生情况.结果 观察组肩关节活动度及运动耐力均大于对照组(P<0.01),术后并发症发生率低于对照组(P<0.05).结论 早期阶段性康复锻炼可有效提高乳腺癌术后患者肩关节活动度,提高运动耐力,降低并发症发生率,值得临床推广应用.

目的 探讨认知行为干预对鼻咽癌患者放疗后吞咽功能的影响.方法 选择2018年1—12月经放射治疗的鼻咽癌患者79例,随机分为对照组38例和试验组41例.对照组在出院前进行放疗后常规健康宣教,试验组在常规健康宣教的基础上给予认知行为干预,半年后评价患者咬肌痉挛、吞咽障碍的发生率,评估其张口范围、齿间距、生存质量.结果 试验组患者放疗后咬肌痉挛、吞咽障碍的发生少于对照组(P<0.05).试验组患者张口范围为(3.55±0.45)cm,齿间距为(3.61±0.34)cm,生活质量评分为(71.21±6.12)分,均优于对照组(P<0.05).结论 认知行为干预能减少张口困难、咬肌痉挛、吞咽障碍的发生,可以改善生活质量,提高患者满意度.

目的:研究循环肿瘤细胞水平监测对乳腺癌术后放化疗效果评定的价值.方法:选取2017年2月-2018年10月本院人类表皮生长因子受体2(HER-2)基因阳性的乳腺癌术后拟行放化疗者43例为乳腺癌HER-2阳性组、HER-2阴性者45例为乳腺癌HER-2阴性组、单纯乳腺疾病者22例为对照组.检测和观察乳腺癌患者放化疗前后、对照组的肿瘤标志物(CEA、CA125、CA15-3)和循环肿瘤细胞水平变化.建立各指标ROC曲线,比较曲线下面积(AUC),计算各指标敏感度、特异度;分析循环肿瘤细胞水平与各指标相关性.结果:放化疗前,乳腺癌HER-2阳性组肿瘤标志物和循环肿瘤细胞水平均高于乳腺癌HER-2阴性组、对照组,差异均有统计学意义(P＜0.05);放化疗后,乳腺癌HER-2阳性组上述指标仍高于乳腺癌HER-2阴性组、对照组,但差异均无统计学意义(P＞0.05),乳腺癌HER-2阳性组、乳腺癌HER-2阴性组上述指标均低于放化疗前,差异均有统计学意义(P＜0.05);CEA、CA125、CA15-3和循环肿瘤细胞AUC分别是0.581、0.715、0.793、0.829,且循环肿瘤细胞水平的敏感度及特异度均高于血清CEA、CA125、CA15-3指标(P＜0.05);循环肿瘤细胞水平与血清CEA、CA125、CA15-3水平均呈正相关关系(P＜0.05).结论:外周血循环肿瘤细胞水平状态监测能有效评定乳腺癌术后放化疗病情及化疗效果,该方法具有可行性,但仍需进一步加强研究.

目的:评价吉西他滨联合顺铂治疗复发或转移性晚期鼻咽癌的临床效果和不良反应.方法:将174例复发或转移性晚期鼻咽癌患者随机分为试验组和对照组,各87例,试验组采用吉西他滨联合顺铂,对照组采用5-氟尿嘧啶联合顺铂.检测两组循环肿瘤细胞,评价与化疗效果和预后的关系.结果:试验组临床总有效率为72.4％,对照组为52.9％,试验组临床总有效率明显高于对照组(P＜0.05).对照组恶心呕吐、口腔黏膜反应等发生率均明显高于试验组(P＜0.05),化疗后血小板抑制情况较对照组严重(P＜0.05).化疗开始前后,循环肿瘤细胞呈阳性率由71.8％逐步下降至12.1％,差异有统计学意义(P＜0.001).试验组的无病生存和总生存均优于对照组,差异均有统计学意义(P＜0.05),Cox多因素回归分析,结果显示转移、化疗后循环肿瘤细胞状态以及化疗方法是晚期鼻咽癌患者的独立预后因子.结论:吉西他滨联合顺铂治疗复发或转移晚期鼻咽癌效果较好,循环肿瘤细胞检测可作为评估化疗效果和预后的有效指标.

目的 研究心理干预在治疗癌痛并伴有抑郁状态患者中的作用.方法选取我院肿瘤科2012年6月～2015年5月具有癌痛并伴有抑郁状态的恶性肿瘤患者168例,参考随机数字表法,按照1:1比例将上述患者随机分为对照组和观察组,各84例.所有患者给予规范的癌痛三阶梯止痛治疗,观察组再联合心理干预治疗,包括药物治疗(艾司西酞普兰片)和心理疏导.记录两组患者疼痛数字分析法(NRS)、汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA-14)评分和世界卫生组织生活质量评定量表(WHO-QOL)评分变化,分析心理干预在治疗癌痛中的作用.结果两组患者抑郁焦虑状态有所改善,但观察组疗效明显优于对照组(P<0.05);疼痛程度与抑郁情绪评分呈正相关(r=0.86,P<0.05);治疗后,两组NRS评分差异有统计学意义(P<0.05),接受心理干预的观察组疼痛缓解更明显(P<0.05).结论癌痛和抑郁相互影响,心理干预可以提高癌痛患者止痛效果,提高患者生活质量.

Objective PDCA circulation management is implemented in PICC catheterization nursing for cancer patients, providing reference for the nursing management of PICC catheterization for cancer patients. Methods A total of 126 cancer patients admitted and treated in the department of oncology of the hospital from January 2015 to December 2016 were selected as the research objects, and randomly divided into the control group and the research group with 63 cases each. Patients in the control group were treated with the conventional nursing management method of PICC catheterization in the department of oncology of the hospital, and patients in the study group were treated with PD-CA circulation nursing management mode. The incidence of complications of PICC catheterization and the satisfaction of patients with PICC catheterization were compared between the two groups. Results The incidence of phlebitis, skin al-lergy, catheter obstruction or prolapse was lower in the PDCA group than in the control group ( P<0. 05) . However, there was no significant difference in the incidence of thrombosis ( P>0. 05) . It may be due to the small sample size of this study. Patients in the control group were 62. 8% satisfied with PICC catheterization, while those in the study group were 81. 3% satisfied with PICC catheterization. Patients in the study group implementing PDCA circular nursing man-agement were significantly more satisfied with PICC catheterization than those in the control group ( P<0. 05) . Conclu-sions PDCA circular nursing management in PICC catheterization of cancer patients can significantly reduce the inci-dence of various complications and improve the satisfaction of patients, which is worthy of clinical application.

Objective:To probe into applied effect of clinical nursing path in health education on nasopharyngeal carcinoma patients receiving radiotherapy.Methods:A total of 120 cases of nasopharyngeal carcinoma patients receiving radiotherapy were randomly divided into control group and experimental group,the control group of patients received conventional care,besides that,the experimental group of patients received clinical nursing path for nursing intervention,then to compare the health knowledge awareness,compliance and patients' satisfaction to nursing services between both groups.Results:The health knowledge awareness,compliance and satisfaction of patients in observation group were higher than that of control group(P<0.05).Conclusion:Application of clinical nursing path in implementation of health education for nasopharyngeal carcinoma patients undergoing radiotherapy can improve patients' health knowledge awareness and compliance behaviors,enhance patients' satisfaction to nursing services,and make the nurse-patient relationship close.

Objective To explore the effect of PDCA(Plan,Do,Check and Action) management in the chemotherapy safety management.Methods PDCA management was used in chemotherapy management.The main methods conclude: establishing nursing special management team about PDCA management,implementing the strict chemotherapy safety plan and chemotherapy management process,doing well the health education before chemotherapy,strengthening the monitoring and control of PDCA management,checking the plan making and consolidating the achievements.Results The nursing defects reduced by 13% after using PDCA(P<0.05).The patients improved by 35% about the disease knowledge and the satisfaction degree of nursing service reached 100%.There were significant differences before and after using PDCA(P<0.01).Conclusion The application of PDCA circulation management mode can reduce significantly medication errors;improve the safety quality of nursing care and the understanding ratio about the disease of the patients,and the nurses have a close relation with the patients.

目的 加强应用赫赛汀(药物通用名为曲妥珠单,Trastuzumab,商品名Herceptin)治疗乳腺癌的用药观察,遵守操作规范,使患者顺利安全完成治疗.方法 对37例经静脉输注赫赛汀药物的HER-2阳性乳腺癌患者,加强心理护理,用药中加强观察,严格遵守配药操作流程.结果 37例患者均能顺利完成治疗,无1例出现严重心脏不良反应.结论对应用赫赛汀治疗的患者,加强心理护理、用药观察及遵守用药操作要求,是使患者顺利完成治疗的重要保障.

[目的]探讨临床护理路径在鼻咽癌放疗中的应用及效果.[方法]将120例鼻咽癌放疗病人随机分为对照组和实验组,对照组采用常规护理,实验组在常规护理的基础上采用临床护理路径进行护理干预,比较两组病人的健康知识知晓率、依从性和病人对护理服务的满意度.[结果]观察组病人的健康知识知晓率及依从性和满意度均高于对照组(P＜0.05).[结论]应用临床护理路径对鼻咽癌放疗病人实施健康教育,可提高病人对健康知识知晓率、遵医行为及病人对护理服务的满意度.

将静脉化疗的患者200例为对照组,实施常规护理管理;200例为试验组,实施护理风险管理;对比两组患者静脉并发症的发生率。结果实施护理风险管理后,静脉炎及药物外渗的发生率明显降低,与对照组比较有显著差异(P<0.01),组织坏死的发生率无统计学意义(P>0.05)。采用护理风险管理可有效降低静脉并发症的发生,提高静脉化疗的护理质量及安全性。

Objective To analyze the cause of death and related factors of death of SLE,to explore the method of reducing mortality rate. Methods 31 death cases of hospitalized patients with SLE were analyzed retrospectively, and investigated the relations between the causes of death and clinical related factors. Results The mortality rate of patients in this group was 9.7% ,26 cases( 83.9% )were dead of organ lesion which was caused by SLE ,5 cases( 16.1% )were dead of infection. The clinical related factors for the death of these patients were long time diagnostic errors, failing to promptly adjust the immunosuppressive therapy according to the disease,poor treatment compliance etc. Conclusion The main cause of death of patients in this group is still the organ lesion caused by SLE, the reason is immunosuppressive therapy relatively conservative. Early diagnosis, timely and reasonable immunosuppressive therapy, positive patients education and enhancing patient's treatment compliance can improve the survival rate of SLE.

Objective To investigate the clinical characteristic of viral hepatitis complicated fatty liver. Methods To analyze 83 cases with viral hepatitis complicated fatty liver in our hospital from year 2000 to 2002 by patient's clinical rating ,clinical presentations, hepatic function test, hyperlipidemia test, and hepatic fibrosis test.Result In the selected cohort, mild 33 cases, moderate 33 cases, severe 17 cases. Tired, inappetence , and celiopathy are the main clinical presentations. In 83 cases , Major fatty liver make hepatic function test, hyperlipidemia test, and hepatic fibrosis test acosmia severely . Conclusion Viral hepatitis complicated fatty liver damage the hepar sharply.

Objective This study was to explore the possibility of approach to treat malignant tumors by using fixed dose rate of gemicitabine.Methods Total 32 pathologically or imaging-diagnosed patients with malignant tumors(NSCLS,NPC,relapsed breast cancer and pancreatic cancer) were enrolled.GP regimen(Gemcitabine: 1200 mg/m~2 at fixed dose rate of 10 mg/m~2 per minute;DDP:80-100 mg/m~2) was administrated to these patients every 3 weeks.And for each patient,at least two cycles of GP was received.Both the response and side effects were observed.Results Total 51 cycles of treatments were finished and all patients were evaluable for both response and side effects to chemotherapy.The total response rate is 52.17% and benefit rate(CR+PR+SD) was 86.95%.The major side effect is hematological toxicity.Ⅲ/Ⅳ grade thrombocytopenia were occurred in 31.4%(16/51) of cycles.Conclusion The GP regimen with fixed dose rate of gemcitabine is feasible in the treatment of advanced NSCLC,NPC,relapsed breast cancer and advanced pancreatic cancer.This regimen is of high response rate,clinical benefit response.The side effects are tolerable.This regimen is worth of further study to explore the appropriate dosage of gemcitabine.

Objective To observe the short term efficacy and toxicity of combination gencitabine and cisplatin(GC) chemotherapy for advanced metastatic or recurrent nasopharyngeal carcinoma.Methods 23 patients withadvanced metastatic or recurrent nasopharyngeal carcinoma were received GC chemotherapy every 28 days (16 caseshad been treated with radiotherapy and/or chemotherapy), all the patients had received 6 cycles chemotherapies.Result There were 4 complete responses and 14 partial responses in the 23 patients, achieving an overall responserate of 78.26%. Toxicity was mainly hematological:3 patients achieving grade III leucopenia. The median nausea/vomiting grading was I/II found in 60.86%(14/23) patients.7 patients reported grade I and 3 a grade II peripheralneurotoxicity after chemotherapy.Conclusion Gemcitabine plus cisplatin chemotherapy offers a satisfactoryoverall response rate and safety profile for advanced The regiment of Gemcitabine combined with DDP can be usedas induction chemotherapy in advanced metastatic or recurrent nasopharyngeal carcinoma.These encouragingresults were obtained irrespective of an exposure to prior cisplatin chemotherapy.It can be used as one-line andsecond-line salvage chemotherapy with the same efficacy.

Objective:To observe the short term efficacy of induction chemotherapy of Taxol combined with DDP plus radiotherapy in treating advanced nasopharyngeal carcinoma.Methods:72 patients with stageⅢ、Ⅳa nasopharyngeal carcinoma were randomly divided into two groups.36 patients in the observed group treated with induction chemotherapy of Taxol combined with DDP(Taxol:175mg/m~2,DDP100mg/m~2)for 3 cycles.Then followed by conventional radiotherapy;the control group was given the same radiotherapy alone.Result:The RR of TP regiment is quite higher in the NPC patients who were untreated before. The T-stage and N-stage can be reduced in 33.3% and 44.4% patients respectively.The short term effica- cy showed that within 3 months after radiotherapy,33cases(91.7%)and 32 cases(88.8%) presented complete remission(CR)in nasopharynx tumor and metastatic foci in cervical lymph nodes respectively in the ob- served group.While in the control group,those were 26(72.2%) and 24(66.6%) respectively.There were significant difference between the two groups(P<0.05).Conclusion:The regiment of Taxol combined with DDP can be a good choice used as induction chemotherapy in advanced nasopharyngeal carcinoma patients, with the advantages of better effect,less toxicity and easier to be tolerated.

目的探讨鼻咽癌后装腔内放疗的有效护理方法,确保放疗过程顺利进行,预防并发症发生.方法对 294例鼻咽癌腔内放疗患者采取一系列有效措施,包括放疗前准备,放疗中的配合,放疗后的护理.结果 294例患者中,2例因鼻咽结构异常,置管失败,其余均顺利完成放疗,无 1例发生鼻咽大出血.结论腔内放疗的护理方法有效,提高了鼻咽癌治愈率.