目的 分析肺癌患者术后住院期间发生肺栓塞的危险因素.方法 收集2019年3月至2022年5月于首都医科大学附属北京同仁医院收治的90例肺癌患者的临床资料,根据术后住院期间是否发生肺栓塞将患者分为栓塞组和对照组,每组45例.分析肺癌患者术后住院期间发生肺栓塞的危险因素.结果 栓塞组术前D-二聚体水平、术前C反应蛋白水平、TNM分期为Ⅲ～Ⅳ期的患者比例、术中出血量均高于对照组,手术时间长于对照组,差异均有统计学意义(P﹤0.05).多因素分析结果显示,术前D-二聚体水平升高、术前C反应蛋白水平升高、TNM分期为Ⅲ～Ⅳ期、手术时间﹥3 h和术中出血量﹥200 ml均是肺癌患者术后住院期间发生肺栓塞的独立危险因素(P﹤0.05).结论 术前D-二聚体平、术前C反应蛋白水平、TNM分期、手术时间和术中出血量均与肺癌患者术后住院期间发生肺栓塞密切相关,术前应注意筛查存在这些因素的高危患者,做好针对性预防.

Objective:To construct a risk nomogram early prediction model for myasthenia gravis (MG) after thymoma resection and to verify the predictive performance of the model.Methods:Using the convenient sampling method, a total of 477 patients undergoing thymoma resection who were admitted to Department of Thoracic Surgery in Beijing Tongren Hospital Affiliated to Capital Medical University from March 2018 to February 2021 were selected as the training set. A total of 62 patients who underwent thymoma resection from March 2017 to February 2018 were set as the validation set for retrospective analysis. The clinical data of the included patients were analyzed. Logistic regression analysis was used to explore the independent risk factors of MG after thymoma resection and a risk nomogram prediction model was constructed.Results:The incidence of postoperative MG in 477 patients who underwent thymoma resection was confirmed by chest X-ray, CT and related tests, which was 14.05% (67/477) . There were statistical differences between the two groups of patients with MG and those without MG in terms of combination of immune diseases, preoperative course of disease, surgical route, complete tumor resection, WHO pathological classification, postoperative pulmonary infection, postoperative radiotherapy and chemotherapy and other data ( P<0.05) . Logistic regression analysis showed that combined immune disease, thoracotomy, incomplete tumor resection, WHO pathological classification of A+AB, postoperative pulmonary infection and no postoperative chemoradiotherapy were independent risk factors for MG after thymoma resection ( P<0.05) . Based on 6 independent risk factors, a risk nomogram prediction model of MG after thymoma resection was established. The results showed that the C- index of the training set and the validation set were 0.837 (95% CI: 0.807-0.867) and 0.817 (95% CI: 0.807-0.867) , respectively. The calibration curves for both sets showed good fit to the ideal curve, with areas under the receiver operating characteristic curves of 0.834 (95% CI: 0.794-0.874) and 0.825 (95% CI: 0.789-0.861) , respectively. Conclusions:Combination of immune diseases, surgical approach of thoracotomy, incomplete tumor resection, WHO pathological classification of A+AB, postoperative pulmonary infection and no postoperative radiotherapy and chemotherapy are independent risk factors for MG after thymoma resection. The risk nomogram prediction model established based on the above risk factors can accurately assess and quantify the risk of MG after thymoma resection, which has good predictive ability.

目的 研究聚焦解决模式干预对肺癌术后化疗患者的化疗依从性和疾病复发的影响.方法 选取191例肺癌术后需要化疗的患者作为研究对象,运用EXCEL函数功能进行随机抽样分为干预组(n=98例)和对照组(n=93).将常规护理干预应用于对照组,聚焦解决模式护理干预和常规护理干预相结合的方法应用于干预组.观察2组干预后依从性、化疗1年后转归和患者满意度.结果 干预组化疗的依从性、满意度高于对照组,差异有统计学意义(P＜0.05);化疗1年后,干预分组的复发率低于对照组,差异有统计学意义(P＜0.05).结论 聚焦解决模式能有效改善肺癌术后化疗病人的身心状况,提高病人术后化疗的依从性,从而减少肺癌的复发,有利于疾病的转归.

目的 评价医院—社区合作健康教育模式对乳腺癌患者术后康复的效果作用.方法 选择2017年1月至2018年6月社区的乳腺癌术后患者104例作为研究对象,按随机数字表法分为对照组和干预组,各52例,对照组实施出院时常规健康教育,干预组实施医院—社区合作健康教育模式,比较两组患者术后1个月和术后3个月时生命质量评分(FACT-B)以及肩关节活动度(ROM)改善情况.结果 术后3个月,干预组患者FACT-B中,生理状况、社会/家庭状况、情感状况、功能状况、附加关注及总分评分分别为(20.19±0.2)分、(20.31±0.20)分、(17.19 ±0.58)分、(16.54±0.77)分、(20.10±1.25)和(90.45±1.86)分,均高于对照组的(9.81±0.31)分、(10.33±0.22)分、(7.23±0.34)分、(5.61±0.80)分、(10.23±1.52)和(41.56±1.74)分;干预组患者ROM测量中,肩关节屈、后伸、外展、内收活动度数分别为(138.88±17.27)度、(58.55 ±5.42)度、(138.69±15.71)度和(63.96 ±4.55)度,均大于对照组的(113.61 ±11.21)度、(37.80±3.62)度、(99.18 ±11.46)度和(46.18 ±6.17)度,差异有统计学意义(P＜0.05).结论 开展医院—社区合作健康教育,有利于提高乳腺癌患者生命质量,促进术后康复.

目的 探索认知性健康教育对肺癌患者生活质量及生存期的影响.方法 根据健康教育方法的不同将100例行手术治疗的肺癌患者分为常规组(接受常规管理干预)和教育组(接受认知性健康教育管理干预),每组50例.比较两组患者术后不同时间点的并发症发生情况、干预前后的生活质量及术后2年生存情况.结果 术后4周,教育组患者的不良反应发生率低于常规组(P﹤0.05).干预后,两组患者的生活质量评分均明显高于本组干预前(P﹤0.01);干预后,教育组患者的生活质量评分明显高于常规组(P﹤0.01).教育组患者的生存情况明显优于常规组(P﹤0.01).结论 认知性健康教育能够有效改善肺癌患者的生活质量,延长患者的生存时间,降低术后并发症发生率.

Objective To explore the nursing methods for the treatment of lung cancer by thoracoscopy.Methods A total of 120 patients with lung cancer in our hospital were divided into control group and study group by random numbers table method,with 60 cases in each group.The control group took routine perioperative nursing intervention,while the control group implemented comprehensive nursing intervention.The operation time,length of hospital stay and postoperative complications of the two groups were observed and compared.Results The hospitalization time of the study group was lower than that of the control group (P ＜ 0.05).There was no significant difference in operation time between the two groups (P ＞ 0.05).The incidence of postoperative complications was 1.67％ in the study group,which was lower than 13.33％ in the control group (P ＜0.05).Conclusion Comprehensive nursing can reduce the incidence of postoperative complications,shorten the length of hospital stay,so it is suitable for clinical application.

目的 探讨研究美国国立综合癌症网络(National Comprehensive Cancer Network,NCCN)心理痛苦干预对中晚期肺癌患者行为功能状态和生活质量的影响.方法 选取我院2012年3月～2015年11月收治确诊的154例中晚期肺癌病患,对纳入研究的全体患者采取随机数字表法将其平均分成观察组与对照组,每组各77例.其中对照组实施常规性护理,观察组则在此护理基础上施以NCCN心理痛苦干预,观察比较两组患者的护理前后的行为功能状态量表(KPS)评分,心理痛苦温度计(DT)评分与心理痛苦相关因素调查表(PL)评分、生命质量测定量表(QLQ-C30)评分.结果 两组患者实施护理干预前上述量表评分组间比较差异无统计学意义(P＞0.05);实施护理干预后上每组患者的上述量表评分均较干预前明显好转,且差异有统计学意义(P＜0.05);观察组干预后KPS评分、PL评分及DT的痛苦检出率均明显较对照组为优(P＜0.05).两组患者护理干预后QLQ-C30评分中,只有经济困难维度评分组间比较差异无统计学意义(P＞0.05),剩余各项评分观察组较对照组均显著为优(P＜0.05).结论 NCCN心理痛苦干预可更有效的缓解中晚期肺癌的痛苦,改善其生活质量与行为功能状态.

目的 探讨重症肌无力合并Graves病患者胸腺切除术的围手术期护理方法.方法 对16例重症肌无力合并Graves病患者进行围术期护理,术前认真评价患者重症肌无力及甲亢严重程度,监测基础代谢率,并采取措施改善患者症状,加强沟通,提高患者配合能力；术后严密监护,加强肺部护理及心理护理,高度警惕并有效防止肌无力危象及甲亢危象发生；做好出院指导,告知患者观察内容及服药注意事项,定期复查,调整药物治疗,注意情绪稳定,增强体质,预防感染.结果 16例患者手术过程顺利,术后1～2d可下床活动,平均3 ～4d拔除引流管,术后未发生肌无力危象及甲状腺危象,无死亡病例及并发症发生,术后5～7d顺利出院.结论 术前应充分评估并积极采取措施去除诱发危象发生的因素,术后严密的监护是配合医生提高手术成功率,减少术后并发症,增加患者依从性的关键。