[目的]分析肿瘤患者在入院时、住院期间及出院时的症状分布及患者日记管理工具在疾病管理中的可行性.[方法]选取全国17家医院的恶性肿瘤患者,向其发放患者日记,指导其如何填写,嘱其每日认真填写日记.通过第三方研究者问询获得并分析患者在住院时、住院期间及出院时的相关症状,通过患者对日记满意度调查与主管医生对日记认可度调查分析患者日记工具的可行性.[结果]共纳入符合要求的152例患者,调查发现肿瘤患者入院时排名前10位的症状分别是疲乏、食量下降(近1周)、疼痛、体重下降(近1个月)、睡眠不好、厌食、胸闷气短、便秘、咳嗽咳痰和心情郁闷;住院期间排名前10位的症状分别是便秘、恶心呕吐、厌食、食量下降(近1周)、腹胀、疼痛、睡眠不好、疲乏、腹泻和发热.出院时排名10位的症状分别是疲乏、便秘、睡眠不好、胸闷气短、疼痛、咳嗽咳痰、厌食、出汗、小便减少、心情郁闷.肿瘤疾病分期为Ⅳ期的患者,入院时的症状患病率明显高于非Ⅳ期患者.绝大部分患者(91.4％,139/152)认可患者日记,认为该患者日记能帮助医生更好的了解自己,65.1％(99/152)的患者表示自己出院后会继续填写该日记内容,82.2％(125/152)的患者表示填写日记不会造成负担.绝大部分主管医生(77.6％,118/152)认为患者日记设计合理,77.0％ (117/152)的主管医生认可患者日记并愿意继续使用,75.7％(115/152)的主管医生认为患者日记实用性很强,72.4％(104/152)主管医生认为患者日记能够帮助自己全面了解患者症状,64.4％ (98/152)的主管医生认为患者日记能够提高查房效率.[结论]Ⅳ期肿瘤患者相关症状发生率明显高于非Ⅳ期患者,需重点监测和管理.肿瘤患者临床症状在住院期间部分会得以改善,但治疗相关的不良反应使出院时症状又有升高,需要主管医生引起重视并加强出院后随访及症状管理.患者日记工具能够使患者重视肿瘤所有相关的症状的监测,能提高医护工作人员的查房效率,有助于患者及家属在出院后的疾病全程相关症状管理,值得进一步临床研究及使用.

Objective To investigate the relationship between neutrophils to lymphocytes ratio (NLR) and the prognosis of retroperitoneal liposarcoma patients and other prognostic factors. Methods We collected 109 patients diagnosed asretroperitoneal liposarcoma. All patients were divided into two groups according to the preoperative NLR: high NLR group (NLR > 2.78) and low NLR group (NLR≤2.78). The survival rates were compared between the two groups. In addition, other clinicopathological features and prognostic factors of retroperitoneal liposarcoma patients were analyzed, including the patient's medical history, tumor features and operation characters. Results The 5-year survival rates in the high NLR group and low NLR group were 50% and 84.6%, respectively (P=0.016). Patients with high NLR had a higher malignancy (P=0.033), and the NLR level was associated with immunity, inflammatory response and liver function of patients (P=0.001, P=0.000). Besides, there were significant differences between the two groups of dedifferentiated and highly-differentiated retroperitoneal lipomas (P=0.004). The patients with history of smoking and drinking always had poorer outcomes (P=0.032, P=0.004). Male and female patients with 5-year survival were 45.5% and 84.6%, respectively (P=0.006). In addition, the results of surgical excision showed that 5-year survival rates of the patients with piecemeal resection, palliative resection and complete resection were 66.7%, 90% and 20%, respectively (P=0.027). Conclusion NLR could be used as a prognostic indicator of retroperitoneal lipoma. Preoperative NLR > 2.78 indicates poor prognosis. Patients with history of smoking and drinking have a poor prognosis for retroperitoneal liposarcoma. The 5-year survival rate of patients with palliative resection is higher than those with piecemeal resection and complete resection.

目的:本文报道使用以臭氧介入为主的规范化诊疗综合方案用于顽固性、激惹型疱疹后神经痛患者的5年随访结果.方法:统计资料完整的顽固性躯干部疱疹后神经痛30例住院患者,病史4个月～4年,患者最多住院达10次.入院后接受以臭氧介入为主的规范化诊疗方案,即口服药物+病人自控硬膜外镇痛+臭氧介入治疗,采用自身对照方法考察治疗前、后抑郁量表、疼痛程度、红外线热图、患区遗留症状和睡眠质量等指标.随访评估五年.使用Poisson列联系数法进行统计资料处理.结果:年龄60～85岁(平均70.3±5.9岁).患区剧烈疼痛住院72小时内即得到有效控制,治疗前平均视觉模拟评分(visual analogue scale,VAS)评分为6.7±1.8分,抑郁评分(hamilton depression score,HAMD)评分为22.6±4.2分,局部温度为36.4±2.6℃.治疗后平均VAS评分为3.1±0.8分,HAMD评分为13.5±3.1分,局部温度差为3.6±0.6℃.本组患者未出现与治疗方案相关的并发症.结论:CT监护下以臭氧介入为主的规范化治疗可快速控制剧烈疼痛,使原发和继发损伤区消失或明显缩小,局部温度趋于正常,在长达5年左右随访期间效果比较稳定,疼痛程度及VAS评分未出现明显波动,患者情绪好转,绝大部分患者生活质量明显改善.

目的:三叉神经带状疱疹后神经痛是头面部疼痛疾病中最为剧烈的疼痛疾病之一.本文报道使用牛痘疫苗接种家兔炎症皮肤提取物(神经妥乐平)及连续星状神经节注药(CSGB)对比药物治疗三叉神经区疱疹后遗神经痛的临床疗效分析.方法:本组40例患者,病程3个月～4年.使用VAS评分评价疼痛程度;使用改良HAMD评价抑郁程度;同时检查治疗前、后损伤区域红外热图.门诊(OP)组治疗方法:甲钴胺2 mg/日,神经妥乐平2～4片/日,加巴喷丁600～900mg/日或普瑞巴林150～450mg/日.住院(IP)组治疗方法:口服药同OP组,CSGB处方:0.1％罗哌卡因200 ml+神经妥乐平6ml,连接PCA泵(ZBB-Ⅰ型,南通产),持续量0.5～1 ml/h,追加剂量0.5 ml/次,持续使用一周.两组患者均于治疗两周及随访一年后评价效果.结果:患者主诉头面部自发性闪电样疼痛、刀割样疼痛、烧灼样疼痛为主.两组患者平均HAMD评分为21.8±3.8分,平均VAS评分为7.8±1.6分.经过治疗后OP组和IP组患者平均VAS评分分别为5.4±1.2:3.2±0.8分,HAMD评分为18.5±3.1:11.2±2.1分;复发率为45％:20％;治疗前、后局部红外热图平均差值为:1.2～5.8℃.IP组经过14～18个月的随访,疗效相对稳定.对于复发患者则采用其他方法进行治疗.结论:两组头面疱疹后神经痛患者初步结果表明:与OP组治疗结果比较,IP组加用CSGB方法安全,有效,能够快速控制剧烈疼痛,患区后遗症状大部分缓解.经过一年左右随访大部分患者效果稳定,生活质量明显改善.

目的:制定并验证中文版简版McGill疼痛问卷-2（Short-form McGill Pain Questionnaire-2,SF-MPQ-2）。方法:1.制定中文版SF-MPQ-2:经正向翻译和逆向翻译得出初步中文版SF-MPQ-2,再经预实验和专家讨论后得出最终的中文版本。2.验证中文版SF-MPQ-2:共10家研究中心参与研究;每个中心随机采用神经病理性疼痛患者7例,伤害感受性疼痛患者7例。入选的患者自行填写SF-MPQ-2。3.分析量表的信度（使用Cronbach’sα系数和Guttman分半系数分析组内一致性）和效度（表面效度、结构效度,包括因子分析、Spearman相关系数）。结果:中文版SF-MPQ-2的表面效度好。中文版SF-MPQ-2的信度（Cronbach’sα系数和Guttman分半系数均大于0.7）和结构效度好（共提取出4个公共因子,累计方差贡献率为52.631%;各条目的因子负荷在相应的公共因子中都大于0.40;除1个条目外其他各条目与所属维度之间Spearman秩相关系数均大于0.40）。结论:中文为母语的患者可以使用本研究制定并验证的中文版SF-MPQ-2全面评估包括神经病理性疼痛在内的疼痛情况。

目的 检测阻塞性睡眠呼吸暂停低通气综合征(OSAHS)52例患者外周血淋巴细胞的microRNA-34a(miR-34a)水平,探讨影响miR-34a表达的相关因素.方法 检测患病组患者miR-34a的表达水平,与对照组比较,对miR-34a表达水平、睡眠呼吸监测结果及蒙特利尔认知评估量表(MoCA)测试结果进行相关分析.结果 患病组及对照组血液miR-34a表达随年龄增长而增加,在≥50岁患病组、重度患病组及伴有高血压的患病组中,血液miR-34a水平较对照组明显升高,与年龄及呼吸暂停最长持续时间正相关,与最低血氧饱和度和MoCA问卷中的记忆得分负相关.结论 OSAHS患者较对照组miR-34a表达上调,年龄、睡眠呼吸暂停病情及高血压是miR-34a表达上调的重要影响因素.

目的:探讨人工全髋关节置换翻修术后康复治疗的临床效果.方法:选取2012年1月至2013年8月在我院进行人工全髋关节置换翻修手术的60例患者作为研究对象,对其进行康复治疗,观察其治疗效果.结果:患者手术前后在疼痛、活动度、步行能力及日常生活能力等方面相比差异具有统计学意义(P＜0.05).结论:根据患者的身体状况和骨质情况确定合理有效的训练计划,同时全面记录训练的内容,及时反馈,及时调整,促进患者早日康复.

Objective The clinical observation on the therapeutic effect and safety of PCEA ex-sik in the treatment of the nerve pain caused by lumbar intervertebral disc protrusion.Methods 40cases of nerve pain caused by lumbar intervertebral disc protrusion were randomly assigned into two groups with 20cases each.For both groups,patients orally taken 1mg Mecobalamin capsule,2Lunanbeite tablets,60mg Le Song twice a day.NSAIDs was given in both groups.In addition to 0.1%ropivacaine used in the control group,6ml analgecine and 0.1%ropivacaine were added in the ex-sik group.Both groups flow 1.5～2.0 ml/h by epidural injection,added 2ml every 15minutes and were on an average of 10days for a course of treatment to relieve pain.Meanwhile,the index of VAS scores was recorded.Results Significant pain-relief,improved daily life ability,higher self-confidence could be observed in both groups.The average VAS scores were significantly decreased(P<0.01).Whereas the improvement in numbness and sense of coldness in the therapy group was higher than the control group(P<0.05).Conclusion Ex-Sik in treating nerve pain caused by the waist lumbar intervertebral disc protrusion is effective and safe.

Objective:To explore the analgesia effective of TENS on post-operative pain after total knee replacement.Method: 42 patients were randomly allocated into two groups:TENS and placebo group.The Visual Analogue Scale was used to assess the degree of post-operative knee pain. Repeated Measures ANOVA(SPSS version 10) was used to analyze the VAS data before,among and after TENS or placebo stimulation.Result: A significant difference between-groups in the decrease of VAS scores was found after TENS but not placebo stimulation.The pre-stimulation baseline VAS score of the TENS group gradually dropped from 100% to 83.3%±14.9% at 60 min during,and to 85.7(±16.1)% at 20 min after TENS,with a gradual return to 94.3(±7.8)% at 60 min after TENS.These scores were significantly smaller than those recorded in the placebo group, which showed negligible changes from the baseline value.Conclusion:TENS has a immediate analgesia effect on post-operative knee pain after total knee replacement.

Objective:To investigate the influence factors on range of knee motion after surgery, therefore, to design a appropriate rehabilitation program.Method: 21 patients who received the total knee replacement were involved in this study. They were assessed using the HSS scale, knee function, and range of knee motion before surgery. Pearson correlation was used to analyze the factors measured before surgery and post-operative knee motion at week 1,2. Independent t-test was used to compare the range of knee motion at different time interval. Result:The pre-operative HSS scale, knee pain, knee function, range of knee motion and deformity of knee flexion had a positive correlation with range of knee motion post-surgery.The correlation value was 0.546?0.430?0.423?0.539 and 0.403 respectively(P0.05).Conclusion:Knee pain,knee function,knee flexion deformity have a positive correlation with knee motion after surgery.