癌症患者临终阶段特点及血液指标分析
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摘要
目的探讨癌症患者临终阶段特点及血液指标情况。方法回顾性分析滁州市第一人民医院肿瘤科2014年3月至2018年4月住院期间死亡的133例晚期癌症患者的临床资料。结果 (1)肿瘤患者死亡时间有一定规律,在卯时死亡风险较高,申时死亡风险相对较低。(2)临终症状表现,有26.3%的肿瘤患者神志不清;在神志清楚的患者中,疼痛症状发生率较高,达61.2%,其次为疲乏(57.1%)、胸闷气喘或呼吸困难(53.1%)等。(3)在死亡患者中统计发现,有39.1%的肿瘤患者有高血压病史,16.9%的肿瘤患者有糖尿病史。(4)晚期肿瘤患者死亡时仍有36.8%的患者家属要求积极抢救,且晚期肿瘤患者发生猝死风险达10.5%。(5)晚期肿瘤患者的白细胞、血小板、血红蛋白、中性粒细胞比率、血钾、血钠、血氯、血钙、谷丙转氨酶、谷草转氨酶、总胆红素、白蛋白、尿素均显著异常于正常人群,且差异均有统计学意义(P<0.05)。结论癌症患者临终阶段表现及血液学检查均有一定特点,加强对癌症患者临终阶段特点的认识,有利于提升临终关怀的水平,改善患者临终阶段的生活质量。
Objective To explore characteristics in terminally ill cancer patients, and to analyze their blood indices. Methods A total of 133 advanced cancer patients who died between March 2014 to April 2018 in Department of Oncology of the First People's Hospital of Chuzhou City were enrdled, and their clinical data were analyzed by using retrospective method. Results(1) Cancer patients' death time had a certain regularity, the death frequency in"Mao"period was maximum, and that in"Shen"period was minimum.(2) In terminally ill cancer patients, there were 26.3% patients with unconsciousness; in patients with clear mind, the symptom of pain had the highest incidence rate of 61.2%,followed by 57.1% of fatigue, 53.1% of chest distress and asthma, or dyspnea, etc.(3) Among the dead patients, 39.1%of the cancer patients had a history of hypertension and 16.9% of the cancer patients had a history of diabetes mellitus.(4) The statistic results showed that 36.8% of the family members of patients with advanced cancer still required active rescue when they were dying, and the risk of sudden death of patients with advanced cancer was 10.5%.(5) Leukocyte,platelet, hemoglobin, neutrophil ratio, blood potassium, blood sodium, blood chlorine, blood calcium, alanine aminotransferase, glutamic oxaloacetate aminotransferase, total bilirubin, albumin and urea in patients with advanced cancer were significantly abnormal compared with those in normal people, and the difference was statistically significant(P<0.05). Conclusion Characteristics and blood indices had certain different in terminally ill cancer patients, doctors and nurses should enhance the understanding of the terminal stage characteristics of cancer patients for improving the quality of palliative care and patients' quality of life.
Objective To explore characteristics in terminally ill cancer patients, and to analyze their blood indices. Methods A total of 133 advanced cancer patients who died between March 2014 to April 2018 in Department of Oncology of the First People's Hospital of Chuzhou City were enrdled, and their clinical data were analyzed by using retrospective method. Results(1) Cancer patients' death time had a certain regularity, the death frequency in"Mao"period was maximum, and that in"Shen"period was minimum.(2) In terminally ill cancer patients, there were 26.3% patients with unconsciousness; in patients with clear mind, the symptom of pain had the highest incidence rate of 61.2%,followed by 57.1% of fatigue, 53.1% of chest distress and asthma, or dyspnea, etc.(3) Among the dead patients, 39.1%of the cancer patients had a history of hypertension and 16.9% of the cancer patients had a history of diabetes mellitus.(4) The statistic results showed that 36.8% of the family members of patients with advanced cancer still required active rescue when they were dying, and the risk of sudden death of patients with advanced cancer was 10.5%.(5) Leukocyte,platelet, hemoglobin, neutrophil ratio, blood potassium, blood sodium, blood chlorine, blood calcium, alanine aminotransferase, glutamic oxaloacetate aminotransferase, total bilirubin, albumin and urea in patients with advanced cancer were significantly abnormal compared with those in normal people, and the difference was statistically significant(P<0.05). Conclusion Characteristics and blood indices had certain different in terminally ill cancer patients, doctors and nurses should enhance the understanding of the terminal stage characteristics of cancer patients for improving the quality of palliative care and patients' quality of life.
引文
[1]韦云.恶性肿瘤患者死亡时间与中医阴阳关系的研究[J].北京中医药大学学报(中医临床版), 2008, 15(3):5-8.
[2]王薇,黎元元,杨薇,等.基于HIS真实世界1219例肺癌患者死亡时间分析[J].中国中医基础医学杂志, 2014, 20(12):1668-1669.
[3]欧杰,李永刚,王兴华.乳腺癌住院患者死亡时间分析[J].中国中医药科技, 2014, 21(5):477-481.
[4] SHAHEEN PE, LEGRAND SB, WALSH D, et al. Errors in opioid prescribing:a prospective survey in cancer pain[J]. J Pain Symptom Manage, 2010, 39(4):702-711.
[5] WANG JJ. A survey of cancer pain status in Shanghai[J]. Oncology,2008, 74(Suppl1):13-18.
[6] REIS-PINA P, LAWLOR PG, BARBOSA A. Cancer-related pain management and the optimal use of opioids[J]. Acta Med Port, 2015,28(3):376-381.
[7]王学志,杨晶,孟庆华,等.中晚期癌症合并感染的抗菌药物治疗[J].中华医院感染学杂志, 2006, 16(7):808-810.
[8] WU D, HU D, CHEN H, et al. Glucose-regulated phosphorylation of TET2 by AMPK reveals a pathway linking diabetes to cancer[J]. Nature, 2018, 559(7715):637-641.
[9] PEARSON-STUTTARD J, ZHOU B, KONTIS V, et al. Worldwide burden of cancer attributable to diabetes and high body-mass index:a comparative risk assessment[J]. Lancet Diabetes Endocrinol, 2018, 6(6):e6-e15.
[10] SOUZA VB, SILVA EN, RIBEIRO ML, et al. Hypertension in patients with cancer[J]. Arq Bras Cardiol, 2015, 104(3):246-252.
[11]李小鹰,叶平.老年心血管病急症[M].北京:北京医科大学中国协和医科大学联合出版, 1999:15-70.
[12]余怡,许青,李莉.晚期恶性肿瘤患者临近死亡药物抢救临床价值分析[J].现代肿瘤医学, 2017, 25(20):3320-3322.
[2]王薇,黎元元,杨薇,等.基于HIS真实世界1219例肺癌患者死亡时间分析[J].中国中医基础医学杂志, 2014, 20(12):1668-1669.
[3]欧杰,李永刚,王兴华.乳腺癌住院患者死亡时间分析[J].中国中医药科技, 2014, 21(5):477-481.
[4] SHAHEEN PE, LEGRAND SB, WALSH D, et al. Errors in opioid prescribing:a prospective survey in cancer pain[J]. J Pain Symptom Manage, 2010, 39(4):702-711.
[5] WANG JJ. A survey of cancer pain status in Shanghai[J]. Oncology,2008, 74(Suppl1):13-18.
[6] REIS-PINA P, LAWLOR PG, BARBOSA A. Cancer-related pain management and the optimal use of opioids[J]. Acta Med Port, 2015,28(3):376-381.
[7]王学志,杨晶,孟庆华,等.中晚期癌症合并感染的抗菌药物治疗[J].中华医院感染学杂志, 2006, 16(7):808-810.
[8] WU D, HU D, CHEN H, et al. Glucose-regulated phosphorylation of TET2 by AMPK reveals a pathway linking diabetes to cancer[J]. Nature, 2018, 559(7715):637-641.
[9] PEARSON-STUTTARD J, ZHOU B, KONTIS V, et al. Worldwide burden of cancer attributable to diabetes and high body-mass index:a comparative risk assessment[J]. Lancet Diabetes Endocrinol, 2018, 6(6):e6-e15.
[10] SOUZA VB, SILVA EN, RIBEIRO ML, et al. Hypertension in patients with cancer[J]. Arq Bras Cardiol, 2015, 104(3):246-252.
[11]李小鹰,叶平.老年心血管病急症[M].北京:北京医科大学中国协和医科大学联合出版, 1999:15-70.
[12]余怡,许青,李莉.晚期恶性肿瘤患者临近死亡药物抢救临床价值分析[J].现代肿瘤医学, 2017, 25(20):3320-3322.