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目的探讨卵巢上皮性癌(卵巢癌)患者临终期表现的特点及规律。方法收集1995年1月至2004年12月在北京协和医院妇产科住院期间死亡的98例卵巢癌患者的临终期临床资料,对其常见的临终期症状、体征和并发症(以下简称为临终期表现,包括疼痛、恶液质、胸腹水、呼吸困难、发热、肠梗阻、肾功能衰竭、不可逆的骨髓抑制、肺部感染、出血、下肢深静脉血栓、消化道瘘、真菌感染、黄疸和各种急症)的发生率、发生后的存活时间以及各种临终期表现共存的规律、常见死亡原因进行分析。结果 (1)各种临终期表现的发生率:以胸腹水的发生率最高(63%),依次为疼痛(60%)、恶液质(59%)、呼吸困难(52%)、肠梗阻(49%)。(2)各种临终期表现出现后的存活时间:最长者为真菌感染(77 d),其次为消化道瘘(75 d)、肠梗阻(67 d)、疼痛(60 d)、恶液质(60 d)。比较凶险的临终期表现为不可逆的骨髓抑制、肾功能衰竭、呼吸困难和各种急症,存活时间中位数分别为14、13、12、7 d。(3)各种临终期表现共存的规律:临终期多以症候群为表现特点,每一患者同时存在(4.9±1.5)种临终期表现。同时存在4种及以上临终期表现者84例(86%),多表现为自然缓慢的病程,停止抗肿瘤治疗后的存活时间中位数为63 d;同时存在3种及以下临终期表现者14例(14%),存活时间中位数仅为25 d,两者生存时间比较,差异有统计学意义(P<0.01)。(4)卵巢癌患者的常见死亡原因中肠梗阻占首位(30%),其次为感染(15%)和各种急症(12%)。死于治疗并发症者5例(5%)。结论临终期表现有其特点和规律,加强认识有助于提高对临终期表现的管理水平,改善临终期患者的生活质量。
Objective To investigate the characteristics and regularity of terminal manifestation in patients with epithelial ovarian cancer (ovarian cancer). Methods The clinical data of 98 patients with ovarian cancer who died during the period of inpatient department of obstetrics and gynecology from Peking Union Medical College Hospital from January 1995 to December 2004 were collected and their common symptoms, signs and complications of terminal disease (hereinafter referred to as dying Periodic manifestations include pain, cachexia, hydrothorax, dyspnea, fever, intestinal obstruction, renal failure, irreversible myelosuppression, pulmonary infection, bleeding, deep venous thrombosis of the lower extremities, gastrointestinal fistula, fungal infections, jaundice and The incidence of various emergency), the survival time after the occurrence and the coexistence of various aspects of the appearance of the law of death, common causes of death were analyzed. Results (1) Incidence of various hysterical manifestations: The incidence of pleural effusion and ascites was highest (63%) followed by pain (60%), cachexia (59%), dyspnea (49%). (2) Survival time after various kinds of hysterical appearance appeared: the longest one was fungal infection (77 d), followed by gastrointestinal fistula (75 d), intestinal obstruction (67 d), pain (60 d) Quality (60 d). The more dangerous clinical manifestations of irreversible myelosuppression, renal failure, dyspnea and various emergency, the median survival time was 14,13,12,7 d. (3) The law of coexistence of various hindsight: Most of the symptoms of adulthood were characterized by syndromes, and each patient had (4.9 ± 1.5) kinds of hysterical manifestations at the same time. At the same time, there were 84 cases (86%) of 4 kinds or above of appenic symptoms, which mostly manifested as natural slow course. The median survival time after anti-tumor therapy was 63 days. There were 3 kinds of apnea In 14 cases (14%), the median survival time was only 25 days, the difference was statistically significant (P <0.01). (4) The common cause of death in patients with ovarian cancer intestinal obstruction accounted for the first (30%), followed by infection (15%) and various acute (12%). Five patients died of complications (5%). Conclusions The characteristics of adulthood have its own characteristics and regularity. Awareness-raising helps to improve the management of the performance at the end of life, and improve the quality of life of the patients at the end of life.