复肺方辅助TP方案治疗中晚期非小细胞肺癌患者的临床疗效及对其血清肿瘤标志物、生活质量的影响

目的探讨复肺方辅助TP方案(紫杉醇+顺铂)在中晚期非小细胞肺癌(Non-small-cell lung cancer,NSCLC)中的治疗价值。方法选取2017年1月—2020年8月期间张家港市中医医院收治的中晚期NSCLC患者90例,采用随机数字表法分对照组和试验组,每组各45例。两组患者均给予TP化疗方案(完成4个化疗周期,历时12周),在此基础上,试验组自拟复肺方辅助治疗12周。治疗12周后,观察比较两组患者肿瘤疗效、中医证候疗效、治疗前后血清肿瘤标志物[细胞角蛋白19可溶性片段(Cytokeratin 19 soluble fragment,CYFRA21-1)、糖蛋白抗原125(Glycoprotein antigen 125,CA125)、癌胚抗原(Carcinoembryonic antigen,CEA)]水平及生活质量(European Organization for Research and Treatment of Cancer quality of life questionnaire core 30,EORTC QLQ-C30)评分变化、不良反应发生率,随访12个月,统计两组患者生存情况。结果(1)肿瘤疗效:治疗后试验组疾病控制率91.11%(41/45)高于对照组75.56%(34/45),差异有统计学意义(P<0.05);试验组治疗总有效率55.56%(25/45)高于对照组42.22%(19/45),差异有统计学意义(P<0.05);(2)证候疗效:治疗后试验组中医证候疗效总有效率88.89%(40/45)高于对照组57.78%(26/45),差异有统计学意义(P<0.05);(3)肿瘤标志物:治疗后两组患者肿瘤标志物均低于治疗前,差异有统计学意义(P<0.05);且试验组低于对照组,差异有统计学意义(P<0.05);(4)生活质量:治疗后两组患者总体健康状况领域、功能领域评分较治疗前升高,症状领域评分较治疗前降低,差异有统计学意义(P<0.05);且试验组总体健康状况领域、功能领域评分高于对照组,症状领域评分低于对照组,差异有统计学意义(P<0.05);(5)毒副作用:试验组血小板减少、白细胞减少、血清肌酐升高、丙氨酸氨基转移酶升高、便秘、口腔炎、周围神经异常发生率均低于对照组,差异有统计学意义(P<0.05);(6)生存情况:试验组中位生存时间较对照组长,且12个月生存率较对照组高,差异有统计学意义(P<0.05)。结论复肺方辅助TP方案治疗中晚期NSCLC效果明显,有利于提高疾病控制率,下调血清肿瘤标志物表达,改善患者生活质量,延长生命期限,且能够降低化疗不良反应发生率。

Evaluation of coma patients after cardiopulmonary resuscitation

Background Coma after cardiopulmonary resuscitation （CPR） is commonly seen in daily clinical practice. How to objectively evaluate brain function after CPR is essential to the following treatment. Coma patients after CPR had been studied prospectively at the Neuro-Intensive Care Unit of Xuanwu Hospital since 2002. In this study, we focused on the topic of how to evaluate the severity of coma after CPR . Methods From April 2002 to November 2004, patients in coma 24 hours after CPR were monitored, the evaluation methods included Glasgow coma score （GCS） , brain stem reflection, and spinal reflection. Laboratory evaluation included electroencephalography （EEG）, brainstem auditory evoked potential （BAEP）, short latency somatosensory evoked potential （SLSEP）, and transcranial Doppler （TCD） .Results Twenty-four of 35 patients（68.57% ）were in deep coma. The GCS was 3 except for 2 patients;EEG was evaluated not less than grade Ⅳ except for 4 patients, BAEP was evaluated as grade Ⅲ except for 3 patients, and SLSEP was evaluated as grade Ⅲ except for 1 patient. Twenty-four patients died within 1 month and 11 of them （ 45. 83% ） were determined as brain death. Glasgow outcome score （GOS） was evaluated as grade Ⅰ. Eleven of the 35 patients survived and their consciousness changed from deep coma to coma vigil. EEG was evaluated as grade Ⅰ in 5 patients, BAEP and SLSEP were evaluated as grade Ⅰ in 3 patients, and GOS was all evaluated as grade Ⅱ among the 11 patients. Two patients（ 18.18% ）regained consciousness in 35 and 90 days after cardiopulmonary resuscitation and GOS was evaluated as grade Ⅳ and Ⅲ, respectively. Conclusion objectively Combined or continuous evaluation of clinical examinations and laboratory tests can accurately determine brain function after CPR.