血液科

化療是惡性腫瘤的主要治療方法之一，骨髓抑制是其主要的副作用。骨髓抑制不僅延緩化療的進(jìn)行而影響治療效果，而且可能導(dǎo)致并發(fā)癥而危及患者生命。 一些惡性腫瘤患者或許不會(huì)很快死于疾病本身，卻可能由于骨髓抑制致命。因此，及時(shí)發(fā)現(xiàn)骨髓抑制并給予相應(yīng)處理是化療的重要環(huán)節(jié)。 一、化療后骨髓抑制的分度、一般規(guī)律及其意義: 目前化療后骨髓抑制的分度采用的是世界衛(wèi)生組織抗癌藥物急性及亞急性毒性反應(yīng)分度標(biāo)準(zhǔn)（表1）。 以前對(duì)紅系抑制的關(guān)注較少，原因在于貧血的處理相對(duì)簡(jiǎn)單而且見(jiàn)效迅速，輸血或輸入濃縮紅細(xì)胞均可。但實(shí)際上貧血不僅使患者的組織乏氧導(dǎo)致一般狀況差，而且還可能降低放療或化療的效果。 對(duì)粒系抑制而言，中性粒細(xì)胞絕對(duì)值比白細(xì)胞總數(shù)更為重要。注意兩個(gè)關(guān)鍵節(jié)點(diǎn)：一是中性粒細(xì)胞絕對(duì)值低于1×109/L，二是血小板計(jì)數(shù)低于50×109/L 。它們分別是3度粒細(xì)胞減少和3度血小板減少的臨界點(diǎn)，是容易出現(xiàn)并發(fā)癥的信號(hào)，也是需要給予干預(yù)的指征。 表1 化療后骨髓抑制的分度 0 1 2 3 4 血紅蛋白(g/L) ≥ 110 109-95 94-80 79-65

血常規(guī)檢查 一般來(lái)說(shuō)，血常規(guī)檢查是用來(lái)衡量血液變化的化驗(yàn)項(xiàng)目，它能反映出身體是否受到了感染，而且還能夠簡(jiǎn)單判斷感染的是病毒還是細(xì)菌。另外，它還可以反映人體的營(yíng)養(yǎng)狀況，如有沒(méi)有貧血等。下面就介紹血常規(guī)化驗(yàn)單中關(guān)鍵的幾項(xiàng)。 白細(xì)胞 參考范圍：（4～10）×10`9/L 白細(xì)胞增高常見(jiàn)于各種細(xì)菌感染、炎癥、急性失血、急慢性傳染病。明顯增高時(shí)應(yīng)去醫(yī)院排除白血病。 白細(xì)胞減少可見(jiàn)于病毒感染如流行性感冒、麻疹、病毒性肺炎等；某些細(xì)菌性感染如傷寒；放射性物質(zhì)及化學(xué)療法的影響；營(yíng)養(yǎng)不良，機(jī)體失去防御能力時(shí)；血液病變，如營(yíng)養(yǎng)性巨幼紅細(xì)胞性貧血、再生障礙性貧血、脾功能亢進(jìn)、白細(xì)胞減少癥等。 紅細(xì)胞 參考范圍：（3.50~5.50）×10`12/L 紅細(xì)胞增高見(jiàn)于真性紅細(xì)胞增多癥、繼發(fā)性紅細(xì)胞增多癥（如脫水、燒傷、肺心病、高原氣候）。 紅細(xì)胞減少見(jiàn)于各種貧血。 血紅蛋白 參考范圍：110~160g/L 血紅蛋白生理性升高常見(jiàn)于高原居民、劇烈運(yùn)動(dòng)、大量出汗、恐懼等情況；病理性升高常見(jiàn)于大面積燒傷、嚴(yán)重腹瀉、慢性腎上腺皮質(zhì)功能減退、甲狀腺功能亢進(jìn)、心肺疾病、血管畸形等疾病。 一般成年男性血紅蛋白

By Kubler-Ross 翻譯 劉晶 美國(guó)心理學(xué)家伊麗莎白?庫(kù)伯勒-羅絲在她1969年出版的“論死亡與臨終”（On Death and Dying）一書(shū)中提出的“哀傷的五個(gè)階段”（Five Stages of Grief）。 Grief is a somewhat complicated and misunderstood emotion. Yet, grief is something that, unfortunately, we must all experience at some time or other. We will all inevitably experience loss. Whether it is a loss through death, divorce or some other loss, the stages of grieving are the same. 哀傷是一種復(fù)雜且難以被理解的情感。 而且，不幸的是，我們都會(huì)經(jīng)歷它。我們也必將經(jīng)驗(yàn)失落。無(wú)論這個(gè)失落，是經(jīng)由死亡、離婚或者其他的失落，哀傷的階段都是相同的。 There are five stages of grief. If we get stuck in one stage or the other, the process of grieving is not complete, and cannot be complete. Thus there will be no healing. A person MUST go through the five stages to be well again, to heal. Not everyone goes through the stages at the same time. It is different for each person. You cannot force a person through the stages, they have to go at their own pace, and you may go one step forward then take two steps backward, but this is all part of the process, and individual to each person. But, as stressed, ALL five stages must be completed for healing to occur. 哀傷的階段一共有5個(gè)。如果我們?cè)谄渲械哪硞€(gè)階段被困住，哀傷的過(guò)程沒(méi)有完成，而且不完整。因此，也就沒(méi)有療愈。為了恢復(fù)和治愈，一個(gè)人必須經(jīng)歷這個(gè)5個(gè)哀傷的階段。每個(gè)人經(jīng)歷的階段也是不同步的。每個(gè)人都是不同的。你無(wú)法強(qiáng)迫一個(gè)人去度過(guò)某一個(gè)階段，人們只能按照他們自己的腳步來(lái)，而且有時(shí)候你甚至?xí)M(jìn)一步退兩步，但這都是過(guò)程的組成部分，同時(shí)對(duì)每個(gè)人都是個(gè)性化的。但是，要強(qiáng)調(diào)的是，只有這五個(gè)階段都被完成時(shí)，療愈才會(huì)發(fā)生。 The five stages of grief are: 這五個(gè)階段是： 1 Denial 否認(rèn) "This can't be happening to me", looking for the former spouse in familiar places, or if it is death, setting the table for the person or acting as if they are still in living there. No crying. Not accepting or even acknowledging the loss. “這不會(huì)發(fā)生在我身上”，在熟悉的地方尋找自己的前任，或者如果面對(duì)死亡，依然留著那個(gè)人的位子，或者假裝他們還住在那。沒(méi)有哭泣。沒(méi)有接受甚至意識(shí)到失去。 2 Anger 憤怒 "Why me?", feelings of wanting to fight back or get even with spouse of divorce, for death, anger at the deceased, blaming them for leaving. “為什么是我”感覺(jué)到想去反擊，或者報(bào)復(fù)離婚的前任。如果是死亡，會(huì)對(duì)死者感到憤怒，指責(zé)他們的離去。 3 Bargaining 討價(jià)還價(jià) Bargaining often takes place before the loss. Attempting to make deals with the spouse who is leaving, or attempting to make deals with God to stop or change the loss. Begging, wishing, praying for them to come back. 討價(jià)還價(jià)經(jīng)常發(fā)生在失去之前。想要與要離開(kāi)的那一方做交易，或者想要去與神討價(jià)還價(jià)，去改變失落的內(nèi)容。乞討、許愿、祈禱他們回來(lái)。 4 Depression 消沉 Overwhelming feelings of hopelessness, frustration, bitterness, self pity, mourning loss of person as well as the hopes, dreams and plans for the future. Feeling lack of control, feeling numb. Perhaps feeling suicidal. 強(qiáng)烈的無(wú)助、沮喪、痛苦、自我憐憫，對(duì)人的哀悼，壓倒了一切希望、夢(mèng)想和未來(lái)的計(jì)劃。 覺(jué)得失控，麻木，甚至感到想自殺。 5 Acceptance 接受 There is a difference between resignation and acceptance. You have to accept the loss, not just try to bear it quietly. Realized it takes two to make or break a marriage. Realized that the person is gone (in death) that it is not their fault, they didn't leave you on purpose. (even in cases of suicide, often the deceased person, was not in their right frame of mind) Finding the good that can come out of the pain of loss, finding comfort and healing. Our goals turn toward personal growth. Stay with fond memories of person. Get help. You will survive. You will heal, even if you cannot believe that now, just know that it is true. To feel pain after loss is normal. It proves that we are alive, human. But we can't stop living. We have to become stronger, while not shutting off our feelings for the hope of one day being healed and finding love and/or happiness again. Helping others through something we have experienced is a wonderful way to facilitate our healing and bring good out of something tragic. 妥協(xié)和接受之間是有區(qū)別的。你必須接受這個(gè)失落，而不是去默默的忍耐它。意識(shí)到婚姻的結(jié)合和分離都是兩個(gè)人的事。意識(shí)到那個(gè)人的離開(kāi)（也許是死亡）并不是他們的錯(cuò)，他們并不是蓄意離開(kāi)你。（即使是自殺的情形）尋找失落帶給你的痛苦的好的地方，尋找安慰和療愈。我們的目標(biāo)是轉(zhuǎn)到自我成長(zhǎng)。和那個(gè)人帶給你的美好回憶一起。 獲取幫助，你會(huì)活下去。你會(huì)被療愈，即使你現(xiàn)在不相信，只要知道它是真的就好了。在失去之后感到痛苦是正常的。這證明我們的活著，但是我們并沒(méi)有停止生活，我們必須變得更堅(jiān)強(qiáng)，同時(shí)保持我們對(duì)于內(nèi)心對(duì)于某天被治愈的，重新找到愛(ài)和幸福的希望。通過(guò)幫助他人我們也能體會(huì)到一個(gè)很好地療愈自己體驗(yàn)，并且從悲傷中帶出了好處。