血液科

化疗是恶性肿瘤的主要治疗方法之一，骨髓抑制是其主要的副作用。骨髓抑制不仅延缓化疗的进行而影响治疗效果，而且可能导致并发症而危及患者生命。 一些恶性肿瘤患者或许不会很快死于疾病本身，却可能由于骨髓抑制致命。因此，及时发现骨髓抑制并给予相应处理是化疗的重要环节。 一、化疗后骨髓抑制的分度、一般规律及其意义: 目前化疗后骨髓抑制的分度采用的是世界卫生组织抗癌药物急性及亚急性毒性反应分度标准（表1）。 以前对红系抑制的关注较少，原因在于贫血的处理相对简单而且见效迅速，输血或输入浓缩红细胞均可。但实际上贫血不仅使患者的组织乏氧导致一般状况差，而且还可能降低放疗或化疗的效果。 对粒系抑制而言，中性粒细胞绝对值比白细胞总数更为重要。注意两个关键节点：一是中性粒细胞绝对值低于1×109/L，二是血小板计数低于50×109/L 。它们分别是3度粒细胞减少和3度血小板减少的临界点，是容易出现并发症的信号，也是需要给予干预的指征。 表1 化疗后骨髓抑制的分度 0 1 2 3 4 血红蛋白(g/L) ≥ 110 109-95 94-80 79-65

血常规检查 一般来说，血常规检查是用来衡量血液变化的化验项目，它能反映出身体是否受到了感染，而且还能够简单判断感染的是病毒还是细菌。另外，它还可以反映人体的营养状况，如有没有贫血等。下面就介绍血常规化验单中关键的几项。 白细胞 参考范围：（4～10）×10`9/L 白细胞增高常见于各种细菌感染、炎症、急性失血、急慢性传染病。明显增高时应去医院排除白血病。 白细胞减少可见于病毒感染如流行性感冒、麻疹、病毒性肺炎等；某些细菌性感染如伤寒；放射性物质及化学疗法的影响；营养不良，机体失去防御能力时；血液病变，如营养性巨幼红细胞性贫血、再生障碍性贫血、脾功能亢进、白细胞减少症等。 红细胞 参考范围：（3.50~5.50）×10`12/L 红细胞增高见于真性红细胞增多症、继发性红细胞增多症（如脱水、烧伤、肺心病、高原气候）。 红细胞减少见于各种贫血。 血红蛋白 参考范围：110~160g/L 血红蛋白生理性升高常见于高原居民、剧烈运动、大量出汗、恐惧等情况；病理性升高常见于大面积烧伤、严重腹泻、慢性肾上腺皮质功能减退、甲状腺功能亢进、心肺疾病、血管畸形等疾病。 一般成年男性血红蛋白

By Kubler-Ross 翻译 刘晶 美国心理学家伊丽莎白?库伯勒-罗丝在她1969年出版的“论死亡与临终”（On Death and Dying）一书中提出的“哀伤的五个阶段”（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. 哀伤是一种复杂且难以被理解的情感。 而且，不幸的是，我们都会经历它。我们也必将经验失落。无论这个失落，是经由死亡、离婚或者其他的失落，哀伤的阶段都是相同的。 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. 哀伤的阶段一共有5个。如果我们在其中的某个阶段被困住，哀伤的过程没有完成，而且不完整。因此，也就没有疗愈。为了恢复和治愈，一个人必须经历这个5个哀伤的阶段。每个人经历的阶段也是不同步的。每个人都是不同的。你无法强迫一个人去度过某一个阶段，人们只能按照他们自己的脚步来，而且有时候你甚至会进一步退两步，但这都是过程的组成部分，同时对每个人都是个性化的。但是，要强调的是，只有这五个阶段都被完成时，疗愈才会发生。 The five stages of grief are: 这五个阶段是： 1 Denial 否认 "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. “这不会发生在我身上”，在熟悉的地方寻找自己的前任，或者如果面对死亡，依然留着那个人的位子，或者假装他们还住在那。没有哭泣。没有接受甚至意识到失去。 2 Anger 愤怒 "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. “为什么是我”感觉到想去反击，或者报复离婚的前任。如果是死亡，会对死者感到愤怒，指责他们的离去。 3 Bargaining 讨价还价 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. 讨价还价经常发生在失去之前。想要与要离开的那一方做交易，或者想要去与神讨价还价，去改变失落的内容。乞讨、许愿、祈祷他们回来。 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. 强烈的无助、沮丧、痛苦、自我怜悯，对人的哀悼，压倒了一切希望、梦想和未来的计划。 觉得失控，麻木，甚至感到想自杀。 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. 妥协和接受之间是有区别的。你必须接受这个失落，而不是去默默的忍耐它。意识到婚姻的结合和分离都是两个人的事。意识到那个人的离开（也许是死亡）并不是他们的错，他们并不是蓄意离开你。（即使是自杀的情形）寻找失落带给你的痛苦的好的地方，寻找安慰和疗愈。我们的目标是转到自我成长。和那个人带给你的美好回忆一起。 获取帮助，你会活下去。你会被疗愈，即使你现在不相信，只要知道它是真的就好了。在失去之后感到痛苦是正常的。这证明我们的活着，但是我们并没有停止生活，我们必须变得更坚强，同时保持我们对于内心对于某天被治愈的，重新找到爱和幸福的希望。通过帮助他人我们也能体会到一个很好地疗愈自己体验，并且从悲伤中带出了好处。