【求助】静脉炎在镜下如何分级？

吉*

我的课题是有关化疗性静脉炎的，需对静脉炎的严重程度进行分级，以统计疗效。可目前国内这方面文献分级都是通过观察有无疼痛、红肿、硬结等，主观因素太多。我查到一些国外文献，知道国外对静脉炎有病理分级，但却查不到具体如何分，希望各位病理高手能帮帮我。
最好有详细分级方法及出处！万分感谢！！！

[ 本帖最后由 pathology 于 2006-8-1 11:42 编辑 ]

吉*

主要是观察浅表静脉。
Pathological classification of phlebitis
chemotherapy--induced phlebitis化疗性静脉炎
因为做动物试验，临床的疼痛就很难观察且分级不够细。我用药物进行保护，单观察临床症状似乎不够客观，所以需要病理分级。
现将我查到的国外临床静脉炎分级附上：
The degree of phlebitis shall be measured according to a uniform scale and shall be documented in the nursing record. A phlebitis scale provides a uniform standard for measuring degrees of phlebitis. The presence of pain does not constitute phlebitis. However, pain must always be evaluated to determine appropriate intervention. Pain around the cannula is usually a precursor to phlebitis that requires cannula removal and documentation in the nursing record. A phlebitis scale should be established in organisational policy and procedure. Pearson (1996) recommends the following Phlebitis Rating Scale:
Phlebitis Scale/Desc**tion
0 = No clinical symptoms
1+ = Erythema with or without pain; oedema may or may not be present; no streak formation; no palpable cord
2+ = Erythema with or without pain; oedema may or may not be present; streak formation; no palpable cord
3+ = Erythema with or without pain; oedema may or may not be present; streak formation; palpable cord

[ Last edited by 吉春 on 2005-6-7 at 08:26 PM ]

吉*

上面的确是国外护理人员使用的临床分级the INS phlebitis scale。

我要对比临床常用的保护方法（如激素或肝素的应用）同新方法的差异，需要客观的指标，才有说服性。
我在google上查到：
Journal of Clinical Oncology, Vol 12, 2094-2101, Copyright © 1994 by American Society of Clinical Oncology


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ARTICLES


Vinorelbine is an active antiproliferative agent in pretreated advanced breast cancer patients: a phase II study
G Gasparini, O Caffo, S Barni, L Frontini, A Testolin, RB Guglielmi and G Ambrosini
Department of Radiotherapy and Oncology, St Bortolo Medical Center, Vicenza, Italy.

PURPOSE: To evaluate the efficacy and toxicity of single-agent vinorelbine (VNB), a semisynthetic vinca alkaloid, in patients with breast cancer previously treated with other chemotherapeutic regimens for metastatic disease. PATIENTS AND METHODS: Sixty-seven of 70 patients with assessable disease entered onto the study were assessable. The main characteristics were as follows: median age, 60 years (range, 41 to 77); median performance status (PS; Karnofsky score), 90 (range, 60 to 100); and number of previous chemotherapeutic regimens given--one in 17, two in 27, three in eight, four in two, and five in one patient. The dominant sites of metastasis were viscera in 40, bone in 16, and soft tissues in 11 patients. VNB was administered beginning with the dose of 20 mg/m2 by 60-minute intravenous (iv) infusion weekly, with a dose escalation up to 25 mg/m2 if the first four courses were well tolerated. The treatment was continued until disease progression. RESULTS: Overall, 845 courses of VNB were given (median, 10; range, eight to 33). Objective responses were as follows: complete response (CR) in three (4.5%), partial response (PR) in 21 (31.2%), stable disease (SD) in 20 (30%), and progressive disease (PD) in 23 patients (34.3%). Twenty-four of 67 assessable patients obtained a major objective response (CR or PR, 36%; 95% confidence interval [Cl], 24% to 47%). Thirty-three percent of patients had a > or = 33% reduction of dose-intensity (DI). The median time to progression was 18 weeks. The drug was active in patients pretreated with either cyclophosphamide, methotrexate, and fluorouracil (CMF) or anthracyclines. The most relevant toxicity observed was myelosuppression: 17 (25%) and 19 patients (28%) had World Health Organization grade III, and six (9%) and six patients (9%) had grade IV leukopenia and granulocytopenia, respectively; two (3%) and two patients (3%) had grade III and IV anemia, respectively. Nonhematologic toxicities were phlebitis (grade II or III in 15 patients), alopecia (grade I or II in 16), nausea and vomiting (grade II or III in 15), diarrhea (grade II in two), constipation (grade II or III in 16), stomatitis (grade II or III in 13), pe**heral neuropathy (grade II in seven), and asthenia (grade II in five). CONCLUSION: This study shows that VNB is an effective and well-tolerated agent in pretreated patients with advanced breast cancer. This drug does not seem to present cross-resistance with previous CMF or anthracycline regimens. Future clinical trials should be designed to prove whether the inclusion of VNB in combination chemotherapy regimens, or whether an enhancement of its dose-intensity using bone marrow growth factors, is able to improve further the efficacy of this drug in breast carcinoma.
还有
Supportive Care in Cancer
Publisher: Springer-Verlag GmbH
ISSN: 0941-4355 (Paper) 1433-7339 (Online)
DOI: 10.1007/s005200000190
Issue:  Volume 9, Number 2

Date:  March 2001
Pages: 108 - 111  
Prevention of vinorelbine phlebitis with cimetidine
A two-step design study


M. Vassilomanolakis, G. Koumakis, V. Barbounis, G. Orphanos, A. Efremidis

A1 2nd Department of Medical Oncology, "St Savas", Oncology Hospital Athens, Greece
A2 2nd Medical Oncology Department, "St Savas" Anticancer Hospital, 171 Alexandras Ave., Athens 115-22, Greece


Abstract:


Abstract. One hundred eighteen patients with various malignancies received a total of 847 vinorelbine (VNR) infusions, during 25 of which episodes of vinorelbine phlebitis occurred (1 in each of the 25 patients concerned). Venous irritation was graded with reference to the scale devised by Rittenberg et al. To prevent these 25 patients against further venous toxicity, we pretreated them with cimetidine 200 mg i.v. prior to VNR administration in subsequent cycles of chemotherapy. In most (19, or 76%) complete prevention of recurrent phlebitis was observed, while partial prevention was observed in 5 patients (20%). Treatment was unsuccessful in 1 patient. In 127 VNR infusions given after cimetidine prophylaxis only 7 (6%) episodes of phlebitis occurred. These data show that i.v. administration of cimetidine prior to vinorelbine infusion can successfully prevent recurrence of phlebitis in patients who have shown venous irritation upon prior VNR treatment, at a rate of 94%.


Keywords:

Cimetidine, Phlebitis, Vinorelbine

The references of this article are secured to subscribers.

但找不到原文
不知是不是病理分级？

[ Last edited by 吉春 on 2005-6-8 at 10:59 AM ]

p****y

Originally posted by 吉春 at 2005-6-8 08:45 AM:
Abstract. One hundred eighteen patients with various malignancies received a total of 847 vinorelbine (VNR) infusions, during 25 of which episodes of vinorelbine phlebitis occurred (1 in each of the 25 patients concerned). Venous irritation was graded with reference to the scale devised by Rittenberg et al.
但找不到原文
不知是不是病理分级？

很遗憾，这个不是病理分级，是临床的。
下面是截图和pdf文件，全文你自己好好看看吧～
此附件已经损坏等待作者修复

p****y

不知道 吉春 战友 对我的答复是否满意。
如果还有什么不明白的话，请提出来，大家都可以学习一下。
我觉得静脉炎这个在病理上实在没有分级的必要，只是临床上需要，所以使用的也是临床的指标了。不知道你认为呢？



感谢你热心而耐心地帮助其他会员解决问题!故给予加分奖励,希望其他会员也能互相帮助,互相学习!
                                                                                  shan.lee

[ Last edited by shan.lee on 2005-6-9 at 02:48 PM ]

吉*

既然没有病理分级，我想临床分级应该足够了。
谢谢你的耐心帮助。

这两天查资料，我体会我对文献检索方法掌握的还不够，很多外文文献很有用，但只查到摘要（全文要附费或注册），就只能一知半解。

要是斑竹们能抽时间介绍一下获得外文原文的方法就好了，这样很多问题自己可以去寻找答案，斑竹们也不至于太辛苦

真的非常感谢你！