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行而影響治療效果，而且可能導致并發(fā)癥而危及患者生命。 一些惡性腫瘤患者或許不會很快死于疾病本身，卻可能由于骨髓抑制致命。因此，及時發(fā)現(xiàn)骨髓抑制并給予相應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分度標準（表1）。 以前對紅系抑制的關(guān)注較少，原因在于貧血的處理相對簡單而且見效迅速，輸血或輸入濃縮紅細胞均可。但實際上貧血不僅使患者的組織乏氧導致一般狀況差，而且還可能降低放療或化療的效果。 對粒系抑制而言，中性粒細胞絕對值比白細胞總數(shù)更為重要。注意兩個關(guān)鍵節(jié)點：一是中性粒細胞絕對值低于1×109/L，二是血小板計數(shù)低于50×109/L 。它們分別是3度粒細胞減少和3度血小板減少的臨界點，是容易出現(xiàn)并發(fā)癥的信號，也是需要給予干預的指征。 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 一般來說，血常規(guī)檢查是用來衡量血液變化的化驗項目，它能反映出身體是否受到了感染，而且還能夠簡單判斷感染的是病毒還是細菌。另外，它還可以反映人體的營養(yǎng)狀況，如有沒有貧血等。下面就介紹血常規(guī)化驗單中關(guān)鍵的幾項。 白細胞 參考范圍：（4～10）×10`9/L 白細胞增高常見于各種細菌感染、炎癥、急性失血、急慢性傳染病。明顯增高時應去醫(yī)院排除白血病。 白細胞減少可見于病毒感染如流行性感冒、麻疹、病毒性肺炎等；某些細菌性感染如傷寒；放射性物質(zhì)及化學療法的影響；營養(yǎng)不良，機體失去防御能力時；血液病變，如營養(yǎng)性巨幼紅細胞性貧血、再生障礙性貧血、脾功能亢進、白細胞減少癥等。 紅細胞 參考范圍：（3.50~5.50）×10`12/L 紅細胞增高見于真性紅細胞增多癥、繼發(fā)性紅細胞增多癥（如脫水、燒傷、肺心病、高原氣候）。 紅細胞減少見于各種貧血。 血紅蛋白 參考范圍：110~160g/L 血紅蛋白生理性升高常見于高原居民、劇烈運動、大量出汗、恐懼等情況；病理性升高常見于大面積燒傷、嚴重腹瀉、慢性腎上腺皮質(zhì)功能減退、甲狀腺功能亢進、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 美國心理學家伊麗莎白?庫伯勒-羅絲在她1969年出版的“論死亡與臨終”（On Death and Dying）一書中提出的“哀傷的五個階段”（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. 哀傷是一種復雜且難以被理解的情感。 而且，不幸的是，我們都會經(jīng)歷它。我們也必將經(jīng)驗失落。無論這個失落，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。如果我們在其中的某個階段被困住，哀傷的過程沒有完成，而且不完整。因此，也就沒有療愈。為了恢復和治愈，一個人必須經(jīng)歷這個5個哀傷的階段。每個人經(jīng)歷的階段也是不同步的。每個人都是不同的。你無法強迫一個人去度過某一個階段，人們只能按照他們自己的腳步來，而且有時候你甚至會進一步退兩步，但這都是過程的組成部分，同時對每個人都是個性化的。但是，要強調(diào)的是，只有這五個階段都被完成時，療愈才會發(fā)生。 The five stages of grief are: 這五個階段是： 1 Denial 否認 "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，或者如果面對死亡，依然留著那個人的位子，或者假裝他們還住在那。沒有哭泣。沒有接受甚至意識到失去。 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”感覺到想去反擊，或者報復離婚的前任。如果是死亡，會對死者感到憤怒，指責他們的離去。 3 Bargaining 討價還價 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. 討價還價經(jīng)常發(fā)生在失去之前。想要與要離開的那一方做交易，或者想要去與神討價還價，去改變失落的內(nèi)容。乞討、許愿、祈禱他們回來。 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. 強烈的無助、沮喪、痛苦、自我憐憫，對人的哀悼，壓倒了一切希望、夢想和未來的計劃。 覺得失控，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。你必須接受這個失落，而不是去默默的忍耐它。意識到婚姻的結(jié)合和分離都是兩個人的事。意識到那個人的離開（也許是死亡）并不是他們的錯，他們并不是蓄意離開你。（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。我們的目標是轉(zhuǎn)到自我成長。和那個人帶給你的美好回憶一起。 獲取幫助，你會活下去。你會被療愈，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，但是我們并沒有停止生活，我們必須變得更堅強，同時保持我們對于內(nèi)心對于某天被治愈的，重新找到愛和幸福的希望。通過幫助他人我們也能體會到一個很好地療愈自己體驗，并且從悲傷中帶出了好處。