化疗前内科检查血指标和生化指标的原因与重要性

第一节  化疗前一周医生给患者做血常规检查,检查的主要项目是白细胞、红细胞和血小板,这三个指标严重不合格化疗医生会停止化疗。

白细胞、红细胞、和血小板数值正常是患者身体耐受化疗的重要依据,医生每次化疗前都要检查患者的指标是否合格,指标严重不合格将停止化疗至患者休息调养合格之后恢复化疗,患者和家属一定要每次注意这三个指标是否将接近正常数字底限,提早做好补血补气的食疗调养工作。

白细胞:人体防御的免疫卫士

白细胞是人体重要的免疫细胞,对人体具有保护和防御功能。白细胞的正常参考值(4.0-10.0)×10^9个/L。

白细胞根据形态可以分为中性粒细胞、淋巴细胞、单核细胞、嗜酸性粒细胞和嗜碱性粒细胞。

中性粒细胞

在白细胞中所占百分率最高,达到(50%——70%),它能够吞噬和杀死细菌,防止细菌和有害物质侵入机体,是影响白细胞总数的关键。

淋巴细胞

与免疫有关,它是机体保护自己不受病原体侵袭的主要细胞,主要是通过体液免疫和细胞免疫来发挥作用的。

单核细胞

具有很强的吞噬功能,能够从血液中清除死亡和不健康的细胞、废物和碎片以及杀死入侵的细菌。

白细胞低于正常值人体的免疫力会严重下降,会导致一系列免疫性疾病,并发症增多。营养不良的肿瘤患者免疫力降低,术后发生肺不张、伤口感染、菌血症、肺水肿、尿道感染及脓毒症等并发症的发生率明显增加。

病理性增多

常见于急性感染、白细胞超标一般是患者体内有急性炎症,导致白细胞动员还没有成熟的白细胞童子军出来战斗,血常规发现白细胞计数超标的患者要检查身体哪里有炎症。

红细胞:诊断贫血的一个标准

血红蛋白是红细胞的主要成分,负责氧气的输送。

它将氧气输送到各个组织,再将组织中的二氧化碳输送到肺脏后呼出体外,血液的颜色是红色的,也与血红蛋白有关,故俗称为“血色素”。

血红蛋白的正常参考值是:

男性120–160g/L,女性110–150g/L,临床上常用血红蛋白的指标作为贫血的一个诊断标准。

常见的贫血包括缺铁性贫血、维生素B12叶酸缺乏的营养性贫血、再生障碍性贫血以及溶血性贫血等。

不同的贫血有不同的治疗方法,而肠癌患者多数因为肠道肿瘤表面溃烂长期出血,导致肠癌患者普遍都有贫血的现象,因此,补气补血是患者确诊后至五年康复期内,一直要不懈努力的一项最有意义的调理工作。

血小板:人体的修补工

血小板的主要功能是止血和凝血、修补破损血管。血小板的正常参考值(100-300)×10^9/L。

血小板若低于正常值:必须加以重视,因为它可能提示很多疾病,如免疫性血小板减少症、脾功能亢进、再生障碍性贫血、急性白血病等。

但是,肠癌患者的血小板降低主要是放化疗的骨髓遏制,通常调理的方法是服用五红汤,和红花生皮加枸杞煮水喝!

医生对指标偏离正常值的解读

医生会根据病人的性别、年龄、临床的症状以及体征等因素,结合其他指标进行分析和诊断。

一般白细胞、红细胞、血小板其中有任何一个指标低于化疗标准时,专业医院的医生会停止化疗,让患者休息调养到血指标恢复之后再恢复化疗,而地级市不专业的化疗医生,经常会在患者的血指标都严重不合格了,还不顾患者的风险继续化疗,这对患者身体的破坏远远多于化疗的受益,患者和家属术后每次查血常规都要自己学会粗看血常规的几个重要数值,一般看白细胞计数、红细胞计数、和血小板计数是否接近、低于正常值下限就大差不差了,对这三个指标接近正常值下限时要通过食疗,把血指标提上去,起码要维持住指标不下降,下降也要阻止它急速下降。

什么情况下应该到血液科检查

1.面色苍白、头昏、乏力、心悸,皮肤黏膜淤斑淤点、黄染等。

2.血液检查白细胞、红细胞、血红蛋白和血小板异常增高或降低。

3.颌下、颈部、腋下、腹股沟淋巴结肿大,肝脾肿大等。

4.其他如不明原因的发热,或不思饮食,日渐消瘦等。

第二节  化疗前看生化指标报告,判断患者肝功能是否符合化疗的简易方法

肝脏的肝功能是患者化疗时,帮助人体把化疗药的毒性排出体外的主力器官之一,肝脏和肾脏在化疗期间同心协力把化疗药的毒性维持在身体能够耐受的水平,肝肾功能不合格继续化疗,患者身体的化疗药毒性将会在体内积聚,伤害患者的身体。所以肝肾功能不合格是医生暂停化疗的因素之一。患者和家属要粗略看懂生化报告的肝肾功能指标,适时的调理好肝肾功能,配合医生完成全部化疗疗程。

肝功能检查是通过各种生化实验方法监测与肝脏功能代谢有关的各项指标,以反映肝脏的功能基本状况。肝功能化验单是对肝功能化验结果的显示,医生通过对肝功能化验单的查看,可以很好的判断出一个人肝功能的情况,如果出现病变的话,医生可以根据患者的检查结果得出相应的结论。以此作为参考的依据。对于不同的医院来说,其肝功能化验单的所显示的结果的参考值可能会存在着差别,这是由不同的检测仪器基线决定的。

在肝功能的化验单中显示了包括对转氨酶,像谷丙转氨酶、谷草转氨酶,白蛋白,球蛋白,白球比值,胆红素,胆汁酸等多项检查结果的显示。每一项检查结果显示的内容所代表的意思不尽相同,通过对肝功能化验单所显示的分析,再和参考值结果对比分析,可以判断出一个人的肝脏是否出现了问题,或者是问题的严重程度,不过很多人看不懂肝功能化验单,因此说学会看肝功能化验单很重要。

一般患者和家属看化疗前的生化报告,看肝功能是否健全、是否符合化疗条件一般看几个转氨酶指标,要是那次生化报告发现有1-2个转氨酶指标超标了,就要提醒医生开相应的护肝药调理肝功能问题,一般医生开护肝药患者调理之后不影响下次的化疗,而要是本次化疗前有1-2个转氨酶指标超标,医生没有开护肝药给患者吃的话,下次指标就会急速上升,而导致肝功能不合格被化疗医生停止化疗,就是化疗医生勉强同意化疗,化疗对患者的肝功能损害将非常大。

第三节  化疗前医生看生化报告指标,判断患者肾功能是否符合化疗的简易方法

肾脏是人体最重要的器官之一,也是患者化疗时代谢化疗药毒性排出体外的主力器官,其功能主要是分泌和排泄尿液、废物、毒物和药物;调节和维持体液容量和成分(水分和渗透压、电解质、酸碱度);维持机体内环境(血压、内分泌)的平衡。每日经肾小球滤过的血浆大约有180L。

变态反应、感染、肾血管病变、代谢异常、先天性疾病、全身循环和代谢性疾病、药物、毒素对肾脏的损害,均可影响肾功能,主要表现为肾功能检查指标的异常,在临床诊断和治疗上具有重要的意义。

临床意义

临床常用于检查肾功能的指标是血清尿素、血肌酐、血β2-微球蛋白、尿酸等。

  1. 血清尿素(BUN)

血清尿素正常值(速率法)

成人:3.2~7.1μmol/L

婴儿、儿童:1.8~6.5mmol/L

血清尿素是人体蛋白质的代谢产物,主要是经肾小球滤过而随尿液排出体外,当肾实质受损害时,肾小球滤过率降低,致使血液中血清尿素浓度增加,因此通过测定尿素,可了解肾小球的滤过功能。

1.血清尿素增高

(1)肾脏疾病慢性肾炎、严重的肾盂肾炎等。肾功能轻度受损时,尿素检测值可无变化。当此值高于正常时,说明有效肾单位的超过50%已受损害。因此,尿素测定不能作为肾病早期肾功能的测定指标,但对肾衰竭,尤其是氮质血症的诊断有特殊的价值。

(2)泌尿系统疾病泌尿道结石、肿瘤、前列腺增生、前列腺疾病使尿路梗阻等引起尿量显著减少或尿闭时,也可造成血清尿素增高。

(3)其他高蛋白饮食、脱水、蛋白质分解代谢增高、腹水、水肿、胆道手术后、上消化道出血、妊娠后期妇女、磷、砷等化学中毒等,心输出量减少或继发于失血或其他原因所致的肾脏灌注下降均会引起BUN升高。

2.血清尿素降低

见于中毒性肝炎、急性肝萎缩、类脂质肾病等。

  1. 血肌酐 正常值

血肌酐(Taffe法)

男性:62~115μmol/L

女性:53~97μmol/L

血清肌酐浓度可在一定程度上准确反映肾小球滤过功能的损害程度。肾功能正常时,肌酐排出率恒定,当肾实质受到损害时,肾小球的滤过率就会降低。当滤过率降低到一定程度后,血肌酐浓度就会急剧上升。

1.增高

血肌酐增高主要见于急、慢性肾小球肾炎等肾脏疾病。早期或轻度肾功能损害时,由于肾的储备力和代偿力很强,血肌酐浓度可以表现为正常,当肾小球滤过功能下降到30%~50%时,血肌酐数值才明显上升。在正常肾血流条件下,血肌酐176~355μmol/L时,提示有中度至严重肾损害。血肌酐和尿素如同时增高,提示肾功能损害很严重。

2.降低

见于进行性肌肉萎缩、白血病、贫血、肝功能障碍及妊娠。

  1. 血β2-微球蛋白

血β2-微球蛋白正常值(检测方法不同,参考值不同)

血清:2.14~4.06mg/L

血β2-微球蛋白是由淋巴细胞、血小板、多形核白细胞产生的一种小分子蛋白,其绝大部分在近端肾小管吸收。增高见于:

1.肾功能减退

如各种急性或慢性肾炎、肾衰竭、糖尿病肾病、肾肿瘤、肾移植排斥反应等。在评估肾小球滤过功能方面,比血肌酐更灵敏。

2.恶性肿瘤

原发性肝癌、肺癌、胃癌、多发性骨髓瘤、恶性淋巴瘤等。

3.自身免疫性疾病

系统性红斑狼疮、类风湿关节炎、自身免疫性溶血性贫血等。

  1. 尿酸

.尿酸正常值

男性:150~440μmol/L

女性:95~360μmol/L

尿酸是体内嘌呤代谢的终末产物。主要经肾脏排泄,因而测定尿酸能够了解肾脏的功能。增高见于:

1.痛风

血清尿酸增高是诊断痛风的主要依据。

2.肾脏病变

急性或慢性肾炎、肾盂肾炎、肾结核等可使血清尿酸升高。

3.恶性肿瘤

各种恶性肿瘤都可导致血清尿酸升高。

患者化疗前发现上述四种肾功能指标;一、血清尿素(BUN)、二、血肌酐、三、血β2-微球蛋白、四、尿酸四项主要的肾功能指标超标时,要适时挂号看泌尿科医生,提前调理好肾脏功能,肾功能不合格继续化疗,患者身体的化疗药毒性将会在体内积聚,伤害患者的身体。所以肾功能不合格是医生暂停化疗的因素之一。患者和家属要学会粗略看懂生化报告的肾功能指标,适时的调理好肝肾功能,配合医生完成全部化疗疗程。

我化疗后期就深深的感受到肾功能处于代谢极限时,整个泌尿系统都处于将近崩溃的那种感觉,和化疗药毒性因为肝肾功能处于极限状态,而人体处于化疗药毒性积聚处于最高值时,手麻脚麻那种手脚末端神经被化疗药毒性伤害的感觉。所以患者和家属要学会粗略看懂生化报告的肝肾功能指标,指标不合格就要适时看肝胆内科医生或者泌尿科医生,调理好患者的肝肾功能才能顺利的完成化疗疗程,降低患者化疗期间受毒性副作用的伤害。

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