目的 修订肺癌患者联合药物治疗间歇期症状评估问卷，并评价其信效度。方法 以中文版安德森症状评估量表及肺癌特异性模块为基础，经文献分析、专家会议和认知性访谈形成测试版问卷。于2023年10-12月便利选取福州、莆田2所三级甲等医院278例肺癌患者进行调查，评价其信效度及偏倚风险。结果 修订后问卷含7个症状系统、60个条目，跳转式作答后实际作答21个条目。总问卷Cronbach's α系数为0.856，各维度为0.639～0.747；内容效度指数为0.81。验证性因子分析显示模型拟合尚可（χ2/df=2.366，RMSEA=0.070，CFI=0.858），各维度因子载荷、组合信度及平均方差提取量均达到可接受标准，区分效度良好。COSMIN-RoB评价结果为良好。结论 该问卷信效度良好，可用于评估肺癌患者联合药物治疗间歇期症状严重程度。

Objective To revise the Symptom Assessment Questionnaire for Lung Cancer Patients During Combined Drug Therapy Intervals and evaluate its reliability and validity. Methods Based on the Chinese version of the M. D. Anderson Symptom Inventory and its lung cancer-specific module, a preliminary questionnaire was developed through literature review, expert panel discussions, and cognitive interviews. From October to December 2023, a convenience sample of 278 lung cancer patients was recruited from two tertiary hospitals in Fuzhou and Putian, China. Reliability, validity, and risk of bias were evaluated. Results The revised questionnaire comprised seven symptom-system domains and 60 items, with 21 items completed through a skip-logic design. The overall Cronbach's α coefficient was 0.856, and the coefficients for each domain ranged from 0.639 to 0.747. The content validity index of the questionnaire was 0.81. Confirmatory factor analysis demonstrated an acceptable model fit (χ2/df = 2.366, RMSEA = 0.070, CFI = 0.858). Factor loadings, composite reliability, and average variance extracted of all domains met acceptable standards, indicating good discriminant validity. The overall risk of bias was rated as good according to the COSMIN Risk of Bias checklist. Conclusion The revised questionnaire demonstrated satisfactory reliability and validity and can be used to assess symptom severity in lung cancer patients during combined drug therapy intervals.

摘要目的 探讨基于E-Coach健康管理模式的营养管理联合主动循环呼吸训练（ACBT）在非小细胞肺癌（NSCLC）化疗患者中的应用效果。方法 选取2023年6月至2025年8月我院收治的98例NSCLC化疗患者，采用随机数字表法将所有研究对象分为联合组和常规组，每组49例。常规组给予常规干预，联合组在常规组基础上予以E-Coach健康管理模式的营养管理联合ACBT干预。比较两组干预前后营养状况、肺功能、运动耐力、生活质量以及营养不良发生率。结果 干预12周后，两组BMI、ALB、PA、Hb均较干预前上升且联合组高于常规组（P<0.05）；联合组FVC、FEV1、MVV及6MWT均显著高于常规组（P＜0.05）；干预前两组6MWT组间对比差异无统计学意义（P>0.05），干预4周、6周、8周、12周后，两组6MWT均较干预前增加，且联合组远于常规组（P<0.05）；干预12周后，两组身体功能、社会或家庭功能、情感功能、功能性状况得分均较干预前上升，且联合组高于常规组（P<0.05）。结论基于E-Coach健康管理模式的营养管理联合ACBT能够有效改善NSCLC化疗患者的营养状况和肺功能，提高生活质量和运动耐力。

Abstract Objective To investigate the application effect of nutrition management based on the E-Coach health management model combined with active cycle of breathing technique (ACBT) in patients undergoing chemotherapy for non-small cell lung cancer (NSCLC). Methods A total of 98 NSCLC patients receiving chemotherapy in our hospital from June 2023 to August 2025 were selected and randomly divided into a combination group and a conventional group using a random number table method, with 49 cases in each group. The conventional group received routine intervention, while the combination group received nutrition management based on the E-Coach health management model combined with ACBT in addition to the routine intervention. The nutritional status, lung function, exercise endurance, quality of life, and incidence of malnutrition were compared between the two groups before and after the intervention. Results After 12 weeks of intervention, BMI, ALB, PA, and Hb in both groups increased compared with baseline, and the levels in the combination group were higher than those in the conventional group (P<0.05). The FVC, FEV1, MVV, and 6MWT in the combination group were significantly higher than those in the conventional group (P<0.05). There was no statistically significant difference in 6MWT between the two groups before intervention (P>0.05); after 4, 6, 8, and 12 weeks of intervention, the 6MWT in both groups increased compared with baseline, and the walking distance in the combination group was significantly longer than that in the conventional group (P<0.05). After 12 weeks of intervention, the scores of physical function, social/family function, emotional function, and functional well-being in both groups increased compared with baseline, and the scores in the combination group were higher than those in the conventional group (P<0.05). Conclusion Nutrition management based on the E-Coach health management model combined with ACBT can effectively improve the nutritional status and lung function of NSCLC patients undergoing chemotherapy, and enhance their quality of life and exercise endurance.

【摘要】 目的 探讨基于峰值呼气流速（peak expiratory flow rate，PEFR）的呼吸性肌肉力量减低对I-IIIA期非小细胞肺癌（non-small cell lung cancer，NSCLC）患者术后预后的影响。方法 回顾性分析我院2020年1月-2025年11月接受根治性手术切除的I-IIIA期NSCLC患者临床及影像资料，包括基于肺功能的PEFR（呼吸性肌肉力量指标）及胸部CT的胸肌质量指数（pectoralis muscle index, PMI）。分别采用Jonckheere-Terpstra检验、Spearman’s相关分析比较PEFR与PMI随年龄的变化规律及二者的相关性。低PEFR定义为小于PEFR的性别特异性下四分位数，进一步采用单、多因素Cox回归分析探讨PEFR及PMI对NSCLC患者术后结局的影响。结果 共纳入102例患者，中位年龄62岁（53-67岁），男性65例（63.7%），低低PEFR组24例（23.5%）。低PEFR组在年龄、FEVI、DLCO、FEV1/FVC、FVC、血清白蛋白及随访时间等方面均与正常组间存在显著差异（P＜0.05）。在男、女性患者中，PEFR均表现为随年龄增长逐渐下降的趋势；且与PMI具有较好的相关性（r=0.25，P=0.001）。单因素及多因素Cox回归分析显示，低PEFR是影响NSCLC患者术后无进展生存期（progression free survival, PFS）的独立危险因素（HR=1.57，95%CI：1.03-2.39；P=0.036）结论 呼吸性肌肉力量减低是NSCLC患者术后PFS的独立危险因素，有望成为NSCLC术后复发的早期生物学标志物。

【Abstract】 Objective To investigate the impact of reduced respiratory muscle strength, assessed by peak expiratory flow rate (PEFR), on postoperative outcomes in patients with stage I-IIIA non-small cell lung cancer (NSCLC). Methods Clinical and imaging data of patients with stage I-IIIA NSCLC who underwent radical resection at our hospital from January 2020 to November 2025 were retrospectively analyzed, including PEFR (an indicator of respiratory muscle strength) based on pulmonary function tests and the pectoralis muscle index (PMI) derived from chest CT. The Jonckheere-Terpstra test and Spearman’s correlation analysis were used to evaluate age-related changes in PEFR and PMI and their correlation, respectively. Low PEFR was defined as values below the sex-specific lower quartile of PEFR. Univariate and multivariate Cox regression analyses were performed to assess the impact of PEFR and PMI on postoperative prognosis in NSCLC patients.Results A total of 102 patients were enrolled, with a median age of 62 years (range 53-67 years); 65 patients (63.7%) were male, and 24 (23.5%) were classified into the low PEFR group. The low PEFR group showed significant differences from the normal PEFR group in age, FEV1, DLCO, FEV1/FVC, FVC, serum albumin, and follow-up duration (all P < 0.05). In both male and female patients, PEFR progressively decreased with age and was positively correlated with PMI (r = 0.25, P = 0.001). Univariate and multivariate Cox regression analyses identified low PEFR as an independent risk factor for postoperative progression-free survival (PFS) in NSCLC patients (HR = 1.57, 95% CI: 1.03–2.39; P = 0.036).Conclusion Reduced respiratory muscle strength is an independent risk factor for postoperative PFS in NSCLC patients and may serve as an early biomarker for postoperative recurrence.

目的 探讨靶向治疗前晚期非小细胞肺癌（NSCLC）患者血清肿瘤特异性生长因子（TSGF）、乳酸脱氢酶（LDH）、同型半胱氨酸（Hcy）水平与靶向治疗无效的相关性，并分析其对靶向治疗无效的预测价值。方法 选取2023年1月～2025年1月于本院就诊的晚期NSCLC患者108例作为研究组，另选取同期健康志愿者108例作为对照组。比较两组血清TSGF、LDH、Hcy水平。研究组予以靶向治疗（治疗3个疗程），依据靶向治疗无效将其分为无效亚组36例、有效亚组72例，比较其血清TSGF、LDH、Hcy水平。分析血清TSGF、LDH、Hcy与靶向治疗无效的相关性，并分析其对靶向治疗无效的预测价值。结果 研究组血清TSGF、LDH、Hcy水平高于对照组（P＜0.05）；无效亚组血清TSGF、LDH、Hcy水平高于有效亚组（P＜0.05）；校正吸烟史、分化程度、TNM分期后，治疗1个疗程后血清TSGF、LDH、Hcy水平仍与靶向治疗无效独立相关（P＜0.05）；靶向治疗前血清TSGF、LDH、Hcy水平预测靶向治疗无效的AUC值明显大于各指标单独预测（P＜0.05）。结论 晚期NSCLC患者血清TSGF、LDH、Hcy水平升高与靶向治疗无效独立相关，检测其水平对靶向治疗无效具有一定预测价值，且联合预测的效能更高，可指导临床制定及调整诊治方案。

       目的  分析对肺癌化学治疗（化疗）患者采取个性化营养干预联合分级步行运动方案的应用价值。方法   将郑州大学附属郑州中心医院2023年7月—2024年7月符合标准的198例肺癌化疗患者作为研究对象，通过随机数字表法分为观察组和对照组各99例。对照组仅采用个性化营养干预方案，观察组则联合分级步行运动方案，两组患者均在同一时间内入组并接受持续干预3个月。对两组干预前后癌因性疲乏［Piper疲乏修订量表（PFS-R）］、营养状况、睡眠质量［匹茨堡睡眠质量指数（PSQI）］、生活质量［生活质量评估量表（SF-36）］水平予以比较。结果  相较于对照组，干预后观察组PFS-R、PSQI评分较低，白蛋白、前白蛋白、血红蛋白、铁转蛋白水平和SF-36评分较高（P＜0.05）。结论  对肺癌化疗患者采取个性化营养干预联合分级步行运动方案，有利于促进其癌因性疲乏的减轻和营养状态、睡眠质量及生活质量水平的提高。

       Objective  To analyze the effects of personalized nutritional intervention combined with graded walking exercise treatment on cancer-related fatigue and quality of life in lung cancer patients during chemotherapy．Methods  A total of 198 lung cancer patients undergoing chemotherapy who met the criteria in our hospital from July 2023 to July 2024 were selected as the research subjects．They were divided into an observation group and a control group，with 99 cases in each group，by the random number table method．The control group only received individualized nutritional intervention，while the observation group received graded walking exercise additionally．Both groups of patients were enrolled at the same time and received continuous intervention for three months．Cancer-related fatigue（Piper’s Fatigue Scale-Revised［PFS-R］），nutritional status，sleep quality（Pittsburgh Sleep Quality Index［PSQI］），and quality of life（Quality of Life Scale［SF-36］） before and after the intervention were compared between the two groups．Results  Compared with the control group，the observation group had lower PFS-R and PSQI scores and higher albumin，prealbumin，hemoglobin，transferrin levels and SF-36 scores after the intervention（P＜0.05）．Conclusions  Adopting personalized nutritional intervention combined with graded walking exercise for lung cancer patients during chemotherapy is beneficial to promote the reduction of cancer-caused fatigue and the improvement of their nutritional status，sleep quality and quality of life．

      目的 探讨肺癌根治术后患者康复期的症状体验与心理感受, 为完善症状管理和制定个性化康复干预方案提供依据。方法 采用现象学研究法,对15例肺癌根治术后康复期患者进行半结构式访谈, 运用Colaizzi 7步分析法进行归纳和提炼主题。结果 归纳出5个主题, 12个亚主题：多重躯体症状负担持续存在（术后疼痛综合征、顽固性刺激性咳嗽、劳力性呼吸困难、持续性疲劳感）; 负性心理情绪困扰（病耻感、疾病不确定感与复发恐惧）; 心理调适过程（诊断冲击与认知失调、角色适应与主动应对）; 创伤后成长与健康行为转变（生命意义感提升、健康促进行为强化）; 强烈的康复信息支持需求（自我保健知识需求、结构化康复锻炼指导需求）。结论 医护人员应关注肺癌根治术后患者康复期的症状体验, 动态评估患者的身心状况, 制定精准、有效的个性化干预方案, 帮助患者树立康复信心, 改善术后康复体验和提高生活质量。

       Objective  To explore the symptom experience and psychological feelings of patients during the rehabilitation period after radical resection of lung cancer, aiming to provide a basis for improving symptom management and formulating personalized rehabilitation interventions．Methods The phenomenological research method was used to conduct semi-structured interviews with 15 patients in the rehabilitation period after radical surgery for lung cancer．Colaizzi's 7-step analysis method was used to summarize and extract themes．Results Five themes and 12 sub-themes were summarized：Persistent burden of multiple physical symptoms（postoperative pain syndrome, refractory irritative cough, exertional dyspnea, persistent fatigue）; negative emotional experiences（stigma of illness, illness uncertainty and fear of recurrence）; psychological adjustment processes（diagnostic shock and denial, role acceptance and active coping）; post-traumatic growth and health behavior transformation（enhanced sense of meaning in life, strengthened health-promoting behaviors）; strong demand for rehabilitation information support（self-care knowledge, rehabilitation exercise knowledge）．Conclusions Medical staff should pay attention to the symptom experience of patients during the recovery period after radical lung cancer surgery, dynamically assess their physical and mental conditions, develop precise and effective personalized intervention plans, help patients build confidence in recovery, and thereby improve their postoperative rehabilitation experience and quality of life．

      目的   通过生物信息学手段筛选非小细胞肺癌（NSCLC）中的关键靶点基因，识别预后标志物NDC80，并探讨其在NSCLC中的表达意义，进而分析NDC80作为NSCLC基因治疗靶点的可行性。方法   采用癌症基因组图谱（TCGA）TCGA数据库检索NSCLC相关数据，进行加权基因共表达网络分析（WGCNA）以识别关键基因，并进行差异表达分析、相关性分析和蛋白互作网络构建。对筛选出的关键基因进行功能分析。利用免疫组化染色法检测癌组织及癌旁组织中NDC80蛋白的表达水平，并进一步探究其与临床病理特征的关系。采用Kaplan-Meier法分析NDC80表达与NSCLC患者无进展生存时间（PFS）的关系。结果   共筛选出20个与NSCLC高度关联的关键基因，包括CDC20、CDK1、MCM4、CDC6、MCM2、PLK1、NDC80、CCNB1、CDC45、AURKA、MCM8、BUB1、CDT1、ORC1、CCNA2、CASC5、MAD2L1、BUB1B、CENPA、AURKB。免疫组化验证显示，NDC80蛋白在NSCLC组织中高表达，其在NSCLC组（阳性表达率88.6%）显著高于癌旁组（50.0%）（P＜0.05）。NDC80蛋白的阳性表达率在TNM分期（Ⅲ期+Ⅳ期）、低分化、淋巴结转移的NSCLC组高于TNM分期（Ⅰ期+Ⅱ期）、高分化及中分化以及未发生淋巴结转移的NSCLC组（P＜0.05）。NDC80蛋白的阳性表达率在不同性别、年龄、病灶大小分类的NSCLC组织中无显著差异（P＞0.05）。Kaplan-Meier分析显示，NDC80蛋白高表达组的PFS中位数为（9.00±0.27）个月，明显低于低表达组（11.00±0.79）个月（P＜0.05）。结论   本研究发现的关键基因在NSCLC干细胞的维持中发挥重要作用。免疫组化结果显示，NDC80蛋白在NSCLC组织中高表达，且与肿瘤分化、TNM分期及淋巴结转移密切相关。NDC80蛋白高表达组的PFS明显低于低表达组，提示NDC80可能成为NSCLC筛查、治疗和预后评估的潜在生物标志物。

      Objective  To screen the key target genes in non-small cell lung cancer（NSCLC）by bioinformatics，identify the prognostic marker NDC80，and explore its expression significance in NSCLC，so as to analyze the feasibility of NDC80 as a gene therapy target for NSCLC．Methods  TCGA database was used to retrieve NSCLC-related data，and weighted gene co-expression network analysis（WGCNA）was used to identify key genes，and differential expression analysis，correlation analysis and protein-protein interaction network construction were carried out．The function of the selected key genes was analyzed．Immunohistochemical staining was used to detect the expression level of NDC80 protein in cancer tissues and adjacent tissues，and to further explore its relationship with clinicopathological features．Kaplan-Meier method was used to analyze the relationship between NDC80 expression and progression-free survival （PFS）of NSCLC patients．Results  A total of 20 key genes highly associated with NSCLC were screened out，which were CDC20，CDK1，MCM4，CDC6，MCM2，PLK1，NDC80，CCNB1，CDC45，AURKA，MCM8，BUB1，CDT1，ORC1，CCNA2，CASC5，MAD2L1，BUB1B and CENPA．Immunohistochemical  verification  showed that NDC80 protein was highly expressed in NSCLC tissue，and its positive expression rate in NSCLC group（88.6%）was significantly higher than that in adjacent cancer group（50.0%，P＜0.05）．The positive expression rate of NDC80 protein in NSCLC with TNM staging（Ⅲ+Ⅳ），low differentiation and lymph node metastasis was higher than that in NSCLC with TNM staging（Ⅰ+Ⅱ），high differentiation and moderate differentiation and no lymph node metastasis（P＜0.05）．There was no significant difference in the positive expression rate of NDC80 protein among NSCLC tissues with different gender，age and lesion size（P＞0.05）．Kaplan-Meier analysis showed that the median PFS of high expression group of NDC80 protein was（9.00±0.27）months，which was significantly lower than that of low expression group（11.00±0.79）months（P＜0.05）．Conclusions  The key genes found in this study play an important role in the maintenance of NSCLC stem cells．Immunohistochemical results showed that NDC80 protein was highly expressed in NSCLC，and it was closely related to tumor differentiation，TNM staging and lymph node metastasis．The PFS of high expression group of NDC80 protein was significantly lower than that of low expression group，suggesting that NDC80 may become a potential biomarker for screening，treatment and prognosis evaluation of NSCLC．

      目的   探讨肺癌伴癌性疼痛患者心理僵化现状及其影响因素，为临床制定改善患者心理僵化的针对性干预措施以及提升患者生活质量提供参考依据。方法   采用便利抽样法，选取2023年10月—12月期间焦作市某三级甲等医院收治的肺癌伴癌性疼痛患者为研究对象，采用一般资料调查问卷、疼痛心理僵化量表（PIPS）、简易疾病感知问卷（BIPQ）、家庭功能问卷（APGAR）进行调查，采用Pearson相关性分析肺癌伴癌性疼痛患者心理僵化与疾病感知、家庭功能的关系。采用多元线性回归分析肺癌伴癌性疼痛患者心理僵化的影响因素。结果   本次研究共发放问卷152份，回收有效问卷150份，有效回收率为98.68%。150例肺癌伴癌性疼痛患者心理僵化量表总分为（61.66±2.85）分，回避型经验维度得分为（45.52±1.97）分，认知融合维度得分为（19.74±1.59）分。不同文化程度、家庭人均月收入、疼痛程度的肺癌伴癌性疼痛患者心理僵化得分比较，差异有统计学意义（P＜0.05）。Pearson相关性分析结果显示：肺癌伴癌性疼痛患者心理僵化总分、经验性回避维度得分、认知融合维度得分与疾病感知得分均呈正相关关系（P＜0.001），与家庭功能得分均呈负相关关系（P＜0.001）。多元线性回归结果显示：文化程度、家庭人均月收入、疾病感知、家庭功能是肺癌伴癌性疼痛患者心理僵化的影响因素（P＜0.05），可解释肺癌伴癌性疼痛患者心理僵化43.9%的变异度。结论   肺癌伴癌性疼痛患者心理僵化处于较高水平，且受到文化程度、家庭人均月收入、疾病感知和家庭功能的影响，临床医护人员可从疾病感知、家庭支持等角度出发，采用认知干预、同伴支持等方法，加强对患者的健康教育，以缓解其对疾病的负性认知，从而缓解心理僵化，促进身心健康恢复。

       Objective  To explore the status and influencing factors of psychological  rigidity in patients with lung cancer and cancer pain，and to provide reference for clinical development of targeted interventions to improve patients’psychological rigidity andquality of life．Methods  The convenience sampling method was used to select patients with lung cancer and cancer pain who were admitted to a tertiary hospital in Jiaozuo City from October to December 2023 as the research object．The general data questionnaire，Psychological Inflexibility in Pain Scale（PIPS），Brief Illness Perception Questionnaire（BIPQ），and family function questionnaire（APGAR）were used to investigate．Pearson correlation analysis was used to analyze the relationship between psychological rigidity and disease perception and family function in patients with lung cancer and cancer pain．Multivariate linear regression was used to analyze the influencing factors of psychological rigidity in patients with lung cancer and cancer pain．Results  A total of 152 questionnaires were distributed in this study，and 150 valid questionnaires were recovered，with an effective recovery rate of 98.68 %．The total score of PIPS of 150 patients with lung cancer and cancer pain was（61.66±2.85），the score of avoidance experience dimension was（45.52±1.97），and the score of cognitive fusion dimension was（19.74±1.59）．There were statistically significant differences in the scores of psychological rigidity among lung cancer patients with cancer pain with different educational levels，family per capita monthly income，and pain degree（P＜0.05）．The  results of Pearson correlation analysis showed that the total score of PIPS，the score of empirical avoidance dimension and the score of cognitive fusion dimension were positively correlated with the score of disease perception（P＜0.001），and negatively correlated with the score of family function（P＜0.001）．The results of multiple linear regression showed that education level，family per capita monthly income，disease perception and family function were the influencing factors of psychological rigidity in patients with lung cancer and cancer pain（P＜0.05 ），which could explain 43.9 % of the variation of psychological rigidity in patients with lung cancer and cancer pain．Conclusions  The psychological rigidity of lung cancer patients with cancer pain is at a high level，and is affected by education level，family per capita monthly income，disease perception and family function．Clinical medical staff can use cognitive intervention and peer support from the perspective of disease perception and family support to strengthen the health education of patients，so as to alleviate their negative cognition of the disease，to alleviate the psychological rigidity and promote the recovery of physical and mental health．

目的 探讨导航护士主导的三级质控在胸腔镜肺癌切除术患者加速康复中的应用效果。方法 选取2020年6月—2023年6月周口市中心医院收治的106例肺癌患者,应用随机数字表法分为观察组（n=53）与对照组（n=53）。患者均采取胸腔镜肺癌切除术治疗,对照组实施常规的术前、术中及术后相关围术期护理,观察组在常规围术期护理基础上增加导航护士主导的三级质控护理。对比两组住院时间、术后并发症和护理前后世界卫生组织生活质量-100量表（WHOQOL-100）及癌因性疲乏程度（PFS）,最后对比两组的护理满意度。结果 观察组首次排气时间、首次下床时间、术后疼痛视觉模拟量表（VAS）评分、术后住院时间均优于对照组（P<0.05）;观察组并发症发生率低于对照组（P<0.05）;干预后两组WHOQOL-100评分升高、PFS评分降低,观察组均优于对照组（P<0.05）;观察组护理满意度高于对照组（P<0.05）。结论 对胸腔镜肺癌切除术患者,采取导航护士主导的三级质控管理的加速康复护理,可促进患者术后肠胃功能恢复,缩短住院时间,减轻术后疼痛感与减少并发症,在改善患者癌因性症状的同时,提升其生活质量,提高患者护理满意度。

Objective To explore the application effect of three-level quality control led by navigation nurses in accelerating rehabilitation of patients undergoing thoracoscopic lung cancer resection．Methods A total of 106 lung cancer patients admitted to our hospital from June 2020 to June 2023 were selected and randomly divided into an observation group（n=53）and a control group（n=53）using a random number table method．All patients were treated with thoracoscopic lung cancer resection,while the control group received routine preoperative,intraoperative and postoperative perioperative care,the observation group received a three-level quality control nursing led by navigation nurses in addition to routine perioperative care．The length of hospitalization,postoperative complications,WHOQOL-100 and PFS before and after care,and the nursing satisfaction of the two groups were compared．Results The observation group had significantly shorter first exhaust time,first time out of bed,postoperative visual analogue scale（VAS）score and postoperative hospital stay compared to the control group（P<0.05）．The incidence of complications in the observation group was lower than that in the control group（P<0.05）．After intervention,the WHOQOL-100 scores of both groups increased,and the observation group was higher than the control group．The PFS score decreased,and the observation group was lower than the control group（P<0.05）．The nursing satisfaction of the observation group was significantly higher than that of the control group（P<0.05）．Conclusions Adopting a three-level quality control management led by navigation nurses to accelerate rehabilitation care for patients undergoing thoracoscopic lung cancer resection can promote postoperative recovery of gastrointestinal function,reduce hospitalization time,reduce postoperative pain and complications,improve cancer related symptoms,improve their quality of life and increase patients nursing satisfaction．

目的 评价不同间变性淋巴瘤激酶（ALK）抑制剂联合安罗替尼治疗非小细胞肺癌（NSCLC）的疗效。方法 收集ALK突变阳性NSCLC患者的临床资料,筛选服用ALK抑制剂疗效不佳再加用安罗替尼的病例。根据不同的用药方案分为阿来替尼+安罗替尼,塞瑞替尼+安罗替尼和克唑替尼+安罗替尼三个组别。记录患者联合用药前最近一次的影像学检查结果,并以此为基线按Recist1.1评价疗效,以病情进展、患者死亡、停药、改变治疗方案为终点计算各组患者的无事件生存期（EFS）,收集肿瘤标志物、血常规和肝功、心功能、肾功能生化检测等指标数据,统计分析患者联合用药前后各项指标的变化。结果 经筛选,共纳入49例患者的临床数据。阿来替尼+安罗替尼组有23例,疾病控制率（DCR）为86.96%;平均EFS为（10.8±3.6）个月,中位EFS为8.3个月;塞瑞替尼+安罗替尼组有14例,DCR为71.43%;平均EFS为（6.5±2.9）个月,中位EFS为5.6个月;克唑替尼+安罗替尼组有12列,DCR为66.67%;平均EFS为（7.7±3.2）个月,中位EFS为7.2个月。阿来替尼+安罗替尼组的平均EFS长于另外两组（P<0.05）。各研究组肿瘤标志物仅有CyFra21-1在克唑替尼+安罗替尼组在联合用药后升高（P<0.05）,生化检测和血常规指标在用药前后差异无统计学意义（P>0.05）。结论 ALK抑制剂与安罗替尼联用,疗效最好为阿来替尼,其次为塞瑞替尼,最后为克唑替尼。三种ALK抑制剂与安罗替尼联用后,均未导致心、肝、肾功能和血细胞损害。

Objective To evaluate the efficacy of different anaplastic lymphoma kinase（ALK）inhibitors combined with anlotinib in the treatment of non-small cell lung cancer（NSCLC）. Methods Clinical data of drug resistant NSCLC patients with ALK positive mutation was collected who were treated with ALK inhibitors and anlotinib synchronously．According to different regimens,three groups were set,alectinib+anlotinib,ceritinib+anlotinib,and crizotinib+anlotinib．The latest imageological examination results of the patient before the synchronous therapy was set as the baseline to evaluate the therapeutic effect according to Recist1.1．The event free survival（EFS）of each group was calculated with disease progression,patient death,treatment discontinuation and changing regimen as endpoints．Data of tumor markers,hematology test,liver function,cardiac function,renal function biochemical examination was collected and analyzed statistically before and after the combination therapy,with P<0.05 as the statistically significant difference. Results After screening,clinical data of 49 patients were collected．Twenty-three patients in the alectinib+anlotinib group,with a disease control rate（DCR） of 86.96%;mean EFS was（10.8±3.6）months,median EFS of 8.3 months;14 patients in the ceritinib+anlotinib group,with a DCR of 71.43%,mean EFS was（6.5±2.9）months,median EFS was 5.6 months;12 patients in the crizotinib+anlotinib group,with a DCR of 66.67%,mean EFS was（7.7±3.2）months,median EFS was 7.2 months．EFS of alectinib+anlotinib group was longer significantly than the other two groups（P<0.05）．Only CyFra21-1,increased significantly after the combination of crizotinib and anlotinib（P<0.05）．No statistically significant difference in biochemical test and hematology test before and after the treatment（P>0.05）． Conclusions The therapeutic effect of ALK inhibitors with anlotinib was ordered,alectinib being the most effective,followed by ceritinib and finally crizotinib．The combination of ALK inhibitors with anlotinib did not cause any abnormal results in the examination of heart,liver,kidney and blood cells．