造血干细胞移植病人肛周感染的护理进展

综述造血干细胞移植病人肛周感染相关因素及护理的研究进展.指出影响造血干细胞病人肛周感染因素主要与性别、年龄、化疗、粒细胞减少、血液病类型和肛门的特殊解剖结构有关.护理预防、针对性的护理措施、心理护理等方式可减少造血干细胞移植病人肛周感染,提高移植成功率.     

1例严重肛周溃疡患者行非血缘外周造血干细胞移植的护理

总结1例非血缘外周造血干细胞移植伴严重肛周溃疡的护理体会。探索非血缘外周造血干细胞移植严重肛周溃疡的护理方法,观察在无菌层流室中患者肛周溃疡的变化,采取有针对性的护理措施,同时给予患者必要的心理支持。经过精心护理,患者安全度过白细胞“零期”,肛周溃疡痊愈,非血缘外周造血干细胞移植成功。     

自体外周造血干细胞移植的护理

通过对16例自体外周造血干细胞移植病人的护理,认为针对移植的不同阶段,采取心理护理、预防感染及出血等护理措施,并在层流病房进行全环境保护,能提高移植成功率.加强消毒隔离,预防感染和出血,是自体外周造血干细胞移植护理的关键.     

自体外周血造血干细胞移植患者的护理

目的探讨对行自体外周血造血干细胞移植的患者在不同阶段实施的相应护理措施。方法选取我院2005年10月至2008年12月进行APBSCT治疗的恶性肿瘤患者60例,根据其移植的各个阶段采取相应的护理措施。结果通过施行全环境保护、合理饮食、全身皮肤黏膜清洁消毒、心理支持等护理活动,有效地减少了移植过程中各种并发症的发生率。结论在进行APBSCT治疗的患者中,护理质量的优劣是直接影响APBSCT成败和患者预后好坏的重要因素,良好的护理使癌症患者的生命得到真正的延长。     

自体外周造血干细胞移植的护理

总结了对恶性血液病的自体外周造血干细胞移植病人的护理。从移植前护理（移植前的受者准备、AFR的准备）、自体造血干细胞回输的注意事项和移植后的护理等方面进行了介绍。认为加强消毒隔离，预防感染和出血，是自体外周血干细胞移植护理的关键。     

问题跟踪护理用于造血干细胞移植期患者的效果观察

目的探讨问题跟踪护理在造血干细胞移植(HSCT)患者中实施的效果。方法运用发现问题、跟踪问题、解决问题的模式,对155例HSCT患者实施护理。结果本组98.5%的患者不适症状减轻,出院时对护理服务质量满意率达96.3%;护士的专科护理知识和技能水平得到了提高。结论问题跟踪护理有效保证了HSCT患者移植治疗的成功实施。     

造血干细胞移植患者的心理护理

造血干细胞移植包括骨髓移植,外周血干细胞移植,胎肝造血细胞移植,脐带血造血干细胞移植。我科自1994年11月至1997年5月共施行7例造血干细胞移植,其中自体骨髓移植4例,自体外周血干细胞移植2例,异体外周血干细胞移植1例。在护理过程中,我们体会到心理护理的重要性,只有在治疗各个阶段及时帮助患者完成心理状态的转换和调适,做好有效的心理护理和疏导,才能保证治疗的实施和移植的成     

自体外周造血干细胞移植患者口腔黏膜炎的观察及护理

目的 观察自体外周造血干细胞移植患者发生口腔黏膜炎的主要表现,以实施有效的护理措施.方法 对100例自体外周造血干细胞移植患者的口腔黏膜参照口腔评估标准(OAG)进行评估,加强临床观察并予以针对性的护理措施.结果 100例自体外周造血干细胞移植患者中,发生口腔黏膜炎根据OAG标准:I级占15％,Ⅱ级占60％,Ⅲ级占25％.发生OAG的时间为预处理后2-4d,一般持续10-20d.护理干预后4例仍存在Ⅱ级口腔黏膜炎,其余通过护理干预后逐步好转、愈合.结论口腔黏膜炎是自体外周造血干细胞移植患者常见而严重的并发症,加强观察和护理能减轻患者口腔并发症发生及患者痛苦,提高生活质量,使患者能够耐受自体造血干细胞移植.     

造血干细胞移植患者的心理护理

目的：减轻造血干细胞移植患者治疗中的焦虑、恐惧、抑郁、孤独、悲观、绝望等心理反应,使患者积极配合治疗。方法：对患者在层流病房内化疗和造血干细胞移植过程中,各阶段出现的心理问题,进行恰当的护理干预,改善他们的情感状态及至整个心身状态。结果：10例患者均未因心理问题影响治疗。结论：及时帮助患者克服不良心理反应,是化疗和造血干细胞移植能顺利进行的关键。     

造血干细胞移植患者口腔粘膜炎的观察及护理

目的观察41例患者口腔粘膜炎发生、发展的规律,为临床护理提供科学的依据。方法预先设计好口腔粘膜炎的观察表,每次口腔护理前对口腔粘膜认真评估,逐项填写。结果本组口腔粘膜炎的发生率为83.7%%;发生部位颊(46.3%),舌(34.1%)、唇(31.7%)、齿龈和腭(均为29.3%);发生程度0级、Ⅰ级占83.7%;发生与粒细胞下降速度、幅度、持续时间均有关;粘膜炎时微生物检测均为常居菌。结论口腔粘膜炎是造血干细胞移植患者常见而严重的并发症。虽发生率高,但只要仔细观察、有效护理,是可以降低口腔粘膜炎发生程度的。     

Respiratory failure in the hematopoietic stem cell transplant recipient

The number of patients receiving hematopoietic stem cell transplantation (HSCT) is rapidly rising worldwide. Despite substantial improvements in peri-transplant care, pulmonary complications resulting in respiratory failure remain a major contributor to morbidity and mortality in the post-transplant period, and represent a major barrier to the overall success of HSCT. Infectious complications include pneumonia due to bacteria, viruses, and fungi, and most commonly occur during neutropenia in the early post-transplant period. Non-infectious complications include idiopathic pneumonia syndrome, peri-engraftment respiratory distress syndrome, diffuse alveolar hemorrhage, pulmonary veno-occlusive disease, delayed pulmonary toxicity syndrome, cryptogenic organizing pneumonia, bronchiolitis obliterans syndrome, and post-transplant lymphoproliferative disorder. These complications have distinct clinical features and risk factors, occur at differing times following transplant, and contribute to morbidity and mortality.     

综合心理护理干预对造血干细胞移植患者预处理前焦虑的影响

目的 探讨综合心理护理在造血干细胞移植患者预处理前的应用效果.方法 100例行造血干细胞移植的患者按照完全随机的原则分为观察组和对照组,对照组采用常规护理,观察组在对照组的基础上采用综合心理护理干预,比较两组患者的预处理干预前后的焦虑情况.结果 综合心理护理干预后,观察组焦虑程度显著轻于对照组(P＜0.05).结论 综合心理护理干预有利于减轻造血干细胞移植患者预处理前的焦虑程度,帮助患者减轻心理负担,更好的接受移植治疗.     

Association of crystalloid fluid infusion with intravascular hemolysis and organ dysfunction in hematopoietic stem cell transplant patients

Endothelial cell activation and injury is common after hematopoietic stem cell transplant (HSCT) and is associated with many post-transplant complications. An underexplored mechanism of endothelial cell damage in this population is the infusion of normal saline (NS, 0.9 % sodium chloride) and other crystalloids, as NS use is associated with adverse outcomes in other patient populations. We hypothesized that the infusion of unbalanced crystalloids during HSCT may lead to changes in biomarkers commonly associated with red blood cell (RBC) hemolysis in patients before and after infusion, and that markers of endothelial and end-organ damage during admission may be associated with markers of hemolysis and total crystalloid use. Samples were collected from 97 patients. From pre-fluid infusion to post-fluid infusion, mean haptoglobin decreased (11.7 ug/ml vs 8.4 ug/ml; p < 0.0001), hemopexin decreased (549 vs 512 μg/ml; p = 0.005), and red cell distribution width (RDW) decreased (15.7 vs 15.6; p = 0.0009). During admission (mean 19.4 days, SD 9.9), all markers of tissue and organ damage, including mean creatinine, lactate dehydrogenase (LDH), blood urea nitrogen (BUN), total bilirubin, AST, and ALT, increased from admission to peak levels (p < 0.0001). On linear regression, fluid volume (ml/kg) of crystalloid infusion positively predicted post-fluid infusion cell-free hemoglobin (r(96) = 0.34, p < 0.0001), free heme (r(96) = 0.36, p < 0.0001), and peak LDH during admission (r(75) = 0.23, p = 0.041), and negatively predicted post-fluid infusion hemopexin (r(96) = − 0.34, p < 0.0001). Unbalanced crystalloids may contribute to hemolysis and endothelial damage in HSCT patients. Alternatives such as buffered crystalloid solutions (PlasmaLyte, Lactated Ringer’s) may be worth investigating in this population.     

造血干细胞移植患者人巨细胞病毒监测的临床意义

目的探讨荧光定量聚合酶链反应对造血干细胞移植患者人巨细胞病毒活动性感染的早期诊断价值。方法收集40例造血干细胞移植患者共416份血标本,应用实时荧光定量PCR方法动态监测血浆HCMV—DNA载量,并与60例健康体检者血浆HCMV—DNA载量对比分析。结果416份血标本中96份阳性,阳性率23．1％,病毒载量介于5．0x10^2-1．0x10,拷贝／ml之间。结论实时荧光定量PCR方法检测HCMV—DNA适用于造血干细胞移植后巨细胞病毒活动性感染的早期诊断。     

延续性护理在造血干细胞移植术后患者中应用效果的三年随访研究

目的分析、探讨延续护理对恶性血液病行造血干细胞移植术后出院患者生活质量及心境状态的影响。方法选择2012年1月-2015年10月在我院血液科行造血干细胞移植术的恶性血液病患者共120例,采用随机数字表法分为对照组58例和干预组62例。两组患者出院时均按护理常规给予出院指导,干预组患者出院后按延续护理方案给予干预。在实施干预前、干预6个月后、干预12个月、干预3年后采用欧洲癌症研究机构治疗组织制定的生活质量量表(QLQ-C30)中文版、造血干细胞移植特异性量表(FACT-BMT量表)和简明心境状态量表(POMS-SF)对患者进行了问卷调查。结果经重复测量方差分析,两组患者生活质量QLQ-C30量表的角色功能、情绪功能、总体健康维度得分,生活质量FACT-BMT量表的情绪稳定状况、功能健康状况、移植特异模块和生活质量总分,心境状况POMS-SF量表得分的紧张、愤怒、精力和抑郁得分的分组效应、时间效应及交互效应差异均有统计学意义(P<0.05)。结论对恶性血液病行造血干细胞移植术后出院患者给予延续护理干预能够有效提高其生活质量,减轻负性情绪。     

Oral cryotherapy for the prevention of high-dose melphalan-induced stomatitis in allogeneic hematopoietic stem cell transplant recipients

Goals The purpose of this study was to evaluate the efficacy of oral cryotherapy to prevent high-dose melphalan-induced stomatitis.Patients and methods Eighteen consecutive recipients of allogeneic hematopoietic stem cell transplant conditioned with high-dose melphalan (140 mg/m²) in combination with fludarabine alone or with fludarabine and additional chemotherapy or radiation were enrolled. The severity of stomatitis was graded according to the National Cancer Institute Common Toxicity Criteria. Patients were kept on oral cryotherapy using ice chips and ice-cold water shortly before, during, and for additional 90 min after completion of melphalan administration.Results Only two of 18 patients (11.1%) developed grade 2 or 3 stomatitis while six of seven patients in the historical control developed it (85.7%; P=0.001).Conclusion These results suggested that oral cryotherapy could effectively prevent stomatitis caused by high-dose melphalan, and we recommend that it should be incorporated into the conditioning regimen with high-dose melphalan.     

造血干细胞移植患者腹部超声特点

目的 探讨血液病患者造血干细胞移植治疗后腹部超声特点及相关临床意义.方法 对51例接受造血干细胞移植患者进行常规腹部超声检查,观察腹腔脏器声像图变化.结果 同移植前比较,患者在移植后发生弥漫性肝实质损害、肝静脉纤细、胆囊壁增厚、胆汁淤积、脾体积缩小、肠蠕动异常及腹水等一系列变化,差异有显著性意义（P〈0.05）;而肝大小、肾实质损害、脾内部回声及胰腺变化则差异无显著性意义（P〉0.05）.结论 造血干细胞移植后患者常发生一系列腹腔脏器超声特征性变化,常规腹部超声检查能为移植相关并发症早期诊断提供及时、可靠的诊断依据.     

Clostridium difficile infection in cancer patients and hematopoietic stem cell transplant recipients

Clostridium difficile has become the most common bacterial cause of nosocomial diarrhea. High rates of C. difficile infection (CDI) coupled with increasing morbidity and mortality attributed to CDI have sparked a renewed interest in this disease. Emergence of hypervirulent strains, rising rates of severe and recurrent infection and associated infection control challenges, and diagnostic and therapeutic dilemmas are major issues in the non-oncology population. Scant data on CDI exist in the cancer/transplant population. The purpose of this article is to describe the epidemiology, pathogenesis and management of CDI in patients receiving cancer chemotherapeutic agents, and in hematopoietic stem cell transplant recipients.     

Parental caregiving of children prior to hematopoietic stem cell transplant

Using the Caregiver Reaction Assessment (CRA), we assessed positive reactions and burdens of the caregiving experience among parental caregivers (n = 189) of children scheduled to undergo hematopoietic stem cell transplant. Although widely used in non-parental caregivers, the CRA has not been used in parents of pediatric patients. Reliability (Cronbach's alpha: .72-.81 vs. .63) and concurrent validity (correlation: .41-.61 vs. .28) were higher for negatively framed than positively framed subscales. Results indicate that the caregiving experience is complex. The parents experienced high caregiver's esteem and moderate family support, but also negative impacts on finances and schedule, and to a lesser degree, health. Compared to non-parental caregivers, parental caregivers experienced higher esteem and more impact on finances and schedule.