单倍体造血干细胞联合脐带间充质干细胞移植治疗急性重型再生障碍性贫血的护理

目的探讨单倍体异基因造血干细胞移植(allo-HSCT)治疗重型再生障碍性贫血(severe aplastic anemia,SAA)的护理方法。方法观察抗胸腺细胞球蛋白(antithymosyte globulin,ATG)药物应用时的不良反应、严格控制骨髓干细胞及脐带间充质干细胞(UC-MSC)的输入速度、时间,掌握移植物抗宿主病(graft vs host disease,GVHD)预防措施。结果 5例患者应用ATG药物均无反应,骨髓干细胞及UC-MSC输入顺利,未出现溶血及输血反应,全部获得异体造血重建;GVHD发生3例皮肤排异(其中2例并肝脏排异);1例肠道排异。到随访期止,除例4于+78d出院失去联系,其余4例均无病存活。结论对移植后发生的GVHD采取有效的预防护理是保证移植成功的关键。

Nursing for patients with acute severe aplastic anemia treated with combined transplantation of haploid hematopoietic and umbilical cord mesenchymal stem cells

Objective To study the nursing methods of patients with severe aplastic anemia（SAA） after transplantation of haploid hematopoietic stem cells（haplo-HSC）.Methods Toxic reaction to antithymocyte globulin（ATG） in SAA patients was observed,transfusion speed and time of bone marrow stem cells and umbilical cord-derived mesenchymal stem cells（UC-MSC） were strictly controlled,and measures were taken to prevent graft versus host disease（GVHD）.Results No toxic reaction to ATG occurred in the 5 SAA patients.Bone marrow stem cells and haplo-HSC were successfully transfused into the patients with no hemolytic and blood transfusion reaction.Heterogeneous hematopoiesis was reconstructed in all patients.Skin rejection occurred in 3 patients（2 of them were complicated by liver rejection） and intestinal rejection occurred in 1 patient.The patients survived disease-free at the end of follow-up except 1 patient who was discharged 78 days after transplantation and lost contact.Conclusion Effective nursing for patients with GVHD after transplantation is the key to the success of transplantation.