血浆置换治疗恶性浆细胞疾病的疗效观察与护理要点

目的观察血浆置换治疗恶性浆细胞疾病的疗效，总结护理要点。方法应用血浆置换联合药物治疗6例恶性浆细胞病并发充血性心力衰竭和尿毒症患者，置换期间注意患者的心肺功能变化及有无缺钙症状、荨麻疹和过敏性休克等。结果置换结束后，患者胸闷、气喘症状明显减轻，室性早搏明显减少或消失；血清白蛋白升高，免疫球蛋白明显下降（P〈0.05）。结论血浆置换能有效去除恶性浆细胞疾病患者体内的M蛋白等病理性大分子成分，稀释患者的血浆黏稠度，降低血管内压力，有利于改善患者的心功能，增进常规化疗的效果；置换期间的心电监护、应用药物防治低血钙和过敏性休克是血浆置换护理的重点。

Observation and Nursing Care for Patients with Malignant Plasmacyte Disease and Treated with Plasmapheresis

Objective To observe the curative effect of plasmapheresis for patients with malignant plasmacyte disease,so as to develop nursing care guidelines for the treatment.Methods Plasmapheresis combined with medication treatment were used to 6 patients with malignant plasmacyte diseases and complicated with congestive heart failure and uremia.Changes on heart and pulmonary function,symptoms of hypocalcemia,urticaria and allergic shock were observed during the plasmapheresis treatment.Results After plasmapheresis,the symptoms of chest tightly and asthma were relieved;ventricular premature beats were decreased or disappeared;levels of serum albumin were increased;and levels of serum immune globulins were decreased significantly(P<0.05).Conclusion Plasmapheresis treatment for patients with malignant plasmacyte diseases was proved to be effective in cleansing M protein in patient's body,diluting the plasma mucosity,decreasing intravascular pressure,and improving heart function and effects of chemotherapy.The nursing care should be focused on monitoring ECG and preventive medications for hypocalcemia and allergic shock during plasmapheresis.