儿童恶性肿瘤患者接受体外扩增HLA-半相合供者免疫细胞输注的不良反应分析  

Side effect analysis and nursing for childhood malignant patients who received in-vitro amplification HLA-haploidentical donor immune cell infusions

作　　者：蔡瑞卿[1] 彭彩芬[1] 覃少敏[1] 刘美玲[1] 

机构地区：[1]中山大学肿瘤防治中心儿童肿瘤科华南肿瘤学国家重点实验室,广州510060

出　　处：《中国实用护理杂志》2013年第31期36-39,共4页Chinese Journal of Practical Nursing

摘　　要：目的探讨儿童恶性肿瘤患者接受体外扩增人类白细胞抗原（HLA）-半相合供者免疫细胞输注（HDICIs）的不良反应，为如何护理此类患儿提供依据。方法2011年9月至2012年9月收治的12例儿童恶性肿瘤患者共接受92例次HDICIs，观察并记录每位患儿在HDICIs过程中、结束2h及24h内的不良反应，并为患儿提供心理护理，输注前护理，输注过程不良反应分析及护理，输注后出院宣教及随访。结果在92次HDICIs过程中，共出现20例次发热反应，其中有6例次伴畏寒、寒战，1例次伴高热惊厥，对症处理后缓解；共出现5例次轻微情绪改变；其余各例次HDICIs过程中及结束后生命体征均平稳，无恶心、呕吐、腹痛、腹泻、皮疹、水肿、过敏反应等异常反应的发生。每程HDICIs前后，所有患儿的血象及生化指标均未见明显异常。结论儿童恶性肿瘤患者接受HDICIs行免疫治疗是安全的；在整个治疗过程中重视心理护理，输注前的抗过敏治疗，重视体温监测、及时发现高热惊厥的前兆，重视不良反应的对症处理，重视随访和出院宣教对于儿童恶性肿瘤患者接受HDICIs行免疫治疗的顺利进行具有重要意义。Objective To analyze the side effects of in-vitro amplification human leukocyte antigen （HLA） -haploidentical donor immune cell infusion（HDICI） in childhood malignant patients, and to provide the basis for how to nurse these patients. Methods From September 2011 to September 2012, twelve hospitalized childhood malignant patients were recruited in Cancer Center of Sun Yat-sen University, and they received a total of 92 times of HDICIs for immunotherapy. Side effects were carefully observed both during and 2 hours and 24 hours after each infusion, and we also provided psychological nursing, pre-infusion nursing, side effect analysis and corresponding care during infusion, post-infusion education and follow- up for every childhood patient. Results Among 92 times of HDICIs, fever occurred in 20 cases, of whom 6 cases were with chills, 1 case with febrile convulsion, all achieved remission after receiving symptomatic treatment. 5 cases were also recorded with a slight change of mood. Vital signs were all stable both during and after every HDICIs; and no nausea, vomiting, abdominal pain, diarrhea, rash, swelling or allergic reaction was observed. Neither change of the hemogram nor biochemical indexes was recorded before or after every course of HDICI. Conclusions Our study showed that HDICIs for immunotherapy in childhood malignant patients were safe, and during the whole infusions, much attention should be paid both for psychological nursing, pre-infusion anti-anaphylactic treatment, temperature monitoring, discovery of the precursor of febrile convulsion promptly, symptomatic treatment against corresponding side effects, and postinfusion education and follow-up, all those above are of great importance for childhood malignant patients who received HDICIs for immunotherapy successfully.

关 键 词：儿童恶性肿瘤患者 HLA-半相合供者免疫细胞 不良反应 护理 

分 类 号：R473.73[医药卫生—护理学]