儿童肝移植术后淋巴细胞增生性疾病诊疗过程的护理  

Nursing experience in the process of diagnosing and treating post-transplantation lymphoproliferative disorder

作　　者：黄明珠[1] 陆晔峰[1] 陆鹰 胡秦智 Huang Mingzhu;Lu Yefeng;Lu Ying;Hu Qinzhi(Department of Liver Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200127, China)

机构地区：[1]上海交通大学医学院附属仁济医院肝脏外科,200127

出　　处：《中国实用护理杂志》2019年第27期2124-2128,共5页Chinese Journal of Practical Nursing

摘　　要：目的探讨儿童肝移植术后常见并发症——移植后淋巴组织增生性疾病(PTLD)诊疗过程中的护理要点。方法回顾性分析21例肝移植术后发生PTLD患儿临床资料,总结归纳其预防、起病、诊断及治疗等病程中的护理要点。结果经个体化综合性治疗后,18例患儿康复,正常存活。1例患儿因消化道穿孔后并发顽固性消化道出血死亡,2例患儿进展至淋巴瘤死亡。就护理而言,在预防阶段,需注意坚持随访以便早期诊断;诊断时需取得患儿配合;美罗华治疗时需加强监护;针对消化道穿孔、梗阻及出血等并发症时也需加强相应护理。结论PTLD护理复杂,需在不同环节根据具体情况做到个体化、精细化护理。Objective To explore the key points of nursing in the process of diagnosing and treating the common complication--- post-transplantation lymphoproliferative disorder (PTLD) after pediatric liver transplantation. Methods The clinical data of 21 children with PTLD after liver transplantation. The key point of nursing in the process of prevention, onset, diagnosis and treatment was summarized. Results With the individual and combined treatments 18 patients gained remission except for 1 patient died because of perforation and sequent intractable haemorrhage and 2 patient died for the development of lymphoma. In terms of nursing, during the prevention stage, it is critical to insist the regular follow-up to make early diagnosis. More efforts should be made to obtain the children′s cooperation to complete the examination. During the infusion of rituximab, strengthened monitoring is necessary and more attention should be paid to the special nursing when other complications such as intractable haemorrhage, intestinal obstruction or perforation occurs. Conclusions The nursing care of PTLD is complicated. Individual and careful nursing regimens should be made based on the specific situations in different stages.

关 键 词：护理 移植后淋巴组织增生性疾病 儿童肝移植 美罗华 EB病毒 

分 类 号：R473.72[医药卫生—护理学]