异基因造血干细胞移植后急性皮肤型移植物抗宿主病患者的临床特点及护理方法  

Clinical Characteristics and Nursing Methods of Patients with Acute Cutaneous Graft-Versus-host Disease after Allogeneic Hematopoietic Stem Cell Transplantation

作　　者：卢丹 胡艳 LU Dan;HU Yan(Department of Hematology,West China Hospital Affiliated to Sichuan University,Chengdu,Sichuan 610041)

机构地区：[1]四川大学华西医院血液科/四川大学华西护理学院,四川成都610041

出　　处：《医学临床研究》2020年第8期1201-1203,1206,共4页Journal of Clinical Research

摘　　要：【目的】探讨异基因造血干细胞移植后并发急性皮肤型移植物抗宿主病(GVHD)患者的临床特点及护理方法。【方法】回顾性分析2013年1月至2015年1月在本院诊治的42例异基因造血干细胞移植患者的临床特点,分析急性皮肤型GVHD的发生率、临床特点及护理方法。【结果】42例患者中术后并发急性皮肤型GVHD的15例,发生率35.7%,其中男5例,女10例。其中急性粒细胞性白血病(AML)5例(33.3%)、急性淋巴细胞性白血病(ALL)2例(13.3%)、骨髓增生异常综合征(MDS)4例(26.7%)、再生障碍性贫血(AA)2例(13.3%)、慢性髓细胞白血病(CML)1例(6.7%)、急性混合细胞白血病(MAL)1例(6.7%)。同胞供者13例(86.7%)、无关供者2例(13.3%)。本组15例急性皮肤型GVHD皮疹出现时间最早为干细胞输注后3 d,最晚为38 d;皮疹最初表现为轻微的弥漫性红斑及丘疹,类似麻疹、猩红热样药疹,可有轻微疼痛或瘙痒。初发于手掌或足底,渐扩散至全身;早期皮损多以毛囊性分布;最常见的发生部位是手掌、头面部和耳后;皮损严重程度为Ⅰ级和Ⅱ级。15例患者均采用了心理护理,沟通后患者的情绪明显好转,能够积极面对病情,均能以最佳心态接受治疗和护理,均未发生严重感染,15例急性GVHD患者累及皮肤均为Ⅰ-Ⅱ度,无一例出现皮肤水泡及皮肤完整性受损,无一例发生医用粘胶相关性皮损。15例患者中13例患者经过积极治疗及精心护理后皮疹消退出院,有2例发生在甲基强的松龙减量后d3皮疹范围扩展明显,且颜色明显变红,由于护士及时发现并处理,皮疹很快得到了控制,2例皮疹明显好转出院。15例急性GVHD患者均获得异基因造血干细胞移植成功。【结论】急性皮肤型GVHD有一定的临床特点,观察皮肤症状,及早发现并干预有助于改善预后、保证造血干细胞移植的顺利完成。【Objective】To investigate the clinical characteristics and nursing methods of patients with acute skin graft-versus-host disease(GVHD)after allogeneic hematopoietic stem cell transplantation.【Methods】The clinical characteristics of 42 patients with allogeneic hematopoietic stem cell transplantation who were treated in our hospital from January 2013 to January 2015 were retrospectively analyzed.The incidence,clinical characteristics and nursing methods of acute skin type GVHD were analyzed.【Results】Among the 42 patients,15 cases were complicated with acute skin GVHD,the incidence rate was 35.7%,including 5 males and 10 females.There were 5 cases of acute myeloid leukemia(AML)(33.3%),2 cases of acute lymphoblastic leukemia(ALL)(13.3%),4 cases of myelodysplastic syndrome(MDS)(26.7%),2 cases of aplastic anemia(AA)(13.3%),1 case of chronic myeloid leukemia(CML)(6.7%),1 case of acute mixed cell leukemia(MAL)(6.7%).There were 13 sibling donors(86.7%)and 2 unrelated donors(13.3%).In this group,15 cases of acute skin type GVHD rash appeared at the earliest 3 days after stem cell infusion,and the latest time was 38 days;the rash initially manifested as mild diffuse erythema and papules,similar to measles and scarlet fever like drug eruption,with slight pain or pruritus.The most common sites were palms,head and face,and behind ears.The severity of the lesions was gradeⅠand gradeⅡ.All the 15 patients were treated with psychological nursing.After communication,their mood improved significantly,they were able to face the disease positively,and they were able to accept treatment and nursing with the best mentality.No serious infection occurred.The skin involved in 15 patients with acute GVHD was gradeⅠtoⅡ.No skin blister and skin integrity damage occurred,and no medical adhesive related skin lesions occurred.Among the 15 patients,13 patients'rash subsided and discharged after active treatment and careful nursing.2 cases occurred after the reduction of methylprednisolone.The range of rash was obviously extend

关 键 词：移植物抗宿主病/护理 皮肤移植 造血干细胞移植 

分 类 号：R457.7[医药卫生—治疗学]