干细胞移植术后环孢素相关脑病早期预警评分表的制定及应用  

Development of an early warning score scale for cyclosporine-related encephalopathy after hematopoietic stem cell transplantation and its application

作　　者：刘燕晔[1] 戴霞[2] 陈英华[1] 李智[1] 范静[1] LIU Yanye;DAI Xia;CHEN Yinghua(Stem Cell Transplantation Ward,the First Affiliated Hospital of Guangxi Medical University,Guangxi,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院干细胞移植病房,南宁市530021 [2]广西医科大学第一附属医院内分泌科,南宁市530021

出　　处：《河北医药》2024年第24期3726-3730,共5页Hebei Medical Journal

基　　金：广西壮族自治区卫生和计划生育委员会自筹经费科研课题(编号: Z2015527)。

摘　　要：目的探讨造血干细胞移植(hematopoieitic stem cell transplantation,HSCT)术后运用环孢素(cyclosporine,CsA)相关脑病患者的改良早期预警评分表的制定及应用效果。方法选取2017年1月至2022年1月收治的行HSCT术后采用CsA治疗产生CsA相关脑病患者125例作为研究对象,运用MEWS评分表找出截断点,在原有MEWS评分表的基础上增加CsA浓度、白蛋白(alibumin,ALB)参数并进行赋值、信度、效度验证,建立一个能准确帮助医护人员早期识别CsA相关脑病的校正版MEWS评分表,运用校正版MEWS评分表评估2022年2月~2022年7月收治的行干细胞移植术后运用CsA治疗的27例CsA相关脑病患者的截断点,针对评估结果进行干预,观察CsA相关脑病患者的发生率。结果单因素分析证实:心率、收缩压、呼吸频率、体温、意识、CsA血药浓度和Alb均是影响HSCT手术及CsA相关脑病患者的单因素(P<0.05)。Logistic回归分析证实:心率、收缩压、呼吸频率、体温、意识、CsA血药浓度和Alb均是影响校正版MEWS评分量表的多因素(P<0.05)。评估者信度检验:所纳检验对象与评估者有相关关系,ICC=0.904(0.823≤95%CI≤0.978),说明校正版MEWS评分量表的评定者之间的信度良好。校正版MEWS评分量表的内部一致性检验:校正版MEWS评分量表的总Cronbach'sα系数为0.867,各条目的Cronbach'sα系数(0.815~0.859)良好,条目得分系数与校正版MEWS评分量表总分的相关系数为0.452~0.925(P<0.05),说明各条目能达到评估目的。校正版MEWS评分量表6个条目平均CVR为0.880,探索性因子分析显示各条目结构良好。主成分分析法结果显示,公因子心率、收缩压的生成特征值均>1,能解释78.652%的总变异量。所纳125例HSCT术后CsA治疗患者中,患CsA相关脑病者占总数的16.80%。运用校正版MEWS评分量表对2022年2~7月收治的行HSCT术后CsA治疗的27例患者进行预警干预(医疗干预)后CsA相关脑病发生率为3.70%,较2017�Objective To develop an modified early warning score(MEWS)scale to assess cyclosporine(CsA)-related encephalopathy after hematopoietic stem cell transplantation(HSCT),and to explore its application.Methods A total of 125 patients with CsA-related encephalopathy treated with CsA after HSCT from January 2017 to January 2022 were selected as the study objects.The cutoff point was found out using the MEWS.On the basis of the original MEWS,the newly developed scale was created by adding parameters of CsA and albumin(ALB).Assignment and assessment of the reliability and validity were performed.A new version of MEWS was then established to accurately help medical staff to identify CsA-related encephalopathy at an early stage.Using the new version of MEWS,the cutoff point of 27 patients with CsA-related encephalopathy who were treated with CsA after HSCT from February 2022 to July 2022 was calculated.Intervenes were given according to the evaluation results.The incidence of CsA-related encephalopathy was recorded.Results Univariate analysis confirmed that heart rate,systolic blood pressure,respiratory rate,body temperature,consciousness,blood concentration of CsA and Alb were all significantly related with CsA-related encephalopathy after HSCT(P<0.05).Logistic regression analysis confirmed that heart rate,systolic blood pressure,respiratory rate,body temperature,consciousness,blood concentration of CsA and Alb were all independent factors affecting the new version of MEWS in distinguishing CsA-related encephalopathy after HSCT(P<0.05).Evaluator reliability test showed a correlation between the test object and the evaluator,with an intraclass correlation coefficient(ICC)of 0.904(95%confidence interval[CI]0.823,0.978),indicating a reliability of the new version of MEWS in distinguishing CsA-related encephalopathy after HSCT.Internal consistency test of new version of MEWS showed the total Cronbach'sαof 0.867,and the Cronbach'sαof each item was good(0.815-0.859).The correlation coefficient between the coefficient of each

关 键 词：干细胞移植术 环孢素相关脑病 改良早期预警评分表 制定及应用 

分 类 号：R457.7[医药卫生—治疗学]