造血干细胞移植后患儿造血重建期多症状负担的纵向调查  

Longitudinal investigation of multisymptom burden during hematopoietic reconstitution in children after hematopoietic stem cell transplantation

作　　者：林耿 孙霁雯 何梦雪 沈南平[2] 何春蕾 钱慧敏 Lin Geng;Sun Jiwen;He Mengxue;Shen Nanping;He Chunlei;Qian Huimin(Department of Hematology-Oncology,Shanghai Children′s Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Nursing,Shanghai Children′s Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;School of Nursing,Shanghai Jiao Tong University,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心血液肿瘤科,上海200127 [2]上海交通大学医学院附属上海儿童医学中心护理部,上海200127 [3]上海交通大学护理学院,上海200025

出　　处：《中国实用护理杂志》2025年第7期498-505,共8页Chinese Journal of Practical Nursing

基　　金：上海申康医院发展中心管理研究项目(2023SKMR-23)。

摘　　要：目的分析造血干细胞移植后患儿造血重建期的多症状负担现状及变化趋势,为移植后患儿症状的精准化管理提供参考。方法采用前瞻性纵向研究,便利抽样法选取2022年9月至2023年10月在上海交通大学医学院附属上海儿童医学中心接受造血干细胞移植的7~18岁的患儿为研究对象,采用儿童自我报告版不良事件通用术语标准量表在移植后的第0、7、14、21天调查评估移植后患儿造血重建期多个症状及负担。结果最终,共调查90例造血干细胞移植后患儿,男61例,女29例,年龄(9.98±2.96)岁。患儿在移植后第0、7、14、21天症状数量、症状严重程度、症状干扰程度分别为20.00(14.00)、18.00(14.50)、10.00(9.75)、7.50(9.75)个,0.18(0.30)、0.14(0.29)、0.08(0.13)、0.00(0.08)分,0.27(0.42)、0.19(0.30)、0.09(0.16)、0.03(0.11)分,总体比较差异均有统计学意义(Z=101.69、93.70、96.65,均P<0.01)。患儿的症状负担呈现4种不同变化趋势,包含由高到低、始终有一定的症状负担、先上升后下降以及症状负担始终较低。结论造血干细胞移植后患儿在造血重建期受到多种症状的困扰,且随着治疗时间的变化,不同症状呈现不同的变化趋势。医护人员应及时准确地评估患儿移植后的症状变化并给予针对性的干预,降低患儿的症状负担,促进患儿的治疗恢复。Objective To describe the current status and changes of multisymptom burden during the post-transplant hematopoietic reconstruction period in children with hematopoietic stem cell transplantation,and to provide reference for the precise management of symptoms in post-transplantation children.MethodsChildren aged 7-18 years who underwent hematopoietic stem cell transplantation in Shanghai Children′s Medical Centre,Shanghai Jiao Tong University School of Medicine from September 2022 to October 2023 were selected by convenience sampling method.The Pediatric Patient Reported Outcomes version of Common Terminology Criteria for Adverse Events was used to assess multiple symptoms and burden during the reconstruction period on days 0,7,14,and 21 after transplantation.ResultsFinally,90 children who underwent hematopoietic stem cell transplantation were investigated,including 61 males and 29 females,aged(9.98±2.96)years old.On days 0,7,14,and 21 after transplantation,the number of symptoms,severity of symptoms,degree of symptom interference were 20.00(14.00),18.00(14.50),and 10.00(9.75),with scores of 0.18(0.30),0.14(0.29),0.08(0.13),0.00(0.08),and 0.27(0.42),0.19(0.30),0.09(0.16),0.03(0.11),respectively.The overall differences were statistically significant(Z=101.69,93.70,96.65,all P<0.01).The symptom burden in children showed four different trajectories including higher symptom burden in the early stages and lower in the later stages,consistently high burden,high symptom burden followed by low symptom burden,and consistently low burden.ConclusionsChildren after hematopoietic stem cell transplantation are plagued by multiple symptoms during hematopoietic reconstruction,and with the treatment and time,different symptoms show different trajectories of change.Healthcare professionals should accurately assess the symptomatic changes of children after transplantation and provide targeted interventions to reduce the symptomatic burden and promote the recovery of children.

关 键 词：儿童 造血干细胞移植 患者报告结局 症状负担 纵向研究 

分 类 号：R473.72[医药卫生—护理学]