造血干细胞移植术后感染发生的因素与对症护理分析
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摘要
目的分析造血干细胞移植手术(HSCT)术后感染的相关性影响因素,探讨预防感染发生的对症护理措施。方法选取我院2016年1月～2018年1月间收治HSCT患者220例为研究对象。一方面,截取研究对象的性别、年龄、HLA配型、疾病类型、移植方式、预处理方式、ATG/ACG应用情况、GVHD患病情况作为自变量,以上述各自变量对应的术后1年内的感染发生率作为因变量建立Logistic模型,对自变量、因变量分别赋值,分析诱发HSCT术后感染的相关因素;另一方面,采用随机数字表法将220例分为两组,各110例,对照组给予常规抗感染护理,观察组给予对症抗感染护理,比较两组疗效及预后。结果 (1)多因素Logistic分析结果提示,GVHD级别与HSCT术后感染发生率呈正相关,不同HLA配型、是否应用ATG/ACG的患者的术后感染发生率间比较,差异有统计学意义(P <0.05);(2)术后1个月,观察组治疗有效率为90.91%,明显高于对照组77.27%(P <0.05);术后1年内,观察组术后感染发生率和死亡率分别为20.00%和10.91%,对照组分别为52.73%和21.82%,观察组术后感染发生率及死亡率均显著优于对照组(P<0.05)。结论 GVHD级别、选择HLA配型选择、是否应用ATG/ACG与HSCT术后的感染发生率具有显著相关性,而针对HSCT术后易感染部位、病原特点采取相关对症护理措施,则可改善疗效及预后,值得临床借鉴。
Objective To analyze the factors and symptomatic nursing of infection after hematopoietic stem cell transplantation. Methods A total of 220 cases of HSCT patients admitted to our hospital from January 2016 to January 2018 were selected as subjects.The sex,age,HLA matching,disease type,transplantation mode,pretreatment mode,ATG/ACG application and GVHD prevalence of the subjects were taken as independent variables.The incidence of infection within one year after operation corresponding to the above variables was taken as dependent variables to establish a Logistic model.The independent variables and dependent variables were assigned respectively,and the related factors inducing infection after HSCT were analyzed.The 220 cases were divided into two groups by random number table method,110 cases in each group.The control group was given routine anti-infection nursing,while the observation group was given symptomatic anti-infection nursing.The curative effect and prognosis of the two groups were compared. Results(1)Multivariate logistic analysis showed that GVHD level was positively correlated with the incidence of infection after HSCT.There were significant differences in the incidence of infection among patients with different HLA types and whether ATG/ACG was used or not(P < 0.05).(2)One month after operation,the effective rate of treatment in the observation group was 90.91%,which was significantly higher than that in the control group 77.27%(P < 0.05);Within one year after operation,the incidence and mortality of infection in the observation group were 20.00% and 10.91%,respectively,while those in the control group were52.73% and 21.82%,respectively.The incidence and mortality of infection in the observation group were significantly higher than those in the control group(P < 0.05). Conclusion GVHD grade,HLA matching selection,ATG/ACG application or not are significantly correlated with the incidence of infection after HSCT,while symptomatic nursing measures aiming at the susceptible sites and pathogenic characteristics after HSCT can improve the curative effect and prognosis,which is worthy of clinical reference.
Objective To analyze the factors and symptomatic nursing of infection after hematopoietic stem cell transplantation. Methods A total of 220 cases of HSCT patients admitted to our hospital from January 2016 to January 2018 were selected as subjects.The sex,age,HLA matching,disease type,transplantation mode,pretreatment mode,ATG/ACG application and GVHD prevalence of the subjects were taken as independent variables.The incidence of infection within one year after operation corresponding to the above variables was taken as dependent variables to establish a Logistic model.The independent variables and dependent variables were assigned respectively,and the related factors inducing infection after HSCT were analyzed.The 220 cases were divided into two groups by random number table method,110 cases in each group.The control group was given routine anti-infection nursing,while the observation group was given symptomatic anti-infection nursing.The curative effect and prognosis of the two groups were compared. Results(1)Multivariate logistic analysis showed that GVHD level was positively correlated with the incidence of infection after HSCT.There were significant differences in the incidence of infection among patients with different HLA types and whether ATG/ACG was used or not(P < 0.05).(2)One month after operation,the effective rate of treatment in the observation group was 90.91%,which was significantly higher than that in the control group 77.27%(P < 0.05);Within one year after operation,the incidence and mortality of infection in the observation group were 20.00% and 10.91%,respectively,while those in the control group were52.73% and 21.82%,respectively.The incidence and mortality of infection in the observation group were significantly higher than those in the control group(P < 0.05). Conclusion GVHD grade,HLA matching selection,ATG/ACG application or not are significantly correlated with the incidence of infection after HSCT,while symptomatic nursing measures aiming at the susceptible sites and pathogenic characteristics after HSCT can improve the curative effect and prognosis,which is worthy of clinical reference.
引文
[1]汪生,刘丹波,郑晓丽,等.不同方式的造血干细胞移植术后巨细胞病毒感染的临床分析[J].中国实验血液学杂志,2015,23(5):1438-1444.
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[9]唐琪,李成媛,刘亚琪.异基因造血干细胞移植患者术后并发脑脓肿的护理[J].护理学杂志,2017,32(11):30-32.
[10]李伟达,高志勇,喻新建,等.两种HLA不全相合异基因造血干细胞移植治疗恶性血液病[J].中国实验血液学杂志,2016,24(2):562-567.
[11]王晓娜.H-2半相合小鼠双供体造血干细胞移植模型的建立及相关研究[D].北京:中国人民解放军军事医学科学院,2016.
[12]贾延辉.比较不同来源MSCs联合单倍体HSC移植对造血重建的影响[D].重庆:第三军医大学,2017.
[13]王桃,杨建民.供体来源嵌合抗原受体T细胞治疗血液系统恶性肿瘤移植后复发的研究进展[J].白血病·淋巴瘤,2017,26(11):701-704.
[14]车红,周芹.造血干细胞移植术后感染发生的因素分析与对症护理[J].河北医药,2017,39(17):2712-2714.
[15]蒋艺枝,戴艳,苏贵平,等.28例造血干细胞移植术后早期感染的临床研究[J].皖南医学院学报,2016,35(6):562-565.
[16]闻智,郝彩虹,周丽丽.异基因造血干细胞移植术后护理[J].中国病案,2016,17(4):94-96.
[2]蒋艺枝,戴艳,苏贵平,等.28例造血干细胞移植术后早期感染的临床研究[J].皖南医学院学报,2016,35(6):562-565.
[3]Tischer J,Engel N,Fritsch S,et al.Virus infection in HLA-haploidentical hematopoietic stem cell transplantation:incidence in the context of immune recovery in two different transplantation settings[J].Annals of Hematology,2015,94(10):1677-1688.
[4]王芳,赵珍.多学科合作延续护理在造血干细胞移植患者中的应用效果[J].中国临床研究,2017,30(4):572-574.
[5]叶红芳,傅荣.希望护理在造血干细胞移植术患者中的应用研究[J].临床与病理杂志,2016,36(12):1981-1985.
[6]郑晓燕,曹秀艳.单倍体造血干细胞移植骨髓采集术供者的心理护理和健康教育[J].护士进修杂志,2016,31(17):1579-1581.
[7]刘雪克.造血干细胞移植术后感染并发症临床分析[D].江苏:苏州大学,2015.
[8]王亚飞,侯彩妍,王莉莉,等.一例造血干细胞移植术后出现失语、重度GVHD并发症患儿的护理[J].中华现代护理杂志,2016,22(5):733-734.
[9]唐琪,李成媛,刘亚琪.异基因造血干细胞移植患者术后并发脑脓肿的护理[J].护理学杂志,2017,32(11):30-32.
[10]李伟达,高志勇,喻新建,等.两种HLA不全相合异基因造血干细胞移植治疗恶性血液病[J].中国实验血液学杂志,2016,24(2):562-567.
[11]王晓娜.H-2半相合小鼠双供体造血干细胞移植模型的建立及相关研究[D].北京:中国人民解放军军事医学科学院,2016.
[12]贾延辉.比较不同来源MSCs联合单倍体HSC移植对造血重建的影响[D].重庆:第三军医大学,2017.
[13]王桃,杨建民.供体来源嵌合抗原受体T细胞治疗血液系统恶性肿瘤移植后复发的研究进展[J].白血病·淋巴瘤,2017,26(11):701-704.
[14]车红,周芹.造血干细胞移植术后感染发生的因素分析与对症护理[J].河北医药,2017,39(17):2712-2714.
[15]蒋艺枝,戴艳,苏贵平,等.28例造血干细胞移植术后早期感染的临床研究[J].皖南医学院学报,2016,35(6):562-565.
[16]闻智,郝彩虹,周丽丽.异基因造血干细胞移植术后护理[J].中国病案,2016,17(4):94-96.