白血病患儿鞘内注射后去枕平卧时间对并发症的影响研究
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摘要
目的探讨白血病患儿鞘内注射后不同去枕平卧时间对并发症发生情况的影响,以确定适宜的术后去枕平卧时间,提高患儿耐受性。方法 2017年6月5日—12月28日,选取北京市某三级甲等儿童专科医院处于维持治疗阶段,需进行鞘内注射的白血病患儿为研究对象,按照患儿入院先后顺序,应用随机数字表将患儿随机分为3组,鞘内注射后分别去枕平卧2 h、3 h、4 h,观察患儿去枕平卧期间及鞘内注射后1周内并发症的发生情况、患儿对去枕平卧体位的耐受程度以及去枕平卧期间患儿的主要活动。结果共有180例患儿完成研究,每组60例,3组在去枕平卧期间及鞘内注射后1周内并发症发生情况比较,差异无统计学意义(P>0.05);组间去枕平卧体位的耐受性比较,差异具有统计学意义(P<0.05),去枕平卧2 h患儿耐受性最好;3组平卧期间的主要活动比较,差异无统计学意义(P>0.05),卧床时间越长,患儿生理需求越多。结论白血病患儿鞘内注射后去枕平卧2 h不增加并发症的发生率,且能够提高患儿的耐受性,建议白血病患儿鞘内注射后去枕平卧2 h。
Objective To explore the effects of different lengths of supine position after intrathecal chemotherapy on occurrence of complications in children with leukemia,in order to determine an optimum length of supine position for improving comfort. Methods Clinical experimental design was adopted,and children patients were assigned into 3 groups according to the sequence of admission using random table number,including supine position for 2 hours,3 hours,and 4 hours after intrathecal chemotherapy. Complications that occurred during supine position and 1 week after intrathecal chemotherapy were recorded. The level of tolerance and activities during supine position were also recorded. Results Totally 180 children were included in this study with 60 cases in each group. There was no significant difference in the incidence of complications among three groups during supine position and in the following week(P >0.05). Difference in the level of tolerance among groups had significant difference(P<0.05),and the 2-hour group had the best tolerance. There was no difference in activities during supine position among three groups(P >0.05). More physiological needs were observed for longer length of supine position. Conclusion Two hours for supine position after intrathecal chemotherapy does not increase the incidence of complications in children with leukemia,and the level of tolerance would also be improved,which would be recommended.
Objective To explore the effects of different lengths of supine position after intrathecal chemotherapy on occurrence of complications in children with leukemia,in order to determine an optimum length of supine position for improving comfort. Methods Clinical experimental design was adopted,and children patients were assigned into 3 groups according to the sequence of admission using random table number,including supine position for 2 hours,3 hours,and 4 hours after intrathecal chemotherapy. Complications that occurred during supine position and 1 week after intrathecal chemotherapy were recorded. The level of tolerance and activities during supine position were also recorded. Results Totally 180 children were included in this study with 60 cases in each group. There was no significant difference in the incidence of complications among three groups during supine position and in the following week(P >0.05). Difference in the level of tolerance among groups had significant difference(P<0.05),and the 2-hour group had the best tolerance. There was no difference in activities during supine position among three groups(P >0.05). More physiological needs were observed for longer length of supine position. Conclusion Two hours for supine position after intrathecal chemotherapy does not increase the incidence of complications in children with leukemia,and the level of tolerance would also be improved,which would be recommended.
引文
[1]江载芳,申昆玲,沈颖.诸福堂实用儿科学[M].8版.北京:人民卫生出版社,2015:2351.
[2]Yues B,Stefan S,Helene C,et al.The EORTC children's leukemia group:preclinical and clinical research and resulting achievements[J].EJC Supplements,2012,10(1):39-45.
[3]Pui CH,Mullighan CG,Evans WE,et al.Pediatric acute lymphoblastic leukemia:where are we going and how do we get there?[J].Blood,2012,120(6):1165-1174.
[4]Pui CH,Howard S.Current management and challenges of malignant disease in the CNS in paediatric leukaemia[J].Lancet Oncol,2008,9(3):257-268.
[5]Mitri Z,Siddiqui MT,Rassi FE,et al.Sensitivity and specificity of cerebrospinal fluid flow cytometry for the diagnosis of leukemic meningitis in acute lymphoblastic leukemia/lymphoma[J].Leuk Lymphoma,2014,55(7):1498-1500.
[6]魏会平,廖宁.血液肿瘤患儿鞘内注射混有微量长春新碱的甲氨蝶呤后5年随访分析[J].中华实用儿科临床杂志,2013,28(15):1177-1180.
[7]尤黎明,吴瑛.内科护理学[M].4版.北京:人民卫生出版社,2011:359.
[8]鲍迎芳,唐玉华,刘聪.术后不同卧床体位对腰硬联合麻醉后腰痛及头痛发生率的影响[J].现代护理,2007,13(2):146-147.
[9]Robert LF.Lumbar puncture and post-dural puncture headaches:implications for the emergency physician[J].J Emerg Med,2008,35(2):149-159.
[10]严伟玲,窦珍珍,陈天明,等.儿童腰椎穿刺后平卧时间长短对并发症的影响[J].中华实用儿科临床杂志,2014,29(12):914-918
[11]江载芳,申昆玲,沈颖.诸福堂实用儿科学[M].8版.北京:人民卫生出版社,2015:2356.
[12]严伟玲,窦珍珍,陈天明,等.儿童腰椎穿刺后平卧时间长短对并发症的影响[J].中华实用儿科临床杂志,2014,29(12):914-918.
[13]兰群儒.腰椎穿刺术后不同卧位对患者舒适的影响[J].中外健康文摘,2013,10(12):217-218.
[14]虎洁婷,李晓丽,章江琳,等.缩短腰椎穿刺术后绝对卧床时间对患者术后并发症影响的Meta分析[J].解放军护理杂志,2018,35(4):9-15.
[15]Hunter M,McDowell L,Hennessy R,et al.An evaluation of the Face Pain Scale with young children[J].J Pain Symptom Manag,2000,20(2):122-129.
[16]Wong DL,Baker CM.Pain in children:comparison of assessment scales[J].Pediatr Nurs,1988,14(1):9-17.
[17]Downie WW,Leatham PA,Rhind VM.Studies with pain rating scale[J].Ann Rheum Dis,1978,37(4):378-381.
[18]WHO.抗癌药物急性及亚急性毒性分级标准判断(WHO标准)[J].癌症,1992(3):254.
[19]张仙玲.小儿白血病患者骨髓和腰椎穿刺疼痛控制及循证护理干预[J].中国肿瘤临床与康复,2013,20(12):1416-1418.
[20]李小丽,李汝清.强化护理在儿童急性白血病鞘内注射中的应用[J].中国社区医师(医学专业),2012,14(330):293-294.
[21]鲍亚丽.中枢神经系统白血病鞘内注射化疗的观察及护理[J].中国实用神经疾病杂志,2012,15(15):90-91.
[22]Raquel O,Alberto E,Carlos C,et al.Practical aspects of the use of intrathecal chemotherapy[J].Farm hosp,2017,41(1):105-129.
[23]钱静.家长培养学龄前儿童注意力的几点做法[J].教育导刊,2013,3(15):87-88.
[24]吴海鹰,祖薇薇,陈非.综合护理干预在小儿腰椎穿刺术后的应用效果[J].中国实用医药,2016,11(4):235-237.
[25]Gil LG,Clemente BS,Oliveras AM,et al.Dosage of drugs for cerebrospinal administration[J].Farm Hosp,2005,29(3):185-190.
[26]Blaney SM,Poplack DG,Godwin K,et al.Effect of body position on ventricular CSF methotrexate concentration following intralumbar administration[J].J Clin Oncol,1995,13(1):177-179.
[27]Giebel S,Krawczyk-Kulis M,mczyk-Cioch M,et al.Prophylaxis and therapy of central nervous system involvement in adult acute lymphoblastic leukemia:recommendations of the Polish Adult Leukemia Group[J].Pol Arch Med Wewn,2008,118(6):356-361.
[2]Yues B,Stefan S,Helene C,et al.The EORTC children's leukemia group:preclinical and clinical research and resulting achievements[J].EJC Supplements,2012,10(1):39-45.
[3]Pui CH,Mullighan CG,Evans WE,et al.Pediatric acute lymphoblastic leukemia:where are we going and how do we get there?[J].Blood,2012,120(6):1165-1174.
[4]Pui CH,Howard S.Current management and challenges of malignant disease in the CNS in paediatric leukaemia[J].Lancet Oncol,2008,9(3):257-268.
[5]Mitri Z,Siddiqui MT,Rassi FE,et al.Sensitivity and specificity of cerebrospinal fluid flow cytometry for the diagnosis of leukemic meningitis in acute lymphoblastic leukemia/lymphoma[J].Leuk Lymphoma,2014,55(7):1498-1500.
[6]魏会平,廖宁.血液肿瘤患儿鞘内注射混有微量长春新碱的甲氨蝶呤后5年随访分析[J].中华实用儿科临床杂志,2013,28(15):1177-1180.
[7]尤黎明,吴瑛.内科护理学[M].4版.北京:人民卫生出版社,2011:359.
[8]鲍迎芳,唐玉华,刘聪.术后不同卧床体位对腰硬联合麻醉后腰痛及头痛发生率的影响[J].现代护理,2007,13(2):146-147.
[9]Robert LF.Lumbar puncture and post-dural puncture headaches:implications for the emergency physician[J].J Emerg Med,2008,35(2):149-159.
[10]严伟玲,窦珍珍,陈天明,等.儿童腰椎穿刺后平卧时间长短对并发症的影响[J].中华实用儿科临床杂志,2014,29(12):914-918
[11]江载芳,申昆玲,沈颖.诸福堂实用儿科学[M].8版.北京:人民卫生出版社,2015:2356.
[12]严伟玲,窦珍珍,陈天明,等.儿童腰椎穿刺后平卧时间长短对并发症的影响[J].中华实用儿科临床杂志,2014,29(12):914-918.
[13]兰群儒.腰椎穿刺术后不同卧位对患者舒适的影响[J].中外健康文摘,2013,10(12):217-218.
[14]虎洁婷,李晓丽,章江琳,等.缩短腰椎穿刺术后绝对卧床时间对患者术后并发症影响的Meta分析[J].解放军护理杂志,2018,35(4):9-15.
[15]Hunter M,McDowell L,Hennessy R,et al.An evaluation of the Face Pain Scale with young children[J].J Pain Symptom Manag,2000,20(2):122-129.
[16]Wong DL,Baker CM.Pain in children:comparison of assessment scales[J].Pediatr Nurs,1988,14(1):9-17.
[17]Downie WW,Leatham PA,Rhind VM.Studies with pain rating scale[J].Ann Rheum Dis,1978,37(4):378-381.
[18]WHO.抗癌药物急性及亚急性毒性分级标准判断(WHO标准)[J].癌症,1992(3):254.
[19]张仙玲.小儿白血病患者骨髓和腰椎穿刺疼痛控制及循证护理干预[J].中国肿瘤临床与康复,2013,20(12):1416-1418.
[20]李小丽,李汝清.强化护理在儿童急性白血病鞘内注射中的应用[J].中国社区医师(医学专业),2012,14(330):293-294.
[21]鲍亚丽.中枢神经系统白血病鞘内注射化疗的观察及护理[J].中国实用神经疾病杂志,2012,15(15):90-91.
[22]Raquel O,Alberto E,Carlos C,et al.Practical aspects of the use of intrathecal chemotherapy[J].Farm hosp,2017,41(1):105-129.
[23]钱静.家长培养学龄前儿童注意力的几点做法[J].教育导刊,2013,3(15):87-88.
[24]吴海鹰,祖薇薇,陈非.综合护理干预在小儿腰椎穿刺术后的应用效果[J].中国实用医药,2016,11(4):235-237.
[25]Gil LG,Clemente BS,Oliveras AM,et al.Dosage of drugs for cerebrospinal administration[J].Farm Hosp,2005,29(3):185-190.
[26]Blaney SM,Poplack DG,Godwin K,et al.Effect of body position on ventricular CSF methotrexate concentration following intralumbar administration[J].J Clin Oncol,1995,13(1):177-179.
[27]Giebel S,Krawczyk-Kulis M,mczyk-Cioch M,et al.Prophylaxis and therapy of central nervous system involvement in adult acute lymphoblastic leukemia:recommendations of the Polish Adult Leukemia Group[J].Pol Arch Med Wewn,2008,118(6):356-361.