CAR-T治疗急性白血病患者严重并发症CRS与CRES救治的规范化护理*

doi:10.3969/j.issn.1671-2587.2021.03.020

临床输血与检验 ›› 2021, Vol. 23 ›› Issue (3): 384-388.DOI: 10.3969/j.issn.1671-2587.2021.03.020

CAR-T治疗急性白血病患者严重并发症CRS与CRES救治的规范化护理^*

张佳思, 谭方方, 袁嘉, 符刚, 阮潜瑛, 姜盛, 黎诗琦, 钱程

400038 重庆陆军军医大学第一附属医院血液科（张佳思,谭方方,袁嘉,符刚,姜盛）,输血科（阮潜瑛）,医院生物治疗中心（黎诗琦,钱程）

收稿日期:2020-07-09 出版日期:2021-06-20 发布日期:2021-06-22
通讯作者: 谭方方,女,主要从事血液肿瘤患者临床护理方面研究,（E-mail）419354249@qq.com。
作者简介:张佳思（1974-）,女,四川达州人,主任护师,本科,主要从事血液肿瘤患者护理方面研究,（E-mail）13637771933@163.com。
基金资助:
*本课题受重庆市科卫联合医学科研项目（No.2018MSXM046）、国家科技部“ 国家重点研发计划重点专项”（No.2016YFC1303400）资助

Standardized Nursing of Acute Leukemia Patients with Serious Complications after CAR-T Cell Therapy

ZHANG Jia-si, TAN Fang-fang, YUAN Jia, et al

The First Affiliated Hospital of Army Medical University (Southwest Hospital), Chongqing 400038

Received:2020-07-09 Online:2021-06-20 Published:2021-06-22

摘要/Abstract

摘要： 目的总结10例难治、复发的急性淋巴细胞白血病患者实施CAR-T治疗后出现严重并发症的规范化护理经验。方法对10例难治、复发的急性淋巴细胞白血病患者实施CAR-T治疗后出现的严重细胞因子风暴及脑风暴并发症,积极采取科学有效的护理：严密监测患者体温、血压、意识、瞳孔、语言表达,有无抽搐的发生及抽搐发生的前兆表现;尽早实施血浆置换;使用托珠单抗注射液、呼吸机等抢救药物及器材;意识丧失、抽搐发作时及时保持呼吸道畅通;做好患者及家属的健康宣教及心理护理。结果 10例患者中除2例因家属中途放弃治疗外,其余均救治护理成功并顺利出院,护理质量合格率及患者满意度均为100%,均无护理相关并发症发生。结论护士对CAR-T治疗严重并发症能做到：早识别、早救治、早护理,可减轻患者痛苦,提高救治的成功率,保障更好的治疗效果。

关键词: CAR-T, 急性淋巴细胞白血病, 严重并发症, 护理

Abstract: Objective To summarize the standardized nursing experience of 10 patients with refractory and recurrent acute lymphoblastic leukemia who had serious complications after CAR-T treatment. Methods We closely monitored the patient's body temperature, blood pressure, consciousness, pupil, language performance, convulsion or manifestations of pre-convulsion. The central venous catheter was placed to conduct plasma exchange (PE) timely. Sufficient tocilizumab, glucocorticoid, ventilator and other rescue drugs and equipments were prepared. We kept the patient's respiratory tract unobstructed during loss of consciousness and seizures. Health education and psychological nursing for patients and their families were strengthen. Results 8 patients were recovered and discharged and 2 cases gave up treatments after CRS. No nursing-related complication occurred and we got 100% satisfaction rate from patients. Conclusion Early judgment and nursing intervention could alleviate the complication of CAR-T cell therapy and improve the rescue rate.

Key words: CAR-T cell therapy, Acute lymphoblastic leukemia, Serious complications, Nursing

中图分类号:

R446.6

张佳思, 谭方方, 袁嘉, 符刚, 阮潜瑛, 姜盛, 黎诗琦, 钱程. CAR-T治疗急性白血病患者严重并发症CRS与CRES救治的规范化护理^*[J]. 临床输血与检验, 2021, 23(3): 384-388.

ZHANG Jia-si, TAN Fang-fang, YUAN Jia, et al. Standardized Nursing of Acute Leukemia Patients with Serious Complications after CAR-T Cell Therapy[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2021, 23(3): 384-388.

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CAR-T治疗急性白血病患者严重并发症CRS与CRES救治的规范化护理^*

Standardized Nursing of Acute Leukemia Patients with Serious Complications after CAR-T Cell Therapy

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