目的 比较重组人粒细胞集落刺激因子(rhG-CSF)皮下注射(SC)与静脉注射(IV)治疗非霍奇金淋巴瘤(NHL)化疗后中性粒细胞减少症(CIN)的效果.方法 收集该院血液科2015年1月至2020年8月接受rhG-CSF治疗CIN的NHL患者资料.采用倾向性评分(PS)匹配和PS回归调整以控制混杂偏倚.主要结局指标包括:患者中性粒细胞绝对值(ANC)恢复至≥0.1×109/L和≥0.5×109/L所需时间、CIN恢复速率;次要结局指标包括:感染发生率及中性粒细胞减少性发热(FN)持续时间.结果 308例患者(SC组108例,IV组200例)符合纳入排除标准.多种PS方法处理后的统计结果一致表明,与IV组相比,SC组ANC恢复至≥0.1×109/L和≥0.5×109/L所需时间更短(P<0.05),CIN恢复速率更快(P<0.05),感染发生率更低(P<0.05);两组间FN持续时间无明显差异(P>0.05).结论 SC rhG-CSF治疗N H L患者CIN的效果明显优于IV rhG-CSF.

目的:通过实施护理专案改善提高血液科移植病房低年资护士配置化疗药物时职业防护依从性.方法:通过现场观察和问卷调查,按照专案改善步骤对血液科移植病房低年资护士配置化疗药物时职业防护依从性进行观察统计,采取可行的干预措施,比较专案改善前后的护士配置化疗药物时职业防护依从性.结果:实施专案改善后呼吸科医护人员的血液科移植病房低年资护士配置化疗药物时职业防护依从性由实施前49.9％提高至96.8％.结论:通过护理专案改善找出临床护理中存在问题的具体原因,制定针对性强的干预措施,从而能有效提高护理质量.

重症再生障碍性贫血(SAA)是由多种原因导致造血干细胞数量减少和/或功能障碍所引起的一类贫血[1].临床表现为严重的贫血、感染和出血,如不及时治疗,很快危及生命.根据2006年美国血液协会建议,≤40岁的患者首选异基因造血干细胞移植.人类白细胞抗原(HLA)相合同胞供者和无关供者的造血细胞移植临床应用较多,但90%患者因找不到HLA相合的干细胞来源而延误移植最佳时期.故对于无HLA相合供者的SAA患者,选择性应用HLA半相合骨髓联合脐血和外周血造血干细胞混合移植,可及时治疗SAA,提高移植成功率,降低HLA半相合造血干细胞移植中移植物抗宿主病(GVHD)的风险[2,3].2011年1月,本院血液科成功为1例SAA患者施行HLA半相合清髓性骨髓联合脐血和外周血造血干细胞混合移植,现将护理报告如下.

<正>造血干细胞移植患者由于预处理期间腐蚀性、刺激性药物用量大,液体量多,因此需长时间留置中心静脉置管(简称CVC),虽然3MTMTegadermTMHP型透明敷贴固定效果明显,不易脱管,临床上广泛用其固定深静脉导管,但其在使用过程中仍会出现一些不良反应或并发症,其中以过敏性皮炎为常见并发症之一。使用3MTMTegadermTMHP型透明敷贴固定的CVC导管留置一段时间后,穿刺周围皮肤出现潮红、瘙痒、湿疹样小水泡甚至破裂,且更换敷贴时对患者造成的疼痛感,不仅影响

Objective To evaluate the clinical effect of itraconazole in prevention of invasive fungal infections in allogeneic hematopoietic stem cell transplantion.Methods In this retrospective study,110patients receiving allogeneic hematopoietic stem cell transplants were administed itraconazole or fluconazole for prevention of fungal infection.The occurrence and prognosis of invasive fungal infection,and the side effect of both pyrroles were observed.Results Proven and probable invasive fungal infections occurred in 5of 69itraconazole recipients(7.2%)and in 8of 41fluconazole recipients(19.5%)during the first 180days after transplantation,the difference had statistical significance(P<0.05).The fatality rate related to fungal infection had no statistical difference between the two groups(2.9%vs.7.3%).The occurrence of itraconazole adverse reactions were more than fluconazole(26.9%vs.7.0%),and both itraconazole and fluconazole were well tolerated.Conclusion Itraconazole significantly reduces the incidence of invasive fungal infection in the patients receiving allogeneic hematopoietic stem cell transplants,and it is a effective and safe prophylaxis.

Objective To improve skin-disinfection method for patients scheduled for hematopoietic stem cell transplantation before they enter the laminar flow ward,and to achieve better disinfection effect.Methods Totally,46 patients were randomized into two groups,with 23 cases in each group.The two groups were asked to immerse themselves into chlorhexidine acetate for skin disinfection.After that,the observation group additionally were rubbed with 0.05% iodophor all over their body.After disinfection,nurses took samples from patients′ body,totaling 6 swabs for 6 varied parts each person for bacteria culture to evaluate the disinfection effect.Results Totally,11 samples were tested positive of bacterial culture in the control group and 3 in the observation group,with significant difference between the two groups(P<0.05).Conclusion The improved method has better disinfection effect than traditional one.It can be used in clinical practice as a routine disinfection method.

目的:探讨使用Quaqdrant系统腰椎减压+Sexant经皮椎弓根螺钉内固定治疗老年性腰椎滑脱症围手术期的护理.方法:对68例老年性腰椎滑脱症微创手术治疗的患者详细的术前和术后的评估,进行针对性的心理护理及术前指导,做好充分的术前准备,保证手术顺利进行.术后密切观察病情变化,保证正确的体位,缓解疼痛症状.制定相应的护理措施,有效地实施针对性的护理,预防各种并发症的发生,指导患者进行有效的功能锻炼.结果:68例老年腰椎滑脱病人安全度过围手术期.结论:在围手术期给予正确的指导和护理有利于患者加深对疾病和手术的认识,有利于患者的康复.

造血干细胞移植(hematopoietic stem cell transplantation,HSCT)及大剂量化学药物治疗是目前作为治疗血液系统恶性疾病和其他部分实体瘤的重要手段.患者接受HSCT的过程中及大剂量化疗后均可使中性粒细胞及相关免疫细胞减少或缺乏,可导致患者出现严重感染等并发症,为了减少并发症,患者应入住无菌层流病房与外界隔离,严格实施空气、食物以及患者的无菌化,尽可能减少外来及机体内感染,以提高疾病治愈率及患者的生存质量~([1]).因此无菌层流病房成为现代血液病治疗的必不可少的设施,其优点不言而喻,但不利因素也随之产生。

患者男,23岁,体重52 kg,血型为O型Rh阳性.确诊慢性髓细胞白血病慢性期3个月.拟行非血缘异基因外周血造血干细胞移植(allO-PBSCT),于2008年11月22日入院,既往史无特殊.供者男性,血型为AB型Rh阳性,HLA-A、B、CW、DRBl、DQBl等位基因位点全相合.预处理方案为经典Bu/Cy方案,采用环孢素(CsA)+短程甲氨蝶呤(MTX)+抗淋巴细胞免疫球蛋白(ATG-Fresenius S)+吗替麦考酚酯胶囊(MMF)预防移植物抗宿主病(GVHD),前列腺素El、熊去氧胆酸、低分子肝素钙预防肝静脉闭锁综合征(HVOD).