Objective:To further explore the symptom experience and coping strategies of patients with multiple myeloma, so as to provide reference for the formulation of symptom management programs.Methods:Objective sampling method was used to conduct semi-structured in-depth interviews on 15 patients with multiple myeloma in Hematology Department of Nanjing Drum Tower Hospital from December 2021 to June 2022 and the model of symptom management theory was used as the framework to construct an interview outline. The Colaizzi 7-step analysis method was used to analyze data and extract themes.Results:Three main themes were summarized: symptom experience (obvious symptom perception, poor symptom assessment ability, negative symptom response); symptom management strategy (vague knowledge of symptom management, hope to get professional guidance, expect to get continuity of management); symptom management outcomes (recurrent anxiety, reordering, adaptive behavior).Conclusions:Patients with multiple myeloma have diverse and complex real symptom experience in different periods. Medical staff should pay attention to patients′ symptom response and coping needs and develop a systematic symptom management plan, so as to help them create better self-management and improve their quality of life.

造血干细胞移植后,患者可能会发生口腔黏膜炎,影响患者的治疗效果、治疗依从性.针对造血干细胞移植患者实施有效的护理干预能预防口腔黏膜炎的发生,对于已经发生口腔黏膜炎患者实施护理干预也能减轻患者痛苦.综述造血干细胞移植发生口腔黏膜炎的危险因素,并对防治措施与护理干预措施进行总结,为造血干细胞移植患者口腔护理提供参考.

Objective:To investigate the current status of anticipatory grief among caregivers of major relatives of hospitalized patients with hematological malignancies and analyze its influencing factors.Methods:Convenience sampling method was used to select 208 primary relatives and caregivers of patients with hematological malignancies who were hospitalized in the Department of Hematology, Nanjing Drum Tower Hospital from March to November 2020. Self-designed general information questionnaire, Chinese version of Anticipatory Grief Scale, caregiver burden scale and simple coping style questionnaire were used. The current status and influencing factors of anticipatory grief among caregivers of major relatives of hospitalized patients with hematological diseases were also analyzed.Results:The expected sadness score of caregivers of major relatives of hospitalized patients with hematological malignancies was 79(72, 91). The results of multiple linear regression analysis showed that the main influencing factors of anticipatory grief among caregivers of major relatives of hospitalized patients with hematological malignancies were the stage of treatment, the severity of subjective symptoms, whether to seek medical treatment in other places, the working status of caregivers of major relatives was unemployed, relationships with patients were parents, caregiver burden, and negative coping styles, which explained 83.1% of the total variation.Conclusions:Anticipatory grief is more serious among the caregivers of major relatives of hospitalized patients with hematological malignancies. It is recommended that nurses in the Hematology Department detect and assess the level of anticipatory grief of caregivers in a timely manner, and give corresponding interventions according to individual differences, so as to improve the physical and mental health of the caregivers, and then improve the quality of care and promote the recovery of patients.

目的 系统总结恶性血液病患者造血干细胞移植术后2年内的生活体验.方法 检索PubMed、the Cochrane Library、Web of Science、EMbase、EBSCO、中国知网、万方、中国生物医学文献数据库、维普数据库与主题相关的质性研究,检索时间为建库至2020年12月.由2名研究者独立完成文献筛选、提取资料及文献质量评价后,采用Meta整合的方法对结果进行归纳及解释.结果 最终纳入11篇文献、36个主题,将相似的结果重新归纳最终形成3个整合结果,包括7个类别.整合结果1为造血干细胞移植术对患者造成的影响,包括3个类别:生理困扰、外在形象受损、情绪障碍;整合结果2为造血干细胞移植术后患者的内心需求,包括2个类别:渴望获得社会支持、希望尽早恢复社会功能;整合结果3为造血干细胞移植术后患者的调整,包括2个类别:心理调整、饮食与体力活动调整.结论 造血干细胞移植术后2年内是患者免疫功能重建和疾病恢复的关键时期,医护人员需深入了解这一时期患者真实生活体验及需求,并及时提供针对性的措施,引导患者适应并调整造血干细胞移植术后的生活,从而提高患者的生活质量及长期幸存率.

在抗肿瘤治疗中,化疗是常用的治疗手段,通过中心静脉导管输注化疗药物可以最大程度减少对外周血管的刺激[1].随着静疗技术的发展,人们生活水平及生活质量需求的提高,完全植入式静脉输液港被广泛应用于肿瘤化疗患者中,本文将从定义、置入路径、应用优劣势、植入方法、植入术后护理5个方面对不同部位完全植入式静脉输液港在肿瘤化疗患者中的应用现状进行综合论述,以期为患者在选择输液港植入部位提供一些参考.

目的 探究老年多发性骨髓瘤住院病人自我感受负担状况并分析其影响因素. 方法 运用一般资料表、中文版自我感受负担量表(SPBS)、焦虑自评量表、Barthel指数量表及简易应对方式问卷对南京鼓楼医院血液科103例老年多发性骨髓瘤住院病人开展调查.采用多重线性逐步回归分析老年多发性骨髓瘤住院病人自我感受负担的影响因素. 结果 103例老年多发性骨髓瘤住院病人均存在自我感受负担,SPBS平均分为(33.08±5.48)分,处于中度水平.多重线性逐步回归分析结果显示,临床分期、焦虑及消极应对方式是老年多发性骨髓瘤住院病人自我感受负担的主要影响因素. 结论 老年多发性骨髓瘤住院病人自我感受负担处于中度水平且普遍存在,因此,为了减轻病人的自我负担水平,医护人员可通过控制原发病、实施相应的心理护理、促进病人积极应对等进行针对性的干预.

总结1例淋巴瘤病人经外周静脉置入中心静脉导管后41 d体内断管漂移入心脏的护理.护理要点包括断管后的紧急处理、病情观察、心理护理、健康宣教等.通过多学科合作急救和护理,导管断端顺利取出,病人安全出院.

Objective:To further explore the self-knowledge and real experience of hemophilia patients in childbearing age, and provide evidence for nursing workers to design and implement personalized effective intervention strategies.Methods:A semi-structured in-depth interview was conducted among 10 hemophilia patients of hemophilia clinic in our hospital with the purpose sampling method. The data were analyzed by Colaizzi 7-step analysis.Results:Three major themes were refined: emotional experience (role change, fertility anxiety, lack of self-confidence in interpersonal relationships); lack of knowledge; disease benefit.Conclusion:Patients with hemophilia have diverse and complex real psychological experiences during childbearing age. Medical staff develop targeted and personalized health education strategies for patients at this stage to better prevent and treat them and improve their quality of life. Population quality.

从全程护理的角度,综述了嵌合性抗原受体T细胞(CAR-T)治疗的流程及相关并发症的护理,以期为今后建立规范统一的血液系统肿瘤CAR-T治疗护理规范提供依据.

目的 探讨第1滴和第2滴手指末梢血与患者静脉血糖值的差异,为临床采集末梢血测定血糖提供参考.方法 测定210例住院患者的空腹血糖,分别将手指末梢第1滴、第2滴血糖检测值与静脉血血糖值进行比较.结果 血糖浓度分层统计结果显示,当静脉血血糖值2.2～7.0 mmol/L时,末梢第1滴血、第2滴血的血糖值显著高于静脉血血糖值(P＜0.05,P＜0.01);当静脉血血糖值＞7.0 mmol/L时,末梢血与静脉血的血糖值差异无统计学意义(P＞0.05).整体组间比较,末梢第2滴血与静脉血血糖值比较差异有统计学意义(P＜0.01).Bland-Ahman分析结果显示,第1滴、第2滴血与静脉生化血糖检测结果、末梢第2滴血与末梢第1滴血检测结果之间显著相关(均P＜0.01);末梢第1滴血与静脉血糖检测结果的一致性较高.结论 使用便携式血糖仪监测血糖时,若按正规操作,可以使用第1滴末梢血检测血糖值,当血糖值＞7.0 mmol/L时,末梢第1滴血与第2滴血均可反映即时静脉血糖值.

?? [Abstract]? Objective? To explore the effect of physical cooling method by the use of external cooling ice-packs for treatment of the in-patients with fever. Methods? In accordance with the model of Australian JBI evidence-based health care, the evidence was applied to the clinical practice after evidence generation, and synthesis. Admitted from November 2017 to June 2018 into the hematology department in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, the hyperpyretic patients with blood disease were divided into two groups-observation group and control group randomly. 68 patients were included in each group. The patients in observation group were given by 0.5 g acetaminophen orally along with ice-packs while the patients in control group were just given by 0.5 g oral acetaminophen. The temperature lowering effect in both groups was compared and studied. Results? In the observation group, patients' temperature was (38.90±0.37)℃ before intervention, (38.85±0.36)℃ in 30 minutes after intervention, (38.63±0.52)℃ in 1 hour and (38.07±0.76)℃ in 2 hours. And those for control group were (38.89±0.39),(38.82±0.40),(38.58± 0.59),(37.90±0.67)℃,respectively. Repeated measurement analysis of variance indicated that patients' temperature showed significant differences at each point of time during the study in both group (Ftime=77.862,P＜ 0.01). The intervention methods in the two groups did not interact with different point of time (Finteraction=0.728, P＞0.05). The effect of intervention in different groups at different point of time was not significant (Fgroups=0.909, P＞ 0.05). Conclusions? The use of physical cooling method along with medication is proved to be not significant in the patients' temperature control. Health workers should or not select the physical cooling method based on patients' condition and willingness in order to ensure their vital signs' stability and their comfort.

目的 调查多发性骨髓瘤患者心理弹性现状,并探讨其影响因素.方法 采用横断面调查法,应用一般资料调查表、心理弹性量表、社会支持评定量表及医学应对问卷对某三级甲等医院血液科门诊及住院的144例多发性骨髓瘤患者进行问卷调查.采用多元线性回归分析多发性骨髓瘤患者心理弹性的影响因素.结果 多发性骨髓瘤患者心理弹性得分为(56.24±16.22)分;多元线性回归结果显示:家庭人均月收入、长期居住地、医疗费用支付方式、主观支持、客观支持和屈服应对6个因子进入回归方程,共解释总变异的66.2％.结论 多发性骨髓瘤患者心理弹性处于较低水平,医护人员应重点关注家庭人均月收入低、农村合作医疗、长期居住在偏远地区、主观支持或客观支持较少、习惯以屈服的方式应对的患者,依据患者实际情况,提供最优的就医方案,缓解患者的负性情绪;指导家属,多鼓励和陪伴患者,细心照料,加强社会支持;正确引导其以积极的方式应对疾病,改善患者的心理弹性.

目的 研究分析盐城地区血友病患者的临床特征及生活状况.方法 收集盐城地区血友病患者的血样及问卷调查表格,对患者的具体情况进行调研.结果 69例有效资料中血友病A患者66例(95.7％),血友病B患者3例(4.3％).30例患者有阳性家族史,约占43.5％.发生胃肠道出血18例(26.1％),泌尿道出血21例(30.4％),颅内出血8例(11.6％),关节出血60例(87.0％),关节残疾12例(17.4％).69例患者中7例(10.1％)未接受过治疗,50例(72.5％)进行按需治疗,12例(17.4％)进行预防治疗,11例(15.9％)小剂量预防治疗,仅1例(1.4％)足量预防治疗.传染病学检测发现阳性患者共11例(15.9％),其中乙型肝炎2例(2.9％)、丙型肝炎6例(8.7％)、艾滋病毒阳性2例(2.9％)、梅毒1例(1.4％).既往输注血源性凝血因子制品与传染病学检测阳性呈正相关(x2=4.330,P=0.037).11例(15.9％)患者家庭入不敷出,15例成年患者无法工作.结论 盐城地区血友病患者存在诊疗延迟、高伤残率、治疗不足、经济困难、生活质量低等特点,需要通过多种途径、多方共同努力,提高就诊率和预防治疗的比例以提高患者生活质量.

目的 应用SF-36(中文版)和Haem-QoL-A(中文版)评估其在单中心血友病患者中的信效度和生活质量.方法 对原始问卷进行翻译、回译、校对后形成最终的Haem-QoL-A中文版.SF-36中文版采用标准版.两问卷通过信函在2011年8至12月间向南京鼓楼医院血友病登记中心登记的血友病患者邮寄并回收.采用SPSS 17.0软件对问卷进行信效度分析.结果 两问卷内部一致性显示Cronbach's oα＞ 0.7;重测信度显示组内相关系数ICC＞0.8;分半信度显示Pearson相关系数＞0.80.内容效度显示Haem-QoL-A中文版的各项Pearson相关系数均大于0.5,而SF-36中文版则除维度VT及部分条目外各项Pearson相关系数均大于0.5.结构效度显示两问卷各维度间相关系数小于各维度与总量表间的相关系数.Haem-QoL-A中文版与SF-36中文版相关系数为-0.799.69例血友病患者SF-36中文版问卷与我国常模及英国重型血友病患者相比在许多维度均存在显著差异.结论 Haem-QoL-A中文版和SF-36中文版信效度较好,可用以评估血友病患者生活质量;本中心血友病患者生活质量有待改善.

细胞因子诱导的杀伤细胞(CIK)是将外周血单个核细胞在体外与多种细胞因子共同培养后获得的一群异质细胞.CIK具有增殖速度快、杀瘤活性高、杀瘤谱广、对正常骨髓造血细胞毒性小等特点,CIK输注是新一代的肿瘤生物治疗手段[1].CIK进入肿瘤患者体内可提高患者免疫功能、增强对肿瘤细胞的杀伤作用,且有较好的疗效和很好的安全性[2].2010年10月-2013年6月,我们将责任制整体护理模式应用于进行CIK治疗的恶性血液病患者,取得满意效果,报道如下.

<正>多发性骨髓瘤(Multiple myeloma)是一种单克隆浆细胞异常增生所致的恶性肿瘤,占血液恶性肿瘤的10%左右。当前主要的治疗方法是化疗和干细胞移植,均难以治愈。硼替佐米(Bortezo mib,商品名万珂)是新型的蛋白酶体抑制剂,能特异性抑制哺乳动