TACE联合RFA和CIK治疗原发性肝细胞癌的护理

The nurse of CIKs infusion in treating primary hepatocellular carcinoma after TACE sequentially combined CT-Guided RFA

目的探讨TACE(transcatheter arterial chemoeblization)序贯联合CT导向下RFA(radiofrequency ablation)及CIK(cytokine induced killer cells)细胞经肝动脉灌注治疗原发性肝癌(primary hepatocellular carcinoma,HHC)的护理。方法57例HCC经TACE序贯联合RFA治疗后1～3周,联合C I K治疗,首先连续完成4次C I K细胞经肝动脉回输,每次间隔时间为1～3周;再每4周1次,共行4次C I K细胞经肝动脉回输,每次回输CIK的数量为1.1×1010～1.5×1010。在这过程中,做好患者的心理护理,严格无菌操作,在T A C E、R F A和CIK治疗时严密观察不良反应和并发症,及时采取相应的措施和护理。1.心理护理:详细讲解治疗的目的、方法、必要性、安全性以及可能发生的并发症,使患者解除顾虑,以良好的心态接受治疗;2.T A C E后的护理:观察穿刺点情况和化疗栓塞后的反应;3.R F A后护理:注意穿刺点周围皮肤的变化,观察疼痛的状况;4.C I K采取和回输后的护理:采血时严格无菌操作,培养液要在30分钟内输完。结果57例患者经有效的心理护理,消除了顾虑,均顺利完成了整个过程。大部分患者有轻微的消化道反应,无须作特殊处理;10例患者有发热,体温37.5～39.5之间,部分高热患者需用退热药。结论T A C E序贯联合R F A治疗和抗肿瘤效应细胞(C I K)是治疗原发性肝癌的一种新模式,它提高了原发性肝癌无瘤生存期并明显降低乙肝病毒体内含量或消除乙肝病毒,阻断致癌因素;而且安全性好,副作用少,能提高患者的生活质量。

Objectives： To explore the nursing care of autologous cytokine-induced killer cells （CIK） in treating the patients with primary hepatocellular carcinoma （HCC） after the treatment of transcatheter arterial chemoeblization （TACE） sequentially combined with CT-guided radiofrequency ablation （RFA）. Medthods： 57 cases received autologous CIK cells infusion by common hepatic artery every 1？？3 weeks for four times, then every 4 weeks for 4 times; the number of CIK cells infused ranged from 1.1′10^10-1.5′10^10 every time. In this process, good mental nursing and strict aseptic operation are needed. During the treatment of TACE, RFA and CIK, observe the side effects and complications, and take corresponding measures and nursing. 1. Mental Nursing： explain the objective, methods, necessity, security and the possible complications in detail to lift the patient＇ worry and receive the treatment with a good attitude; 2. The Nursing after TACE： Observe the puncture site and the effect after chemotherapy and embolization treatment. 3. The Nursing after RFA： Pay attention to the change of skin surrounded the puncture site and whether the patients ache. 4. The Nursing after drawing blood and autologous CIK cells infusion： During drawing blood, strict aseptic operation is needed. The culture fluid must be infused in 30 minutes.Results： After effective mental nursing, the 57 patients lifted the worry, all received the treatments. A lot of the patients have minor digestive tract effect and did not need particular treatment; ten patients suffered fever, the temperature between 37.5-39.5, but some of the patients suffered high fever need antipyretics. Conclusions： Autologous CIK cells were efficient effector cells after TACE sequentially combined with CT-guided RFA procedure in the treatment of HCC. It had the effect of anti-B-virus and it may reduce the frequency of recurrence or prolonged the recurrence free span. It also have good security, less side effects, also improve the patients survival equality.