难治性类风湿关节炎的免疫净化治疗及护理

Immunologic Purging Treatment and Nursing of Refractory Rheumatoid Arthritis

目的:观察血浆置换和免疫吸附治疗难治性类风湿关节炎的疗效,探索总结合理的护理方案。方法:11例活动期类风湿关节炎患者接受血浆置换或免疫吸附治疗4～5次,在治疗期间做好患者的宣教、治疗前准备、规范化操作、治疗过程中的监护和并发症的处理。结果:与治疗前比较,治疗后患者关节压痛数、关节压痛指数、关节肿胀数、关节肿胀指数和静息痛评分均明显降低(P<0.05);类风湿因子、C-反应蛋白、红细胞沉降率均明显降低(P<0.05)。有3例出现轻度过敏反应,2例出现低血压,经对症处理后缓解。结论:免疫净化治疗有助于迅速缓解活动期类风湿关节炎患者的病情,不良反应较少,是治疗难治性RA的有效方法之一。充分的术前准备、规范化的操作和密切的观察是免疫净化治疗成功的关键。

Objective：To observe the effect of plasma exchange and immune adsorption in the treatment of refractory rheumatoid arthritis to explore reasonable nursing project.Methods： 11 cases with active rheumatoid arthritis were treated by plasma exchange or immune adsorption for 4-5 times.During the treatment,do such tasks as educating patients,doing preparation for treatment,standardized operation,guardianship and dealing with complications in the course of treatment.Results：Compared with those before treatment,the tender joint count,joint pain index,number of swollen joints,joint swelling index and resting pain scores significantly decreased after treatment （P 〈 0.05 ） ;rheumatoid factor, C-reactive protein,erythrocyte sedimentation rate were also significantly decreased （ P 〈 0.05 ） .There were 3 cases with mild allergic reaction,2 cases with hypotension,all cured after symptomatic treatment.Conclusion：The immunologic purging treatment could help to relieve the active rheumatoid arthritis,with less adverse reaction,being one of the effective methods to treat refractory RA.Sufficient preparation before operation,standardized operation and close observation were the keys to successful immunologic purging treatment.