第三方脐血输注不良反应现状及其影响因素研究

The status and influencing factors of infusion-related adverse events in third-party cord blood stem cell infusion

目的探讨第三方脐血输注中不良反应的发生现状及其相关因素。方法 2013年1月—2015年12月,调查苏州市某三级甲等医院血液造血干细胞移植中心成功实施单倍体造血干细胞移植联合第三方脐血输注的305例恶性血液病患者,采用一般资料调查表及第三方脐血输注不良反应调查表收集资料。结果第三方脐血输注中不良反应发生率为49.51%,以心血管系统不良反应为主(82.78%),其中高血压发生率最高,为77.48%。引起不良反应发生的主要原因为年龄、脐血供受体人类白细胞抗原配型相合度、复苏脐血细胞活力。结论临床护理人员应对年龄较大,脐血供受体人类白细胞抗原配型相合度低,输注复苏脐血细胞活力高的单倍体造血干细胞移植联合第三方脐血输注的患者在干细胞输注期间加强监护,及时给予预见性护理。

Objective To investigate the status and influencing factors of infusion-related adverse events in thirdparty cord blood stem cell infusion. Methods A total of 305 patients successfully underwent haploidentical stem cell transplantation combined with the third-party cord blood（CB） infusion,were recruited by convenience sampling from January 2013 to December 2015,in hematological department of a tertiary hospital in Suzhou. A self-developed questionnaire and adverse event assessment scale were used to investigate the influencing factors. Results The rate of infusion-related adverse events was 49.51%,81.82% were related to cardiovascular adverse events with the highest rate of hypertension （76.14%）. Logistic regression analysis showed that age （OR= 1.030,95CI% ： 1.010-1.051 ）, HLA matching between CB and receptor （OR=0.589,95%CI：0.413-0.838）,thawed CB cell activity （OR=1.064,95%Cl：1.015- 1.115）were major influencing factors. Conclusion Nurses should pay attention to patients who are elderly,with low matching HLA and receive thawed CB product with high cell activities,and provide timely nursing care in advance.