针对性护理在行嵌合抗原受体T细胞(CAR-T)免疫治疗难治性急性淋巴细胞白血病患者中的应用效果

Effect of targeted care in patients with refractory acute lymphoblastic leukemia treated with chimeric antigen receptor T cells(CAR-T)

目的探究行嵌合抗原受体T细胞(CAR-T)免疫治疗难治性急性淋巴细胞白血病的护理要点。方法选取2017年1月~2018年12月我院接诊的难治性急性淋巴细胞白血病患者120例作为研究对象,全部患者均采用嵌合抗原受体(CAR-T)治疗,根据护理方式进行分组,分为实验组(针对性护理)与对照组(常规护理),各60例,分析两组患者的焦虑评分、抑郁评分、并发症发生率及护理满意度。结果护理前,两组患者的焦虑和抑郁评分无统计学意义(P>0.05),护理后,两组患者的SAS和SDS评分均明显下降,且实验组下降更为明显,差异有统计学意义(P<0.05);对照组中12例患者发生细胞因子释放综合征、12例患者发生肿瘤溶解综合征,并发症发生率为40.00%。实验组并发症发生率显著低于对照组,差异有统计学意义(P<0.05);实验组护理满意度为96.66%,明显高于对照组的(78.33%),差异有统计学意义(P<0.05)。结论难治性急性淋巴细胞白血病患者接受嵌合抗原受体T细胞(CAR-T)免疫治疗后,应给予整体护理干预,可达到良好的治疗效果,降低患者肿瘤溶解综合征和细胞因素释放综合征等并发症的发生,该种护理方式具有较高的安全性,值得在临床中推广。

Objective To explore the nursing points of chimeric antigen receptor T cell(CAR-T)immunotherapy for refractory acute lymphoblastic leukemia.Methods 120 patients with refractory acute lymphoblastic leukemia who were admitted to our hospital from January 2017 to December 2018 were enrolled.All patients were treated with chimeric antigen receptor(CAR-T)and divided according to the nursing method into the experimental group(targeted care)and the control group(conventional care),with 60 cases in each group.The anxiety score,depression score,complication rate and nursing statisfaction of the two groups were analyzed.Results There were no statistically significant differences in anxiety and depression scores between the two groups before nursing(P>0.05).After the nursing,the SAS and SDS scores of the two groups were significantly decreased,and the decline was more significant in the experimental group(P<0.05).The complication rate was 40.00%,including 12 patients with cytokine release syndrome and 12 patients with tumor lysis syndrome in control group.The incidence of complications in the experimental group was significantly lower than that in the control group(P<0.05).The nursing satisfaction of the experimental group was 96.66%,which was signif icantly higher than the satisfaction of the control group(78.33%),there was significant difference(P<0.05).Conclusion Patients with refractory acute lymphoblastic leukemia should receive holistic nursing intervention after receiving chimeric antigen receptor T cell(CAR-T)immunotherapy,which can achieve good therapeutic effect and reduce the complications of tumor lysis syndrome and cellular factor release syndrome with high safety,thus is worthy of being promoted in the clinic.