60例化疗患儿不良反应自我报告与护理记录一致性研究

Consistency of Self-report and Nursing Records of Adverse Reactions in Children with Leukemia:A 60-case Study

目的调查急性淋巴细胞白血病患儿初次诱导化疗2次鞘内注射后不良反应自我报告及同时期护理记录单中不良反应情况,比较2种评估的一致性。方法采用便利抽样法,选取2018年5月—2019年7月在海南省某三级甲等综合医院儿科亚重症病房首次辅助化疗并行鞘内注射的60例急性淋巴细胞白血病患儿作为研究对象,采用鞘内注射后患儿不良反应自我报告问卷,在2次鞘内注射24 h后分别对其进行调查;同时从电子护理记录中提取同期护士对患儿鞘内注射后不良反应的记录信息,与患儿自我报告结果进行一致性比较。结果第1次鞘内注射后,在不良反应发生率方面,患儿不良反应自我报告与护理记录的12项不良反应中有9项差异有统计学意义(P<0.05),分别为恶心、呕吐、便秘、食欲减退、疲劳、肢体麻木、腰痛、头晕、头痛;在不良反应严重程度方面,患儿自我报告与护理记录比较,仅疲劳的差异有统计学意义(P<0.05);患儿自我报告与护理记录不良反应严重程度评估一致性比较,恶心、食欲减退、疲劳、肢体麻木、腰痛、头晕的一致性均较差(Kappa<0.4)。第2次鞘内注射后,在不良反应发生率方面,患儿不良反应自我报告与护理记录的12项不良反应中有10项差异有统计学意义(P<0.05),分别为恶心、呕吐、食欲减退、味觉障碍、腹泻、疲劳、肢体麻木、腰痛、头晕、头痛;不良反应严重程度方面,患儿自我报告与护理记录比较,差异均无统计学意义(P>0.05);患儿自我报告与护理记录不良反应严重程度评估一致性比较,恶心、呕吐、食欲减退、味觉障碍、腹泻、疲劳、肢体麻木、腰痛、头晕的一致性均较差(Kappa<0.4)。结论护理人员对急性淋巴细胞白血病患儿诱导化疗鞘内注射的不良反应发生率及严重程度存在低估与忽视,临床工作中护士应更加重视患儿不良反应自我报告,以提高临床治疗方案的疗效评价准确性,为提高白血病患儿的照护水平提供更有价值的信息。

Objective To investigate the self-report and nursing records of adverse reactions after the initial induction of chemotherapy intrathecal injections in children with acute lymphoblastic leukemia and to compare the consistency of two types of evaluations.Methods With convenience sampling method,60 acute lymphocytic leukemia children having adjuvant intrathecal injection for the first time from May 2018 to July 2019 in pediatric intensive care units of a tertiary grade-A hospital of Hainan province were selected and investigated using the self-reporting questionnaire on adverse reactions in children after intrauterine injection after twice of intrauterine injections.Children’s self-reported adverse reactions were compared with electronic nursing record of adverse reactions after intra-injection.Results After the first intrasheath injection,there was a statistical difference in the incidence of adverse reactions in 9 of the 12 adverse reactions reported by the children and nursing records(P<0.05),which were nausea,vomiting,constipation,loss of appetite,fatigue,limb numbness,lumbago,dizziness and headache,respectively.Among the severity of adverse reactions,the difference of“fatigue”in the children’s self-report and nursing records was statistically significant(P<0.05),and the consistency of nausea,appetite loss,fatigue,limb numbness,lumbago and dizziness was poor(Kappa<0.4).After the second intrasheath injection,the incidence of adverse reactions was statistically different in 10 of the 12 adverse reactions reported by children and nursing records(P<0.05),which were nausea,vomiting,loss of appetite,taste disorders,diarrhea,fatigue,limb numbness,lumbago,dizziness and headache,respectively.Among the severity of adverse reactions,there was no statistically significant difference between the children’s self-report and nursing records(P>0.05),but the consistency of nausea,vomiting,loss of appetite,taste disorder,diarrhea,fatigue,limb numbness,lumbago and dizziness was poor(Kappa<0.4).Conclusion The incidence and severity of adverse reactions induced by intrathecal injection of chemotherapy in children with acute lymphoblastic leukemia are underestimated and neglected by nurses.Nurses should pay more attention to the self-report of adverse reactions of children,so as to evaluate the adverse reactions of chemotherapy more accurately and improve the quality of care.