英夫利西单抗治疗难治性川崎病护理要点并文献复习

Main points of nursing care strategies on treatment of children with refractory Kawasaki disease by infliximab and literature review

目的探讨英夫利西单抗(IFX)治疗难治性川崎病(rKD)患儿的护理要点。方法选择2019年8月25日至9月7日,于成都市妇女儿童中心医院住院,并采用IFX治疗的1例rKD患儿(男性,年龄为1岁5个月)为研究对象。回顾性分析其临床病例资料。对该例患儿采取的护理措施要点涵盖应用IFX治疗的整个过程,包括从药房取回IFX及其运送、配制、相关急救用品准备、采取阶梯式递增方式静脉输注IFX、输注过程中及输注后对患儿病情观察及感染防控。对中国知网数据库、万方数据知识服务平台及PubMed文献数据库中,关于IFX治疗rKD患儿护理措施、IFX治疗其他疾病过程中对发生的不良反应的护理措施,以及IFX治疗其他疾病患者的护理措施相关文献进行检索,并进行相关文献复习。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》。结果 (1)在IFX治疗过程中,对本例rKD患儿采取涵盖上述护理要点的措施后,无相关不良反应发生,并取得良好治疗效果并顺利出院。(2)文献复习结果:1篇采取IFX治疗rKD患儿的护理研究显示,通过IFX的正确配制、严格遵守操作规程及加强用药观察,8例rKD患儿静脉输注IFX过程中均未发生不良反应。2篇文献报道IFX治疗银屑病及强直性脊柱炎患者过程中出现不良反应,对患者采取对症治疗后,轻度不良反应者可继续IFX治疗,中、重度者停药。26篇对IFX治疗克罗恩病等患者的相关护理研究显示,通过事先对护理人员进行相关培训、对患者及家属健康宣教、IFX治疗前对患者预防性使用抗组胺药、按照规范使用IFX及加强该药治疗过程对患者的观察,可预防、减轻或避免IFX治疗过程中的不良反应。结论采取涵盖上述护理要点的护理措施,对rKD患儿采取静脉输注IFX治疗安全、有效。

Objective To summarize main points of nursing care strategies on treatment of children with refractory Kawasaki disease(rKD)by infliximab(IFX).Methods One case of rKD child(male,1 year and 5 months old)who was hospitalized in Chengdu Women′s and Children′s Central Hospital from August 25 to September 7,2019,and treated with IFX was chosen as research subject.His clinical data was analyzed retrospectively.Main points of nursing care strategies applied to him covered the entire process of applying IFX treatment,including retrieve IFX from the pharmacy and its delivery,preparation,related first aid supplies′preparation,intravenous infusion of IFX in a stepwise increase manner,observation of disease conditions during and after infusion,as well as prevention and control of infection.Literature about nursing care of IFX in treatment of rKD children,nursing care measures for adverse reactions of IFX in treatment of other diseases,and nursing care measures of IFX in treatment of other diseases,were collected from China National Knowledge Infrastructure database,Wanfang Data Knowledge Service Platform and PubMed database,and review the relevant literature.This study was in line with World Medical Association Declaration of Helsinki revised in 2013.Results①After applied above mentioned nursing care strategies to this case of rKD child during IFX treatment,he achieved good treatment results and without any adverse reactions,and was discharged smoothly.②Results of literature review:in a piece of literature,a total of 8 cases of rKD children who didn′t have any adverse reactions during application of IFX through nursing care measures of correctly medicine preparation,strictly follow the operating procedures and strengthen medication observation.In two pieces of literature,the psoriasis and ankylosing spondylitis patients occurred adverse reactions during treatment of IFX,and after symptomatic treatment,patients with mild adverse reactions could continue IFX treatment,and patients with moderate or severe adverse reactions should stopped.In 26 pieces of literature,patients with other diseases,such as Crohn disease etc.,whose adverse reactions could be prevented,reduced or avoided during IFX treatment through nursing care measures of relevant training to nursing staff in advance,health education for patients and their family members,preventive use of antihistamines to patients before IFX treatment,use IFX in accordance with regulations,and enhanced observation of patients during medications.Conclusions Intravenous infusion of IFX to children with rKD may be safe and effective after taking appropriate nursing care measures that covered above main points.