异基因造血干细胞移植患者术后皮肤移植物抗宿主病的临床分析及护理对策

Clinical analysis and nursing measures of cutaneous GVHD after allogeneic haematopoietic stem cell transplantation in 152 patients

目的探讨异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation, allo-HSCT)术后皮肤移植物抗宿主病(graft-versus-host disease, GVHD)的临床特征和相关危险因素,并提出防治皮肤GVHD的护理对策。方法回顾性分析2008年6月-2019年12月在接受allo-HSCT一次成功且随访半年以上的152例患者的临床资料。记录患者移植相关数据资料,包括皮肤GVHD发生情况、供受者条件、疾病相关信息等。随访至2020年6月22日,采用住院记录、门诊、电话和微信平台等随访方式。皮肤GVHD患者根据其分级或严重程度不同给予个性化的综合护理干预措施。结果 152例allo-HSCT术后患者,共确诊94例皮肤GVHD,发生率为61.84%,其中急性者36例(23.68%),慢性者69例(45.39%)。多因素分析中,高危患者、血型不相合、HLA配型不合和发生系统性慢性GVHD是皮肤GVHD的重要危险因素。94例皮肤GVHD患者经过治疗护理后,70例患者皮肤损伤好转,24例死亡,病死率为25.53%。结论皮肤GVHD严重影响患者的日常生活和预后,应优先选择血型相合、HLA配型相合的供者,同时需制定出有效的护理干预方案以减轻患者皮肤损伤程度。

Objective To explore the clinical characteristics and risk factors associated with cutaneous graft-versus-host disease(GVHD)after allogeneic haematopoietic stem cell transplantation(allo-HSCT)and put forward prevention and treatment nursing countermeasures for cutaneous GVHD.Methods The clinical data of 152 patients who received successful allo-HSCT from June 2008 to December 2019 and were followed up for more than six months were retrospectively analysed.Data regarding patient transplantation,including the occurrence of cutaneous GVHD,patients'conditions and disease-related information,were recorded.Follow-up to June 22,2020,using inpatient records,outpatient,telephone and WeChat platform follow-up.Patients with cutaneous GVHD were given individualised comprehensive nursing interventions according to their grade or severity.Results A total of 94 cases of cutaneous GVHD were diagnosed in 152 allo-HSCT patients,with an occurrence rate of 61.84%.Amongst them,36 cases(23.68%)were acute,and 69 cases(45.39%)were chronic.Multi-factor analysis showed that high-risk patients,blood type mismatch,human leucocyte antigen mismatch and the occurrence of systemic chronic GVHD were important risk factors for cutaneous GVHD.After the treatment and care of 94 cases of cutaneous GVHD,70 cases of cutaneous injury improved,and 24 cases died.The fatality rate was 25.53%.Conclusion Cutaneous GVHD seriously affects patients'daily life and prognostics.Thus,donors with compatible blood type and HLA type should be preferred,and effective nursing intervention programs should be performed to reduce the degree of cutaneous injury of patients.