急性白血病异基因造血干细胞移植分阶段辨证施护

Syndrome Differentiation Nursing by Stages in Allogeneic Hematopoietic Stem Cell Transplantation of Acute Leukemia

[目的]总结归纳急性白血病异基因造血干细胞移植前准备期、移植中预处理及植入早期、移植后恢复期患者的中医证候特点及对应护理要点,为该类患者的护理提供借鉴方案。[方法]根据患者移植过程,将移植全程分为移植前准备期、移植中预处理及植入早期、植入后恢复期3个阶段,分析各阶段患者的中医证候,辨证选取中医护理技术,并对选穴、应用时间、观察要点等关键环节进行说明。[结果]移植前准备期的护理要点包括情志护理、导管护理,移植中预处理及植入早期的护理要点包括化疗相关并发症护理、干细胞输注不良反应护理、饮食调护和情志指导,植入后恢复期的护理要点包括症状护理、移植物抗宿主病护理。[结论]基于中医辨证施护和整体护理观,对急性白血病异基因造血干细胞移植前准备期、移植中预处理及植入早期、植入后恢复期各阶段的辨证施护要点进行总结,有助于指导护理人员规范、科学地开展移植患者的中医精准护理。

[Objective] To summarize the characteristics of traditional Chinese medicine(TCM) syndromes and corresponding nursing interventions of allogeneic hematopoietic stem cell transplantation(allo-HSCT) for acute leukemia in pre-transplantation preparation stage,conditioning during transplantation and early implantation stage, and post-implantation recovery stage, and to provide a reference scheme for peer nursing of such patients. [Methods] According to the whole process of allo-HSCT: Pre-transplantation preparation stage,conditioning during transplantation and early implantation stage, and post-implantation recovery stage. The TCM syndrome of patients in each stage was analyzed, and TCM nursing techniques were selected based on syndrome differentiation, and the key links such as acupoint selection, application time and observation points were explained. [Results] The main points of nursing during the pre-transplantation preparation stage include emotional care and catheter care;the main points of nursing during conditioning and early implantation stage include chemotherapy-related complications care, stem cell infusion adverse reaction care, diet care, and emotional guidance;the main points of care during the recovery stage after transplantation include symptom care and graft versus host disease care. [Conclusion] Based on the concept of TCM syndrome differentiation nursing and the holistic nursing, this paper summarized the key points of syndrome differentiation nursing at each stage of acute leukemia allo-HSCT, pre-transplantation preparation, conditioning during transplantation and early implantation, and post-implantation recovery, which can guide nursing staff to carry out TCM precision nursing of allo-HSCT patients in a standardized and scientific manner.