肾移植术前血液透析的风险因素分析及护理对策

肾移植术前血液透析存在一定的风险,在进行手术前采取护理措施能够更好的应对风险,降低对患者安全的影响,提高手术治疗效果。方法 以我院收诊的120例肾移植术前血液透析患者为研究对象。结果 护理后对照组的生活质量评分低于观察组。护理后对照组的焦虑与抑郁评分高于观察组。对照组护理满意度低于观察组。结论 肾移植患者手术后容易出现较多的风险,若是不注意可能会出现手术失败情况,肾移植患者手术前进行血液透析要做好准备,降低对患者身体的影响,尽量的做好手术前准备工作,做好护理管理工作,采取针对性护理措施后患者的恢复情况更好,发生护理的风险降低,情绪更为稳定,有推广的价值。

血液移植病房汽化过氧化氢消毒机消毒效果监测方法

为了提高血液移植病房汽化过氧化氢消毒机消毒效果,通过对血液移植病房汽化过氧化氢消毒机消毒效果统计大数据分析,实现对血液移植病房汽化过氧化氢消毒机消毒效果的定量监测,提出一种基于大数据分析的血液移植病房汽化过氧化氢消毒机消毒效果监测方法。构建血液移植病房汽化过氧化氢消毒机消毒效果的大数据统计平均分析模型,结合样本回归分析方法进行血液移植病房汽化过氧化氢消毒机消毒效果的分段样本回归分析,构建血液移植病房汽化过氧化氢消毒机消毒效果评价的决策目标函数,采用模糊决策评价的方法进行血液移植病房汽化过氧化氢消毒机消毒效果的交叉感染项量化分析,结合模型匹配检验结果进行消毒效果监测的统计特征提取和关联性描述。对提取的血液移植病房汽化过氧化氢消毒机消毒效果的统计特征量采用网格分区域聚类方法进行模式识别和特征筛选,实现血液移植病房汽化过氧化氢消毒机消毒效果监测。仿真结果表明,采用该方法进行血液移植病房汽化过氧化氢消毒机消毒效果监测的置信度水平较高,监测结果准确可靠。

心理护理对血液科移植护理患者负性情绪和生活质量的影响

探讨心理护理对血液科移植(以造血干细胞为例)护理患者负性情绪及生活质量的影响效果。方法 选取2022年5月至2023年5月该时间段本院接收的学业移植科护理患者50例,为进一步观察心理护理对该类患者的影响,将选取的患者分为甲乙两组,分别采用常规、心理两种方式展开护理干预,观察不同护理方式在该类患者中的应用效果。结果 研究显示,对血液科移植护理患者进行心理护理干预的方式,乙组患者负性情绪的改善情况优于甲组患者,同时乙组患者的生活质量得到了显著的提升,两组患者研究数据之间存在的差异显著,具有统计学意义。结论 对血液科移植护理的患者实施心理护理,对其负性情绪的改善及生活质量的提升均有积极临床效果,值得在临床上推广应用。

淋巴瘤血液移植术后护理策论研究

淋巴瘤现如今已成为非常常见的肿瘤之一,该病的患者通常早期没有显著症状,而晚期通常会有发热、盗汗、全身疼痛、体重大幅下降。淋巴瘤造血干细胞移植是治疗淋巴瘤的一种方式,造血干细胞移植有利于清除微小的残留病灶,可以使患者的治愈率增加。通过造血干细胞移植,大概40%到50%的淋巴瘤的患者可以获得缓解,有一些病例,有可能会被治愈。本文对于进行了造血干细胞移植的患者的术后护理展开策略研究。

血液科移植护理对造血干细胞移植患者的影响分析

目的:探讨血液科移植护理对造血干细胞移植患者的心理应激指标、患者家属护满意度的影响。方法:选取我院收治的60例行造血干细胞移植患者为观察对象,将患者随机分为两组,对照组30例采用常规护理;观察组30例行血液科移植护理(积极心理干预),即在对照组基础上为患者提供积极心理干预,对两组的干预效果进行对比。结果:干预后观察组患者焦虑(SAS)、抑郁(SDS)评分均低于对照组(P<0.05),治疗状态(Frank)评分明显高于对照组(P<0.05);干预后,观察组患者心境状态(POMS)量表各评分均优于对照组(P<0.05);观察组家属对护理服务的满意度高于对照组(P<0.05)。结论:针对造血干细胞移植患者实施积极心理干预效果理想,对改善患者心理应激指标有积极帮助,可推广应用。

急诊游离第二足趾移植再造拇指术后血液循环的观测与护理

拇指缺损不可避免会影响手的外观,并丧失一定手的功能,因此,许多患者有再造要求。游离第二足趾移植,可Ⅰ期再造拇指。报告了40例接受该手术患者的血液循环的观测与细致护理,血液循环的观测包括术后护理,皮肤颜色观测,皮肤张力观测,毛细血管回充盈时间观测,经皮氧分压测定,血管超声多普勒检查。5例出现血管危象的早期症状,我们对发生血管危象的病人,及时分析原因,采取抬高患肢,拆线减压,小切口放血,有效止痛措施,适当应用解痉剂等。本组再造拇指全部成活。

烷化剂为主的预处理方案在造血干细胞移植中近期和远期毒性(英文)

背景:造血干细胞移植成功的主要障碍是移植后的各种并发症,早期并发症主要与预处理有关。找出合理的剂量和新的高效低毒的预处理方案是提高造血干细胞移植成功率的关键。目的:了解以烷化剂为主的联合化疗作预处理,进行造血干细胞移植治疗恶性血液病的相关毒性和移植效果。设计:观察对比实验。地点:徐州医学院附属医院血液科。对象:选择1997-07/2006-02在徐州医学院附属医院住院的45例白血病及淋巴瘤患者,男31例,女14例,年龄7～52岁,中位年龄31岁。移植时病程5～17个月,平均8个月。方法:对45例白血病及淋巴瘤缓解期患者进行骨髓及外周血干细胞移植,预处理方案为以烷化剂为主的联合化疗,髓外毒性分级采用Bearman等制订的标准,预处理相关毒性分5个级别,即由无毒性(0级)至致死性毒性(Ⅳ级)。统计分析完全缓解率、完全缓解时间、复发率和无病生存期。主要观察指标:各脏器预处理相关毒性发生情况。结果:①5例无任何毒性发生,最大毒性为Ⅲ级者占13%(6/45)。各脏器预处理相关毒性大多数为Ⅰ～Ⅱ级,严重的预处理相关毒性Ⅲ级不多见。在Ⅰ～Ⅱ级预处理相关毒性中口腔黏膜溃疡和胃肠道毒性发生率较高,分别为73%(33/45)和51%(23/45),经治疗后短期内恢复;心脏毒性发生率低,均为Ⅰ级,多为心动过速和ST-T改变;肝脏预处理相关毒性,除2例肝静脉闭塞病外,多表现为转氨酶增高,4例出血性膀胱炎,其中1例为迟发性出血性膀胱炎。肾、肺和中枢神经系统预处理相关毒性少见。②移植后43例患者造血功能获得重建,植入失败死亡2例(4%)。中位随访时间37(8～102)个月,复发10例及移植相关并发症死亡5例,28例仍长期无病生存(62.2%)。100d内移植相关死亡原因主要为急性移植物抗宿主病,巨细胞病毒性间质性肺炎,侵袭性感染,多脏器功能衰竭和早期复发。结论:烷化剂为主的预处理方案进行造血干细胞移植治疗白血病和淋巴瘤相关毒性轻,患者耐受好。

同种异体肾移植术患者血流动力学的变化及其调控

选择2005-01/2006-12于江门市中心医院在硬膜外麻醉下行同种异体肾移植的患者38例,均知情同意。记录肾移植手术麻醉前、血流开放前、血流开放后、手术结束时患者的血流动力学指标,包括平均动脉压、心率、中心静脉压的变化。肾移植患者血流开放后的平均动脉压、中心静脉压均显著低于麻醉前及血流开放前(P<0.05～0.01),心率显著高于血流开放前(P<0.05)。硬膜外麻醉下肾移植术围手术期的血流动力学随手术步骤变化而变化,供肾恢复血供后变化最大。

血液科移植护理对造血干细胞移植患者的影响分析

探究血液科移植护理对造血干细胞移植患者的影响。方法 选取在2020年1月至2023年1月本院收治的90例造血干细胞移植患者,随机分为观察组(血液科移植护理)、对照组(常规护理)各45人。结果 观察组并发症低、不良情绪、生活质量改善更明显(P<0.05)。结论 血液科移植护理对造血干细胞移植患者的影响效果十分显著。

非血缘脐血移植治疗成年人恶性血液病的展望

近年来,非血缘脐血移植(UCBT)治疗成年人恶性血液病取得较多进展.UCBT治疗急性白血病的疗效与单倍体移植、非血缘骨髓移植、外周血干细胞移植的疗效相当,成为治疗恶性血液病的重要选择.单份UCBT的优势在于移植物抗宿主病(GVHD)发生率低且易于控制,保留有较好的移植物抗肿瘤(GVT)效应,并且患者接受治疗后生活质量较好.而UCBT的劣势在于其脐血干细胞数量少(尤其对于成年患者),因此其植入率低、植入较慢、免疫重建慢、移植早期感染发生风险高.改善UCBT的植入率低、免疫重建慢等问题,可以提高UCBT治疗成年人恶性血液病的疗效,丰富造血干细胞移植的供源.本文对今后UCBT治疗成年人恶性血液病,主要在解决UCBT植入问题、免疫重建问题、脐血人类白细胞抗原(HLA)配型等方面进行展望.

高博集团层流病房工程技术介绍

笔者所在医疗集团,在血液病治疗方面,形成了特色鲜明的学科特色——造血干细胞移植治疗疑难恶性血液病;并围绕学科特色建立完整的血液病诊治体系,整体学科水平处于全国领先地位,特别是 car-T 治疗、JMML 孤儿病治疗、严重地中海贫血等,处于全球领先地位。目前全集团下属医院,在运营移植仓数量 88 间,规模上已处于全国血液病医疗机构前三。

异基因造血干细胞移植治疗髓系恶性血液病移植前临床特征与预后的相关性研究

目的 :回顾性分析髓系白血病接受异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)患者的预后相关因素。方法 :纳入175例接受allo-HSCT治疗患者,其中男性105例,女性70例,中位年龄37(28,46)岁,急性髓系白血病(acute myeloid leukemia,AML)145例,骨髓增生异常综合征(myelodysplasia syndrome,MDS)30例。根据移植前疾病状态将患者分为早期和进展期2组。早期患者包括AML第1次完全缓解(first complete remission,CR1)期和低中危MDS共116例;进展期患者包括AML非CR1期和高危MDS共59例。所有患者按照欧洲血液和骨髓移植组(European Group for Blood and Marrow Transplantation,EBMT)移植评分分为低危组(EBMT积分0~2分)86例和高危组(EBMT积分≥3分)89例。allo-HSCT干细胞供体来源为人类白细胞抗原(human leukocyte antigen,HLA)全相合同胞供体(Sib)85例,HLA相合非血缘供体(mismatched unrelated donor,MUD)64例和亲缘半相合(Haplo)26例。单因素分析患者年龄、性别、移植前疾病阶段、EBMT积分、供者来源对移植后整体生存(overall survival,OS)率、无事件生存(event free survival,EFS)率、非复发死亡率(non relapse mortality,NRM)和复发率(relapse rate,RR)的影响。结果 :所有患者中位随访12.7(3.9,45.1)个月,预期3年OS率、EFS率、NRM和RR分别为51.4%±4.0%、46.8%±4.0%、31.6%±3.7%和29.0%±4.4%。其中疾病早期移植与进展期移植2组,EBMT积分低危和高危2组OS率、EFS率、RR、NRM差异均有统计学意义(均P<0.05)。在所有移植患者或疾病早期移植组和进展期移植组中供体来源移植后OS率等指标差异均无统计学意义。结论:移植前状态及EBMT积分对髓系白血病接受allo-HSCT的整体疗效具有重要意义,不同移植供者移植后疗效相近。

Acanthus ilicifolius plant extract prevents DNA alterations in a transplantable Ehrlich ascites carcinoma-bearing murine model

AIM： To investigate the chemopreventive efficacy of the Indian medicinal plant Acanthus ilicifolius L Acanthaceae in a transplantable Ehrlich ascites carcinoma （EAC）- bearing murine model.METHODS： Male Swiss albino mice were divided into four groups： Group A was the untreated normal control; Group B was the EAC control mice group that received serial, intraperitoneal （ip） inoculations of rapidly proliferating 2 × 10^5 viable EAC cells in 0.2 mL of sterile phosphate buffered saline; Group C was the plant extract-treated group that received the aqueous leaf extract （ALE） of the plant at a dose of 2.5 mg/kg body weight by single ip injections, once daily for 10, 20 and 30 consecutive days following tumour inoculation （ALE control）; and Group D was the EAC ＋ ALE- treatment group. The chemopreventive potential of the ALE was evaluated in a murine model by studying various biological parameters and genotoxic markers, such as tumour cell count, mean survival of the animals, haematological indices, hepatocellular histology, immunohistochemical expression of liver metallothionein （MT） protein, sister-chromatid exchanges （SCEs）, and DNA alterations.RESULTS： Treatment of the EAC-bearing mice with the ALE significantly （P 〈 0.001） reduced viable tumour cell count by 68.34% （228.7 × 10^6 ± 0.53） when compared to EAC control mice （72.4 × 10^6 ± 0.49）, and restored body and organ weights almost to the normal values. ALE administration also increased （P 〈 0.001） mean survival of the hosts from 35 ± 3.46 d in EAC control mice to 83 ± 2.69 d in EAC ＋ ALE-treated mice. Haematological indices also showed marked improvement with administration of ALE in EAC-bearing animals. There was a significant increase in RBC count （P 〈 0.001）, hemoglobin percent （P 〈 0.001）, and haematocrit value （P 〈 0.001） from 4.3 ± 0.12, 6.4 ± 0.93, and 17.63 ± 0.72 respectively in EAC control mice to 7.1 ± 0.13, 12.1 ± 0.77, and 30.23 ± 0.57 respectively in EAC ＋ ALE-treated group, along with concurrent decrement （P 〈 0.001） in WBC count from 18.8 ± 0.54 in EAC control to 8.4 ± 0.71 in EAC ＋ ALE. Furthermore, treatment with ALE substantially improved hepatocellular architecture and no noticeable neoplastic lesions or foci of cellular alteration were observed. Daily administration of the ALE was found to limit liver MT expression, an important marker of cell proliferation with concomitant reduction in MT immunoreactivity （62.25 ± 2.58 vs 86.24 ± 5.69, P 〈 0.01）. ALE was also potentially effective in reducing （P 〈 0.001） the frequency of SCEs from 14.94 ± 2.14 in EAC control to 5.12 ± 1.16 in EAC ＋ ALE-treated group. Finally, in comparison to the EAC control, ALE was able to suppress in vivo DNA damage by abating the generations of＇tailed＇ DNA by 53.59% （98.65 ± 2.31 vs 45.06 ± 1.14, P 〈 0.001）, and DNA single-strand breaks （SSBs） by 38.53% （3.14 ± 0.31 vs 1.93 ± 0.23, P 〈 0.01） in EAC-bearing murine liver.CONCLUSION： Our data indicate that, ALE is beneficial in restoring haematological and hepatic histological profiles and in lengthening the survival of the animals against the proliferation of ascites tumour in vivo. Finally, the chemopreventive efficacy of the ALE is manifested in limiting MT expression and in preventing DNA alterations in murine liver. The promising results of this study suggest further investigation into the chemopreventive mechanisms of the medicinal plant A. ilicifolius in vivo and in vitro.

Early plasmapheresis and rituximab for acute humoral rejection after ABO-compatible liver transplantation

Acute humoral rejection （AHR） is uncommon after ABO- compatible liver transplantation. Herein, we report two cases of AHR treated with plasmapheresis and rituximab in two ABO-compatible liver-transplant patients with preformed anti-human leukocyte antigen donor-specific antibodies. Patient 1 experienced a biopsy-proven AHR at day 10 post-transplant. She was treated by steroid pulses, and OKT3. Because of persisting signs of biopsy-proven AHR at day 26, she was treated by plasmapheresis and rituximab. Uver enzyme levels did not improve, and she died on day 41. Patient 2 experienced a biopsy-proven AHR on day 10 post-transplant. She was treated by steroid pulses, plasmapheresis, and rituximab. Liver enzymes returned to within normal range 18 d after diagnosis. Uver biopsies, at 3 and 9 mo post-transplant, showed complete resolution of AHR. We conclude that plasmapheresis should be started as soon as AHR is diagnosed, and be associated with a B-cell depleting agent. Rituximab may be considered as a first-line therapy.

Dextrose in the banked blood products does not seem to affect the blood glucose levels in patients undergoing liver transplantation

AIM: Hyperglycemia commonly seen in liver transplantation (LT) has often been attributed to the dextrose in the storage solution of blood transfusion products. The purpose of the study is to compare the changes of the blood glucose levels in transfused and non-transfused patients during LT. METHODS: A retrospective study on 60 biliary pediatric patients and 16 adult patients undergoing LT was carried out. Transfused pediatric patients were included in Group Ⅰ (GⅠ), those not transfused in Group Ⅱ (GⅡ). Twelve adult patients were not given transfusion and assigned to Group Ⅲ(GⅢ); whereas, four adult patients who received massive transfusion were assigned to Group Ⅳ (GⅣ). The blood glucose levels, volume of blood transfused, and the volume of crystalloid infused were recorded, compared and analyzed. RESULTS: Results showed that the changes in blood glucose levels during LT for both non-transfused and minimally transfused pediatric groups and non-transfused and massively-transfused adult groups were almost the same. CONCLUSION: We conclude that blood transfusion does not cause significant changes in the blood glucose levels in this study.

Efficiency and safety of lamivudine therapy in patients with chronic HBV infection, dialysis or after kidney transplantation

AIM: To analyze the effectiveness and safety of lamivudine treatment in patients with chronic HBV infection undergoing hemodialysis or after kidney transplantation, and to study the frequency of tyrosine - methionine - aspartate - aspartate (YMDD) mutation occurrence after lamivudine treatment. METHODS: We analyzed 91 patients with chronic hepatitis B, among whom, 16 patients underwent hemodialysis, 7 patients had kidney transplantation and 68 patients had normal function of kidney. The hemodialysis patients were treated by lamivudine 300 mg/wk. patients after kidney transplantation and patiente with normal function of kidney were treated with lamivudine 100 mg/d. Therapy lasted for 12 mo. HBV-DNA, HBsAg, HBeAg and anti-HBe, and anti-HCV antibodies were assessed in sera of patients. The analysis was performed before and 6 mo after the end of lamivudine treatment. Before, during and after the lamivudine therapy, the number of erythrocytes, leukocytes, platelets and hemoglobin concentration, ALT and AST activity, as well as bilirubin, urea and creatinine concentrations were analyzed in sera from patients. RESULTS: After the 12-mo lamivudine treatment, elimination of HBV - DNA was observed in 56% patients undergoing hemodialysis and in 53% patients with normal kidney function. Only 1 from 7 (14%) kidney-transplanted patients eliminated HBV-DNA. Furthermore, HBeAg elimination was observed in 36% hemodialysis patients, in 51% patients with normal function of kidneys and in 43% kidney transplanted patients. Among the patients undergoing dialysis, no YMDD mutation was found after 12 mo of therapy, while it was detected in 9 patients (13%) with normal function of kidney and in 2 kidney-transplanted patients (29%, P<0.006). We did not observe significant side effecte of lamivudine treatment in studied patiente. CONCLUSION: Effectiveness of lamivudine therapy in dialysis patients is comparable with that in patiente with normal function of kidney. Lamivudine treatment is well tolerated and safe in patiente with renal insufficiency undergoing hemodialysis and kidney-transplantation. However, in the latter group, high incidence of YMDD mutation after lamivudine treatment was observed.

双平台ISHAGE法与单平台绝对计数法在脐带血CD34+细胞检测的比较分析

目的评估双平台血液治疗和移植工程国际联合会(ISHAGE)法与单平台绝对计数法在脐带血CD34+细胞检测的优缺点。方法选择30份健康新生儿的脐带血标本。采用流式细胞术双平台ISHAGE法与单平台绝对计数法,对其分别进行深低温冷冻前后CD34+细胞检测,并采用Spearman相关性和配对t检验对CD34+细胞百分率、细胞活率和CD34+细胞回收率进行分析。结果 Spearman相关性分析结果:双平台ISHAGE法与单平台绝对计数法所得的CD34+细胞百分率和细胞活率高度相关性(R2=0.949 1、0.796 2),而冷冻前后CD34+细胞回收率无相关性(R2=-1.833)。配对t检验分析结果:双平台ISHAGE法与单平台绝对计数法检测冷冻前脐带血CD34+细胞百分率分别为(0.27±0.14)%、(0.28±0.16)%(t=1.01,P> 0.05),CD34+细胞回收率分别为(102.83±23.11)%、(80.50±23.08)%(t=10.62,P <0.05),细胞活率分别为(96.80±1.85)%、(96.95±1.94)%(t=1.13,P> 0.05)。结论双平台ISHAGE法与单平台绝对计数法检测深低温冷冻前脐带血CD34+细胞百分率和细胞活率具有高度相关性,但在冷冻后CD34+细胞回收率方面单平台绝对计数法要优于双平台ISHAGE法。

国际顶级杂志2010年6～10月发表干细胞基础研究文章对临床转化的意义

○Cell Stem Cell:有助恢复脊髓功能的干细胞○Blood:可促进造血干细胞分裂的蛋白质TIMP3○PNAS:用iPS细胞进行安全治疗的方法○Cell Stem

国际顶级杂志2010年1～5月发表干细胞基础研究文章对临床转化的意义

转化医学将生命科学和生物技术及相关的现代科学技术整合、凝聚到4P医学,推动了医疗改革、提高了人民的健康水平和生活质量,可实现更精确的预警与诊断、更有效的干预和治疗,降低发病率、推迟发病年龄、提高治愈率、减少重症患者、降低医疗的综合成本。

Administration of granulocyte colony stimulating factor after liver transplantation leads to an increased incidence and severity of ischemic biliary lesions in the rat model

AIM： Recently it has been reported that granulocyte colony stimulating factor （G-CSF） can induce hypercoagulability in healthy bone marrow donors. It is conceivable that the induction of a prothrombotic state in a recipient of an organ graft with already impaired perfusion might cause further deterioration in the transplanted organ. This study evaluated whether G-CSF treatment worsens liver perfusion following liver transplantation in the rat model. METHODS： A non-arterialized rat liver transplantation model was employed to evaluate the effect of G-CSF treatment on the liver in a syngeneic and allogeneic strain combination. Study outcomes included survival time and liver damage as investigated by liver enzymes and liver histology. Observation times were 1 d, 1 wk and 12 wk. RESULTS： Rats treated with G-CSF had increased incidence and severity of biliary damage following liver transplantation. In these animals, hepatocellular necrosis was accentuated in the centrilobular region. These lesions are indicative of impaired perfusion in G-CSF treated animals. CONCLUSION： G-CSF should be used with caution in recipients of liver transplantation, as treatment might enhance preexisting, undetected perfusion problems and ultimately lead to ischemia induced biliary complications .