儿童再生障碍性贫血ATG治疗期间的护理措施和不良反应的防治

摘要

Objective To sum up the correlation between routine nursing and the treatments of the adverse reaction of children with aplastic anemia (AA) with Antithymocyte globulin (ATG),to promote the technology of nursing for the childhood hematopoietic disease.Methods Sixty-three cases of children with AA were treated with ATG in the study.The preparations before the treatments,implementation for the therapy,observation and prevention of adverse reaction,and psychological counseling nursing were used to help the successful implementation and ensure medical safety of ATG therapy.Results A total of 63 cases of children with aplastic anemia received ATG based immunosuppression therapy (IST),the total effective rate was 69.84％ (44/63 cases),the overall survival rate was 84.13％ (53/63 cases).The incidence of major adverse reactions,such as allergic reaction,serum disease,platelet loss and secondary infection in the short term,were 38.09％,38.10％,30.16％ and 4.76％,respectively.The ATG therapy could continue to complete after timely controlled the mild anaphylactoid reactions.Serum disease was diagnosed early and controlled.Rate of secondary infection in short term was low (4.76％).ATG induced platelet loss was rescued by timely infusion of platelets,so there was no serious infection and bleeding,irreversible damage to vital organs and ATG treatment-related deaths.Conclusions It's necessary to establish a conventional treatment and nursing system,to specify the clinical details and continuously improve the quality of nursing technology,which is very helpful to ensure the successful implementation of ATG therapy and medical safety,effective popularization of IST therapy,to further improve the long-term outcome of children with AA.%目的 归纳和总结抗胸腺细胞球蛋白(ATG)治疗儿童再生障碍性贫血(简称“再障”)中护理措施与不良反应防治的相关性,以及相关护理经验体会,以助提高儿童血液病护理技术水平.方法 儿童再障在进行ATG治疗时,采用包括治疗前准备、ATG疗法的具体实施、不良反应的观察与防治以及心理疏导等专科护理常规,帮助ATG疗法顺利实施,并确保医疗安全.结果 63例再障患儿接受以ATG为主的免疫抑制疗法(IST)后,总有效率为69.84％(44/63例),总生存率(OS)为84.13％(53/63例).类过敏反应、血清病、血小板损耗和短期内继发感染等ATG主要相关不良反应发生率分别为38.09％、38.10％、30.16％和4.76％.类过敏反应均为轻症,及时控制后均能继续完成ATG疗程;血清病均得以早期诊断和及时控制;短期内继发感染率较低(4.76％);ATG所致血小板损耗,均经及时输注单采血小板予以明显纠正,故未发生严重感染出血、重要脏器不可逆损伤和ATG治疗相关死亡.结论 制定规范详尽的治疗和护理常规、注重临床细节和不断提高护理技术质量水平,将非常有助于确保ATG疗法的顺利实施和医疗安全,有效推广IST疗法,以进一步提高儿童再障远期疗效.