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【摘要】 目的:观察抗胸腺细胞球蛋白(ATG)/抗淋巴细胞球蛋白(ALG)在非清髓性造型干细胞移植应用过程中的不良反应并提高其护理水平。方法:在18例非清髓性异基因造血干细胞移植(NST)的预处理中对ATG/ALG进行观察及相关护理。结果:6例皮试阳性,12例皮试阴性。在应用过程中,多数病例出现发热、寒颤、皮疹等反应,4例出现血清病,8例出现血压下降,经预防性用药及监护处理,顺利完成ATG/ALG治疗;结论:只要做好充分的预防措施及严密的监控护理,能顺利完成NST的预处理,保证基因造血干细胞移植的顺利。 9 s. ~2 `( n- ]' N8 l
【关键词】非清髓性;造血干细胞移植;ATG/ALG;护理 ' e6 _ P6 K! z Y& f+ P } Observation and nursing of use of anti-themocyte globulin/anti-lymphocyte globulin in nonmyeloablative transplantation 0 ]8 X% q2 ~3 c9 c7 i7 `3 `- y, x! R# R+ L* D5 Z9 a( [$ |
DENG Xiu-yun, ZHOU Su-zhen, PENG Qun-ying, et al (Department of Hematology, the First People's Hospital of Guangzhou City, Guangzhou 510180, China)9 N6 F$ N0 B2 G
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Abstract: ObjectiveTo observe the side-effects of using anti-themocyte globulin (ATG) /anti-lymphocyte globulin (ALG) in nonmyeloablative transplantation and to improve nursing levels. MethodUsing of ATG/ALG in the course of conditioning regiments of nonmyeloablative stem cell transplantation (NST) on 18 patients were observed. ResultsPositive and negative reactions of subtaneous tests were 6 and 12 cases, respectively. Most of the patients had fever, chills and skin rashes during the use of ATG/ALG. Four patients developed serum diseases, 8 had blood pressure decreasing. All the patients smoothly finished the projects by means of monitoring and prophylactic treatment. ConclusionConditioning regiments of NST are enable to be smoothly finished in order that the allo-haemotopoietic stem cell transplants is ensured to be succeeded if adequate prophylaxes and carefully monitors are performed. 2 C- P3 ]5 t6 h! z/ C3 x+ J1 H! ~ 9 {' R4 U. u: p4 I: E+ T9 _ CKey Words: Nonmyeloablative; Stem cell transplantation; ATG/ALG; Nursing4 s1 x" E8 x$ K( k7 x
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非清髓性造血干细胞移植(NST)是近年兴起的治疗肿瘤和非肿瘤性血液病的新方法,笔者在NST中应用抗胸腺细胞球蛋白(ATG)/抗淋巴细胞球蛋白(ALG),对18例患者进行观察和护理,现报告如下。2 x1 r- Z8 ^" _9 D3 r7 z9 J
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% [- @% D' _* q% h 2结果 # \9 a8 W2 U% r3 L- e' N/ t$ \5 W % H1 [, T( c. A' o皮试阴性12例,阳性6例,需进行脱敏感治疗。12例皮试阴性者,在使用1~3周内出现血清病反应,其中1例SAA患者,出现手指的神经水肿、指尖溃烂结痂。 6 H! F m. E& M) b* ], ? : w4 ~. g9 U2 D3观察与护理 8 f* l9 h ^# E" U$ U I& M b; z3 h0 Y. r; T0 o
3.1观察:①皮试后,密切观察患者的心率、呼吸、皮肤情况,20min后观察皮丘结果,红晕>5cm、硬结>1cm伴瘙痒及伪足者为阳性,皮丘无变化者为阴性[2]。②开始应用药物时,在预用药的前提下,观察其过敏反应,随时调整滴速。③在使用药物过程中,密切观察血象变化,肝、肾、心功能变化,电解质情况及胃肠道反应。④用药过程中,发热、畏寒、寒颤13例,皮疹10例,血压下降8例,心律失常2例(偶发性房性早搏,无心悸、气促,无血压下降),腰痛、关节痛3例,5例无症状及过敏反应。⑤严密观察尿量及体重的变化,因抗原抗体复合物沉积于肾小球基底膜而影响肾脏功能。 Y, D; c0 i# N