|
|
|
| Clinical Characteristics and Nursing Methods of Patients with Acute Cutaneous Graft-Versus-host Disease after Allogeneic Hematopoietic Stem Cell Transplantation |
| LU Dan, HU Yan |
| Department of Hematology, West China Hospital Affiliated to Sichuan University,Chengdu, Sichuan 610041 |
|
|
|
|
Abstract 【Objective】 To investigate the clinical characteristics and nursing methods of patients with acute skin graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation. 【Methods】 The clinical characteristics of 42 patients with allogeneic hematopoietic stem cell transplantation who were treated in our hospital from January 2013 to January 2015 were retrospectively analyzed. The incidence, clinical characteristics and nursing methods of acute skin type GVHD were analyzed.【Results】 Among the 42 patients, 15 cases were complicated with acute skin GVHD, the incidence rate was 35.7%, including 5 males and 10 females. There were 5 cases of acute myeloid leukemia (AML) (33.3%), 2 cases of acute lymphoblastic leukemia(ALL) (13.3%), 4 cases of myelodysplastic syndrome (MDS) (26.7%), 2 cases of aplastic anemia (AA)(13.3%), 1 case of chronic myeloid leukemia (CML) (6.7%), 1 case of acute mixed cell leukemia (MAL)(6.7%). There were 13 sibling donors (86.7%) and 2 unrelated donors (13.3%). In this group, 15 cases of acute skin type GVHD rash appeared at the earliest 3 days after stem cell infusion, and the latest time was 38 days; the rash initially manifested as mild diffuse erythema and papules, similar to measles and scarlet fever like drug eruption, with slight pain or pruritus. The most common sites were palms, head and face, and behind ears. The severity of the lesions was grade Ⅰ and grade Ⅱ. All the 15 patients were treated with psychological nursing. After communication, their mood improved significantly, they were able to face the disease positively, and they were able to accept treatment and nursing with the best mentality. No serious infection occurred. The skin involved in 15 patients with acute GVHD was grade Ⅰ to Ⅱ. No skin blister and skin integrity damage occurred, and no medical adhesive related skin lesions occurred.Among the 15 patients, 13 patients' rash subsided and discharged after active treatment and careful nursing. 2 cases occurred after the reduction of methylprednisolone. The range of rash was obviously extended and the color became red obviously. Because the nurses found and handled the rash in time, the rash was quickly controlled, and 2 cases were obviously improved and discharged. Allogeneic hematopoietic stem cell transplantation was successfully performed in 15 patients with acute GVHD.【Conclusion】 Acute skin GVHD has certain clinical characteristics. Observing skin symptoms, early detection and intervention are helpful to improve the prognosis and ensure the successful completion of hematopoietic stem cell transplantation.
|
|
Received: 13 March 2020
|
|
|
|
|
|
[1] 张跃男,张静,丁小萍.异基因造血干细胞移植并发急性移植物抗宿主病的护理[J].解放军护理杂志,2011,28(5): 47-49.
[2] 颜霞.4例异基因造血干细胞移植患者急性移植物抗宿主病重度皮肤损伤的护理[J].中华护理杂志, 2006, 41(1):38-40.
[3] 陆道培,毕寿庚. 白血病[M]. 北京:中国医药科技出版社, 2003: 358-362.
[4] 游权,张颖.异基因造血干细胞移植术后并发移植物抗宿主病的护理[J].天津护理,2013,21(5):462-463.
[5] 付红敏,郭静,王伟.个体化护理对小儿医用粘胶相关表皮剥脱发生率的影响[J].天津护理,2015,23(5):410-411.
[6] 周兰月,李静,邵琰.65例异基因造血干细胞移植并发急性移植物抗宿主病患者的护理[J].护理学报,2014,21(4):32-34.
[7] Champlin R, Khouri I, Kornblau S, et al. Reinventing bone marrow transplantation: reducing toxicity using nonmyeloablative, preparative regimens and induction of graft versus-malignancy[J].Curr Opin Oncol,1999,11:87-95.
[8] 毛凌,陈凤姣,张川莉.透明敷贴在异基因造血干细胞移植术后并发皮肤GVHD患者PICC导管维护中的应用[J].中华现代护理杂志,2017,23(1):64-66.
[9] 李惠君,钟英强.移植物抗肠道病的诊断与治疗[J].新医学,2009,40(3):141-144.
[10] 田伟,郑雅男,冯昌银,等.急性皮肤型移植物抗宿主病8例临床分析并文献复习[J].临床皮肤科杂志,2015,44(11):682-684.
[11] 颜霞, 孙慧 ,徐晓东. 120例HLA单倍体造血干细胞移植后急性移植物抗宿主病患者的护理[J].中华护理杂志,2007,42(8):701-703.
[12] 裴夫瑜, 廖建云, 李七,等. 供体移植物CD4+CD25+Treg细胞表达水平对儿童异基因造血干细胞移植后急性移植物抗宿主病的影响[J].医学临床研究, 2017, 34(1):188-190. |
| [1] |
. [J]. JOURNAL OF CLINICAL RESEARCH, 2018, 35(8): 1591-1592. |
|
|
|
|
2020, Vol. 37 
