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陈莹莹.嵌合抗原受体T细胞治疗血液肿瘤患者免疫相关不良反应的预见性护理干预方案的构建[J].内科急危重症杂志,2026,32(2):146-152
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| DOI：10.11768/nkjwzzzz20260209 |
| 中文关键词: 血液肿瘤 嵌合抗原受体T细胞治疗 不良反应 风险识别 预见性护理 方案构建 |
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| 摘要点击次数: 103 |
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| 中文摘要: |
| 摘要 目的：基于文献检索及临床实践经验构建嵌合抗原受体T细胞（CAR-T）治疗血液肿瘤患者免疫相关不良反应的护理方案，为临床护理工作提供科学指导。方法：通过系统检索国内外CAR-T细胞治疗的相关文献，梳理整合现有护理流程及方案，结合护理人员访谈结果，经专家函询优化后形成CAR-T细胞治疗血液恶性肿瘤患者免疫相关不良反应的预见性护理方案。结果：本研究对22名专家进行2轮专家函询，问卷回收率和有效率均为100%，专家权威系数分别为0.91、0.93，专家提出意见率分别为59.09%、9.09%，指标条目重要性评分分别为4.00～4.80分、4.20～4.86分，变异系数分别为0.09～0.22、0.07～0.21，肯德尔协调系数分别为0.529、0.532，专家协调程度较好（P＜0.001）。最终构建的护理方案涵盖了9个维度共72项内容。具体包括临床护理文书资料的建立、人员培训、入院评估及健康教育、预处理期间护理、输注期间的护理、3种并发症的护理、出院及随访指导。结论：本研究构建的CAR-T细胞治疗血液肿瘤患者免疫相关不良反应的预见性护理方案具有全面性、科学性、实用性，能够有效指导护理人员为患者实施及时、科学、同质化护理。 |
| 英文摘要: |
| Abstract Objective: Based on literature search and clinical practice experience, to construct a nursing plan for immune-related adverse reactions in patients with hematologic tumors treated with chimeric antigen receptor T-cells therapy (CAR-T), and to provide a predictive nursing plan for patients treated with CAR-T. Methods: The system retrieved relevant literature on CAR-T cell therapy at home and abroad, summarized and sorted out the relevant nursing processes and plans, and conducted interviews with nursing staff. After expert inquiries, a predictive nursing plan for immune-related adverse reactions in tumor patients treated with CAR-T cell therapy was formed. Results: This study conducted two rounds of expert consultation with 22 experts. The questionnaire recovery rate and effective rate were both 100%. The expert authority coefficients were 0.91 and 0.93 respectively, and the expert opinion rates were 59.09% and 9.09% respectively. The importance scores of the index items ranged from 4.00 to 4.80，4.20 to 4.86 respectively, with a coefficient of variation of 0.09 to 0.22，0.07 to 0.21 respectively. The Kendall’s coefficient of concordance was 0.529 and 0.532 respectively, indicating a good degree of expert coordination (P< 0.001). The final constructed nursing plan included 9 aspects and 72 items, covering the establishment of clinical nursing document materials, personnel training, admission assessment and health education, pre-treatment period nursing, infusion period nursing, nursing for three types of complications, discharge and follow-up guidance. Conclusion: The predictive nursing program of CAR-T cell therapy for immune-related adverse reactions in blood tumor patients established in this study is comprehensive, scientific and applicable, and can guide nurses to implement timely, scientific, effective and homogenized nursing for patients. |
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