1例食管癌术后并发重度免疫检查点抑制剂相关肺炎及吻合口瘘患者的护理

doi:10.3761/j.issn.0254-1769.2024.14.013

中华护理杂志 ›› 2024, Vol. 59 ›› Issue (14): 1752-1756.DOI: 10.3761/j.issn.0254-1769.2024.14.013

1例食管癌术后并发重度免疫检查点抑制剂相关肺炎及吻合口瘘患者的护理

胡银燕(), 赵林芳(), 贺晓映, 刘敏君

310016 杭州市浙江大学医学院附属邵逸夫医院胸外科（胡银燕，贺晓映），静脉治疗专科（赵林芳），护理部（刘敏君）

收稿日期:2023-09-04 出版日期:2024-07-20 发布日期:2024-07-11
通讯作者: 赵林芳，E-mail：3193159@zju.edu.cn
作者简介:胡银燕：女，本科（硕士在读），主管护师，E-mail：849622571@qq.com
基金资助:
浙江省医药卫生科技计划项目(2024KY1119);浙江省医药卫生科技计划项目(2023-KY803)

Nursing care of a postoperative patient with esophageal cancer complicated by severe immune checkpoint inhibitor-related pneumonia and anastomotic fistula

HU Yinyan(), ZHAO Linfang(), HE Xiaoying, LIU Minjun

Received:2023-09-04 Online:2024-07-20 Published:2024-07-11

摘要/Abstract

摘要：

总结1例术前接受免疫治疗、术后并发重度免疫检查点抑制剂相关肺炎及吻合口瘘的食管癌患者的护理经验。护理要点：成立多学科个案管理小组，制订个性化干预方案；密切关注病情变化，早期识别并处理免疫检查点抑制剂相关肺炎；早期识别吻合口瘘并规范管理，降低脓毒性休克发生风险；评估营养风险，提供序贯式营养支持；基于卡诺夫斯基健康状况评分，实施分阶段个体化肺康复策略；开展个体化出院指导，定期进行线上及门诊随访。经过88 d的综合治疗与精心护理后，患者好转出院，出院后定期随访，随访1年患者恢复良好。

关键词: 食管癌, 免疫检查点抑制剂相关肺炎, 吻合口瘘, 肿瘤护理

Abstract:

This report presents the nursing care for a surgical patient with esophageal cancer who received immunotherapy before surgery and developed severe immune checkpoint inhibitor-related pneumonia and anastomotic fistula postoperatively. Key points of nursing：establishing a multidisciplinary case management team to develop personalized intervention programs；vigilantly monitoring disease progression，promptly identifying and treating immune checkpoint inhibitor-related pneumonia；early identification of anastomotic fistula and standardized management to reduce the risk of septic shock；assessing nutritional risks and providing sequential nutritional support；implementing a phased individualized pulmonary rehabilitation strategy based on Kanowski’s health status score. After 88 days of comprehensive treatment and meticulous nursing care，the patient was discharged in a recovered state. Regular follow-up was conducted after discharge，and the patient recovered well.

Key words: Esophagus Cancer, Immune Checkpoint Inhibitor-Related Pneumonia, Anastomotic Fistula, Oncology Nursing

胡银燕, 赵林芳, 贺晓映, 刘敏君. 1例食管癌术后并发重度免疫检查点抑制剂相关肺炎及吻合口瘘患者的护理[J]. 中华护理杂志, 2024, 59(14): 1752-1756.

HU Yinyan, ZHAO Linfang, HE Xiaoying, LIU Minjun. Nursing care of a postoperative patient with esophageal cancer complicated by severe immune checkpoint inhibitor-related pneumonia and anastomotic fistula[J]. Chinese Journal of Nursing, 2024, 59(14): 1752-1756.

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1例食管癌术后并发重度免疫检查点抑制剂相关肺炎及吻合口瘘患者的护理

Nursing care of a postoperative patient with esophageal cancer complicated by severe immune checkpoint inhibitor-related pneumonia and anastomotic fistula

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