血液系统恶性肿瘤患者对T细胞免疫治疗体验的Meta整合及护理启示

doi:10.3761/j.issn.0254-1769.2024.17.015

摘要/Abstract

摘要：

目的系统评价血液系统恶性肿瘤患者对嵌合抗原受体T细胞（chimeric antigen receptor T-cell，CAR-T）治疗的体验，为护理人员制订个体化的干预策略提供参考。方法系统检索PubMed、Web of Science、Embase、CINAHL、Cochrane Library、PsycINFO、Scopus、澳大利亚乔安娜布里格斯研究所（Joanna Briggs Institute，JBI）循证卫生保健中心数据库、中国知网、万方数据库、维普数据库及中国生物医学文献数据库，收集有关血液系统恶性肿瘤患者对CAR-T治疗体验的质性研究，检索时限为建库至2023年9月。根据澳大利亚JBI循证卫生保健中心质性研究真实性评价标准评价文献质量，并采用汇集性整合法进行分析。结果共纳入15篇文献，提炼出76个主题，归纳成8个类别，形成3个整合结果。①患者存在矛盾心理，期望与现实的差距导致其情绪变化：对治疗的期望及对治疗风险的顾虑并存；情绪随治疗期望及体验的变化而波动。②患者的生理及社会功能受损，但随着病情缓解会逐渐复原：生理功能的急剧衰退和改善；社会功能的丧失及重拾。③患者渴望获得专业指导和社会援助：获取知识和共享信息；接受居家照护指导；获得经济援助；寻求心理社会支持。结论接受CAR-T治疗的血液系统恶性肿瘤患者常存在矛盾心理，治疗后生理、社会功能改变使其渴望获得多方面的医疗及护理支持，建议护理人员在治疗前加强对患者心理状况的动态评估和干预，在治疗后聚焦不良反应的早期识别和管理，且在出院后开展延续性护理，以提高患者对CAR-T治疗的信心，改善其生活质量。

关键词: 血液肿瘤, 嵌合抗原受体, 免疫治疗, 质性研究, Meta整合, 肿瘤护理

Abstract:

Objective This study aims to systematically evaluate the experiences of patients with hematologic neoplasm undergoing chimeric antigen receptor T-cell（CAR-T） therapy and nursing care，and to provide a reference basis for healthcare providers to develop personalized intervention strategies. Methods PubMed，Web of Science，Embase，CINAHL，Cochrane Library，PsycINFO，Scopus，Australia Joanna Briggs Institute（JBI） EBP Database，China National Knowledge Infrastructure（CNKI），Wanfang Data，VIP Database，and China Biology Medicine（CBM） Database were systematically searched for qualitative studies on the experiences of patients with hematologic neoplasm undergoing CAR-T therapy and nursing care. The search period extended up to September 2023. The quality of the literature was reviewed according to the JBI Qualitative Assessment and Review Instrument，and a pooled analysis was applied to integrate the results. Results A total of 15 studies were included，generating 76 findings，which were then organized into 8 categories，resulting in 3 integrated findings.（1）Patients experienced conflicting emotions，with expectations often at odds with reality，leading to emotional fluctuations：expectations about treatment were entangled with concerns about risks；emotions fluctuated with expectations and actual experiences. （2）Patients experienced physical and social functional impairments，but as the disease eased，normal functioning recovered：rapid decline and improvement in physical functions；loss and recovery of social functions. （3）Patients desired access to professional guidance and psychosocial support. Conclusion Patients undergoing CAR-T therapy often contend with emotional conflicts. Changes in physical and social functions after the completion of treatment result in needs for seeking comprehensive medical and nursing support. It is recommended that healthcare providers conduct dynamic assessments and interventions regarding patients’ emotional states before treatment，focus on early identification and management of adverse reactions after treatment，and offer continuous nursing services after discharge to enhance patients’ confidence in participating in CAR-T therapy and improve their overall quality of life.

Key words: Hematologic Neoplasm, Chimeric Antigen Receptor, Immunotherapy, Qualitative Research, Meta-Synthesis, Oncology Nursing

黄莺, 王华芬, 邵丽芳, 郑力, 孙丹萍, 楼方圆, 姚小飞. 血液系统恶性肿瘤患者对T细胞免疫治疗体验的Meta整合及护理启示[J]. 中华护理杂志, 2024, 59(17): 2147-2155.

HUANG Ying, WANG Huafen, SHAO Lifang, ZHENG Li, SUN Danping, LOU Fangyuan, YAO Xiaofei. Experiences of patients with hematologic neoplasm regarding T-cell immunotherapy：a meta-synthesis review and inspiration for nursing care[J]. Chinese Journal of Nursing, 2024, 59(17): 2147-2155.

图/表 4

图1 PubMed检索策略

Figure 1 Literature search strategies of PubMed

图2 文献筛选流程

Figure 2 Literature screening process

表1 纳入文献的基本特征（n=15）

Table 1 The essential characteristics of included studies（n=15）

表2 纳入文献的方法学质量评价结果（n=15）

Table 2 Methodological quality evaluation of included studies（n=15）

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