Nursing care of 2 cases of lung transplantation patients with graft-versus-host disease after allogeneic hematopoietic stem cell transplantation

doi:10.3761/j.issn.0254-1769.2022.04.015

Abstract

Abstract:

To summarize the nursing experience of 2 cases of lung transplantation in patients with versus host disease after allogeneic hematopoietic stem cell transplantation. Nursing points include observation and prevention of rejection reaction;strictly implementing prevention and control measures to reduce the risk of infection;through various rehabilitation training,promoting the recovery of respiratory function;conducting nutritional screening and developing nutritional support programmes;timely assessment of psychological state,individual psychological counseling. With aggressive treatment and care,2 patients recovered well and were transferred out of the intensive care unit.

Key words: Allogeneic Hematopoietic Stem Cell Transplantation, Lung Transplantation, Airway Clearance Technique, Pulmonary Rehabilitation, Perioperative Nursing

摘要：

总结2例异基因造血干细胞移植术后移植物抗宿主病患者行肺移植术的护理经验。护理要点包括排异反应的观察及预防;严格落实防控措施,降低感染风险;通过各种康复训练,促进呼吸功能恢复;进行营养筛查,制订营养支持计划;及时评估心理状态,个体化靶向心理疏导等。经过积极的治疗和护理,2例患者恢复良好,顺利转出监护室。

关键词: 异基因造血干细胞移植, 肺移植, 气道廓清技术, 肺康复, 围手术期护理

LIN Yan, YU Chao, WANG Fengtao, GAO Chunhua, ZHANG Shuai, CHU Junqing. Nursing care of 2 cases of lung transplantation patients with graft-versus-host disease after allogeneic hematopoietic stem cell transplantation[J]. Chinese Journal of Nursing, 2022, 57(4): 481-485.

林燕, 俞超, 王奉涛, 高春华, 张帅, 褚君卿. 2例异基因造血干细胞移植术后移植物抗宿主病患者行肺移植术的护理[J]. 中华护理杂志, 2022, 57(4): 481-485.

References 22

[1]	Kao RL, Holtan SG. Host and graft factors impacting infection risk in hematopoietic cell transplantation[J]. Infect Dis Clin North Am, 2019, 33(2):311-329. DOI URL
[2]	Penack O, Holler E, van den Brink MR. Graft-versus-host disease:regulation by microbe-associated molecules and innate immune receptors[J]. Blood, 2010, 115(10):1865-1872. DOI PMID
[3]	Ferrara JL, Levine JE, Reddy P, et al. Graft-versus-host disease[J]. Lancet, 2009, 373(9674):1550-1561. DOI PMID
[4]	Bergeron A, Cheng GS. Bronchiolitis obliterans syndrome and other late pulmonary complications after allogeneic hematopoietic stem cell transplantation[J]. Clin Chest Med, 2017, 38(4):607-621. DOI PMID
[5]	Ing MK, Williamson JP. Con:bronchoscopy is essential for pulmonary infections in patients with haematological malignancies[J]. Breathe(Sheff), 2020, 16(4):200210.
[6]	Rushton C, Burton CS, Goddard K, et al. Monitoring lung function in patients with chronic graft versus host disease:a pilot study[J]. Br J Nurs, 2019, 28(18):1196-1200. DOI PMID
[7]	赵金河, 谢彦晖. 移植物抗宿主反应中抗原提呈细胞作用的研究进展[J]. 临床血液学杂志, 2008, 21(3):170-173.
	Zhao JH, Xie YH. Research progress of surface presentation re-sponse in graft anti-reaction response[J]. J Clin Hematol, 2008, 21(3):170-173.
[8]	张媛媛, 沈捷, 马向华. 人类白细胞抗体与实体器官移植的研究进展[J]. 国际移植与血液净化杂志, 2011, 9(3):6-11.
	Zhang YY, Shen J, Ma XH. Research progress of human leukocyte antibodies and solid organ transplantation[J]. Int J Transplant Hemopurification, 2011, 9(3):6-11.
[9]	Kim N, Kashetsky N, Velykoredko Y, et al. Acute graft-versus-host disease after double lung transplantation[J]. JAAD Case Rep, 2021, 13:62-64.
[10]	Lund LH, Edwards LB, Kucheryavaya AY, et al. The registry of the international society for heart and lung transplantation:thirty-second official adult heart transplantation report—2015;focus theme:early graft failure[J]. J Heart Lung Transplant, 2015, 34(10):1244-1254. DOI URL
[11]	徐辉, 张稷, 陈静瑜. 肺移植后他克莫司血药浓度和剂量比与受者CYP3A5基因型的相关性研究[J]. 中华器官移植杂志, 2014, 35(2):103-105.
	Xu H, Zhang J, Chen JY. Relationship between tacrolimus blood level/dose and the genotype of CYP3A5 after lung transplantation[J]. Chin J Organ Transplant, 2014, 35(2):103-105.
[12]	Saldanha IJ, Akinyede O, Robinson KA. Immunosuppressive drug therapy for preventing rejection following lung transplantation in cystic fibrosis[J]. Cochrane Database Syst Rev, 2018, 6:CD009421.
[13]	谢华, 王荣, 武晓玉, 等. 他克莫司血药浓度监测与合理用药分析[J]. 中国药房, 2013, 24(26):2427-2429.
	Xie H, Wang R, Wu XY, et al. Analysis of blood concentration monitoring of tacrolimus and rational use of drugs[J]. China Pharm, 2013, 24(26):2427-2429.
[14]	Hayes D Jr, Harhay MO Jr, Cherikh WS Jr, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation:twenty-third pediatric lung transplantation report—2020;focus on deceased donor characteristics[J]. J Heart Lung Transplant, 2020, 39(10):1038-1049. DOI URL
[15]	Kucewicz-Czech E, Wojarski J, Zegleń S, et al. Pulmonary hypertension-intra-and early postoperative management in patients undergoing lung transplantation[J]. Kardiol Pol, 2009, 67(9):989-994. PMID
[16]	吴南海, 栾佐, 鲍亮, 等. 无关脐血移植治疗Ⅰ型黏多糖病[J]. 中华实用儿科临床杂志, 2015, 30(8):604-607.
	Wu NH, Luo Z, Bao L, et al. Clinical research on unrelated cord blood transplantation treatment for mucopolysaccharidosis Ⅰ[J]. Chin J Appl Clin Pediatr, 2015, 30(8):604-607.
[17]	葛慧青, 孙兵, 王波, 等. 重症患者气道廓清技术专家共识[J]. 中华重症医学电子杂志(网络版), 2020, 6(3):272-282.
	Ge HQ, Sun B, Wang B, et al. Expert consensus of airway clearance in critically ill patients[J]. Chin J Crit Care Intensive Care Med Electron Ed, 2020, 6(3):272-282.
[18]	刘博, 戚思华. 超声技术在围手术期呼吸道管理中的应用进展[J]. 医学综述, 2019, 25(22):4520-4524.
	Liu B, Qi SH. Application progress of ultrasound in perioperative respiratory management[J]. Med Recapitul, 2019, 25(22):4520-4524.
[19]	Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement:key concepts and advances in pulmonary rehabilitation[J]. Am J Respir Crit Care Med, 2013, 188(8):e13-e64. DOI URL
[20]	吕秀霞, 陈瑞云, 魏立, 等. 肺移植患者肺康复的研究进展[J]. 中华护理杂志, 2019, 54(5):765-770.
	Lü XX, Chen RY, Wei L, et al. Research progress on pulmonary rehabilitation in patients underwent lung transplantation[J]. Chin J Nurs, 2019, 54(5):765-770.
[21]	汪璐璐, 徐凤玲, 刘钢, 等. 机械通气患者早期肺康复分级方案的构建与应用研究[J]. 中华护理杂志, 2020, 55(8):1125-1132.
	Wang LL, Xu FL, Liu G, et al. Construction and preliminary application of early pulmonary rehabilitation grading scheme for patients with mechanical ventilation[J]. Chin J Nurs, 2020, 55(8):1125-1132.
[22]	Liu P, Wang B, Yan X, et al. Comprehensive evaluation of nutritional status before and after hematopoietic stem cell transplantation in 170 patients with hematological diseases[J]. Chin J Cancer Res, 2016, 28(6):626-633. DOI URL