心肌淀粉样变性患者行达雷妥尤单抗首程治疗的护理

doi:10.3761/j.issn.2096-7446.2023.11.013

摘要/Abstract

摘要： 总结1例伴严重心力衰竭的心肌淀粉样变性患者行达雷妥尤单抗首程治疗的护理体会。由于左心室舒张末容积缩小至不足正常的1/2,患者在抗克隆性浆细胞化疗前已合并心力衰竭和胸腔积液,因此使用无创辅助通气救治急性心力衰竭,严密心功能监测下维持动态容量平衡是护理重点;做好达雷妥尤单抗的配置、输注及不良反应观察,合理使用导管降低感染风险,积极管理心外症状。患者完成首程化疗,左心室舒张末容积增加,住院第63天出院。

关键词: 免疫球蛋白轻链淀粉样变性, 心力衰竭, 化学疗法, 危重病护理

Abstract: To summarize the nursing experience of a patient with myocardial amyloidosis accompanied by severe heart failure undergoing the first stage daratumumab chemotherapy. Since the end diastolic volume of the left ventricle had shrunk to less than 1/2 of normal,the patient had heart failure and pleural effusion before chemotherapy,so non-invasive auxiliary ventilation to treat acute heart failure,and the dynamic volume balance under strict cardiac function monitoring was the key point of nursing. Properly admixture,infusion,and adverse reactions observation of daratumumab,reasonable catheters use to reduce the risk of infection,and extracardiac symptoms management were implemented. The patient accomplished the first stage of chemotherapy,the left ventricular end-diastolic volume increased and the patient was discharged after 63 days.

Key words: Immunoglobulin Light-chain Amyloidosis, Heart Failure, Chemotherapy, Critical Care Nursing

陈曦, 陈海莲, 黄丹丹. 心肌淀粉样变性患者行达雷妥尤单抗首程治疗的护理[J]. 中华急危重症护理杂志, 2023, 4(11): 1026-1029.

CHEN Xi, CHEN Hailian, HUANG Dandan. Nursing care of a patient with cardiac amyloidosis undergoing the first stage daratumumab chemotherapy[J]. Chinese Journal of Emergency and Critical Care Nursing, 2023, 4(11): 1026-1029.

参考文献

[1] 中国系统性轻链型淀粉样变性协作组,国家肾脏疾病临床医学研究中心,国家血液系统疾病临床医学研究中心,等. 系统性轻链型淀粉样变性诊断和治疗指南(2021年修订)[J]. 中华医学杂志,2021,101(22):1646-1656.
Chinese Systemic Light Chain Amyloidosis Collaborative Group,National Clinical Research Center for Kidney Diseases,National Clinical Research Center for Hematology,et al. Guidelines for the diagnosis and treatment of systemic light chain amyloidosis(2021 revision)[J]. Chin J Med,2021,101(22):1646-1656.
[2] Kastritis E,Palladini G,Minnema MC,et al.Daratumumab-based treatment for immunoglobulin light-chain amyloidosis[J]. N Engl J Med,2021,385(1):46-58.
[3] 黄湘华,刘志红. 积极应对系统性轻链型淀粉样变性诊治带来的挑战[J]. 中华医学杂志,2021,101(22):1631-1634.
Huang XH,Liu ZH.To positively deal with the challenges brought by the diagnosis and treatment of systemic light chain amyloidosis[J]. Natl Med J China,2021,101(22):1631-1634.
[4] Berthelot E,Broussier A,Hittinger L,et al.Patients with car-diac amyloidosis are at a greater risk of mortality and hospital readmission after acute heart failure[J]. ESC Heart Fail,2023, 10(3):2042-2050.
[5] Masip J,Peacock WF,Price S,et al.Indications and practical approach to non-invasive ventilation in acute heart failure[J]. Eur Heart J,2018,39(1):17-25.
[6] 刘闵育,周炳凤,王举红,等. 无创呼吸机压力支持在急性心源性肺水肿急救中的疗效[J]. 中国循证心血管医学杂志,2021, 13(9):1058-1062,1067.
Liu MY,Zhou BF,Wang JH,et al.A review on curative effect of non-invasive ventilator pressure support in rescue of acute cardiogenic pulmonary edema[J]. Chin J Evid Based Cardiovasc Med,2021,13(9):1058-1062,1067.
[7] 罗桢蓝,胡三莲,朱凌燕,等. 慢性心力衰竭患者自我容量管理的最佳证据总结[J]. 中华护理杂志,2022,57(7):880-886.
Luo ZL,Hu SL,Zhu LY,et al.Evidence summary for self volume-management in patients with chronic heart failure[J]. Chin J Nurs,2022,57(7):880-886.
[8] 赵旭,王伟,赵小静,等. 慢性心力衰竭患者出入量管理的最佳证据总结[J]. 中华护理杂志,2020,55(3):456-461.
Zhao X,Wang W,Zhao XJ,et al.Best evidence summary for management of output and input in chronic heart failure patients[J]. Chin J Nurs,2020,55(3):456-461.
[9] Palladini G,Kastritis E,Maurer MS,et al.Daratumumab plus CyBorD for patients with newly diagnosed AL amyloidosis:safety Run-in results of ANDROMEDA[J]. Blood,2020,136(1):71-80.
[10] Nooka AK,Kaufman JL,Hofmeister CC,et al.Daratumumab in multiple myeloma[J]. Cancer,2019,125(14):2364-2382.
[11] 吕芳芳,殷静静,杨丽娟. 肺切除术后胸腔引流管管理的最佳证据总结[J]. 中华护理杂志,2020,55(5):773-779.
Lü FF,Yin JJ,Yang LJ.Summary of the best evidence for nursing management of thoracic drainage tube after pneumo-nectomy[J]. Chin J Nurs,2020,55(5):773-779.
[12] Writing Committee,Kittleson MM,Ruberg FL,et al.2023 ACC expert consensus decision pathway on comprehensive multidisciplinary care for the patient with cardiac amyloi-dosis:a report of the American College of Cardiology Solution Set Oversight Committee[J]. J Am Coll Cardiol,2023,81(11):1076-1126.

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