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。
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.
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