CAR-T细胞治疗血液肿瘤后细胞因子释放综合征患者自评与护理记录一致性研究

邬祖霞; 左琼; 刘睿; 王兴兵

doi:10.16766/j.cnki.issn.1674-4152.002706

CAR-T细胞治疗血液肿瘤后细胞因子释放综合征患者自评与护理记录一致性研究

doi: 10.16766/j.cnki.issn.1674-4152.002706

中国科学技术大学附属第一医院血液内科一病区，安徽合肥 230001

基金项目:

国家自然科学基金项目 82170221

安徽省科技重大专项 18030801126

详细信息

通讯作者:
王兴兵, E-mail: wangxingbing@ustc.edu.cn

中图分类号: R473.73R733
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- 文章访问数: 267
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- 被引次数: 0
出版历程
- 收稿日期: 2022-03-12
- 网络出版日期: 2022-11-30

Consistency of self-evaluation and nursing records in patients with cytokine release syndrome after CAR-T cell therapy for haematological tumours

The First Ward of Hematology Department, the First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui 230001, China

摘要

摘要: 目的探讨嵌合抗原受体T(chimeric antigen receptor T, CAR-T)细胞治疗血液肿瘤后细胞因子释放综合征(cytokine release syndrome，CRS)患者自评与护理记录一致性。方法选取2016年10月—2018年10月入住中国科学技术大学附属第一医院CAR-T细胞治疗后出现需要临床干预CRS症状的血液肿瘤患者39例，采用标准化评价量表问卷调查对包括恶心、呕吐、呼吸困难、肌痛、头痛、皮疹、乏力与食欲下降程度等症状的自我评估进行总结，然后与病历中护理记录的CRS症状评分采用秩和检验进行比较；并进一步采用组内相关系数ICC检验对两者一致性进行探讨。结果患者自我报告的CRS症状中除皮疹(Z=1.388，P=0.165)之外，恶心、呕吐、呼吸困难、肌痛、头痛、乏力与食欲下降程度均明显高于护理记录的数据(均P＜0.001)；同样，在患者自我评价中除皮疹一致性较好(ICC=0.55，P＜0.001)之外，其余项目与护理评估数据测量一致性稍差(0.21＜ICC＜0.40，均P＜0.05)。结论护理人员对CAR-T细胞治疗血液肿瘤后CRS患者进行的评价与患者自我评价一致性一般，可重复性较差，其护理评估仍需进一步总结。
- 血液肿瘤 /
- 嵌合抗原受体T细胞治疗 /
- 细胞因子释放综合征 /
- 护理研究
Abstract: Objective To explores the consistency of self-evaluation and nursing records of patients with cytokine release syndrome (CRS) after chimeric antigen receptor T (CAR-T) cell therapy of haematological tumours. Methods A total of 39 patients with haematological tumours who developed CRS symptoms requiring clinical intervention after CAR-T cell therapy in the First Affiliated Hospital of University of Science and Technology of China from October 2016 to October 2018 were selected. The self-assessment of symptoms, including nausea, vomiting, dyspnea, myalgia, headache, rash, fatigue and loss of appetite, were summarised using a standardised questionnaire and then compared with the CRS symptom scores in the nursing records using the Wilcoxon rank-sum test and further analysed using an intraclass correlation coefficient (ICC) to explore the consistency between the two. Results Except rash (Z=1.388, P=0.165), the self-reported CRS symptoms of patients, nausea, vomiting, dyspnea, myalgia, headache, fatigue and loss of appetite were significantly higher than the data in nursing records (all P < 0.001). Similarly, in the patient self-assessment, except rash, the consistency was appropriate (ICC=0.55, P < 0.001), and the other items were low with the nursing assessment data measurement (0.21 < ICC < 0.40, all P < 0.05). Conclusion The nurses ' evaluation of CRS patients after CAR-T cell therapy of haematological tumours is not consistent with the patient ' s self-evaluation, and their nursing evaluation still needs to be further summarised.
- Haematological tumours /
- Chimeric antigen receptor T-cell therapy /
- Cytokine release syndrome /
- Nursing research

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表 1 CRS评分标准

Table 1. Scoring criteria of CRS

等级	CRS症状
1级	症状不会危及生命，需要对症治疗，只有发热、恶心、疲劳、头痛、肌痛、不适等
2级	症状需要适度干预，如：呼吸困难(需氧量＜40%)或血压降低(仅需小剂量升压药物治疗)或2级器官毒性
3级	症状需要积极干预，如：呼吸困难(需氧量≥40%)或血压降低(需要大剂量联合用药)或3级器官毒性，4级肝转氨酶升高
4级	症状危及生命，如：需要机械通气支持，4级器官毒性
5级	死亡
注：CRS评分标准参照参考文献[6]，其中2~4级根据美国常见不良反应术语评定标准CTCEA v4.0版本分级。

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表 2 血液肿瘤患者CRS症状自评与护士他评比较[M(P₂₅, P₇₅)，分]

Table 2. Comparison between self-evaluation and nursing records of patient with hematological tumor [M(P₂₅, P₇₅), points]

症状	患者自评	护士他评	Z值	P值
恶心	3.00(3.00，3.00)	2.00(1.00，2.00)	4.425	＜0.001
呕吐	3.00(2.00，3.00)	2.00(2.00，3.00)	3.769	＜0.001
呼吸困难	3.00(3.00，3.00)	2.00(2.00，2.00)	5.153	＜0.001
肌痛	3.00(3.00，3.00)	2.00(2.00，3.00)	3.832	＜0.001
头痛	3.00(3.00，3.00)	3.00(2.00，3.00)	6.079	＜0.001
皮疹	2.00(1.00，3.00)	2.00(0.00，3.00)	1.388	0.165
乏力	3.00(2.00，3.00)	2.00(1.00，2.00)	4.623	＜0.001
食欲下降	3.00(3.00，3.00)	2.00(2.00，2.00)	7.080	＜0.001

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表 3 血液肿瘤患者CRS症状自评与护士他评一致性检验

Table 3. Consistency test between self-evaluation and nursing records of patient with hematological tumor

症状	ICC值	P值
恶心	0.37	0.010
呕吐	0.33	0.021
呼吸困难	0.27	0.044
肌痛	0.29	0.033
头痛	0.27	0.048
皮疹	0.55	＜0.001
乏力	0.29	0.035
食欲下降	0.33	0.020

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