骨肉瘤患者化療Ⅳ度骨髓抑制的精細護理效果評價

李婷+趙燕霞+權冬

摘要：目的 探討骨肉瘤患者化療后發生Ⅳ度骨髓抑制的精細護理方法，并評價其臨床療效。方法 收集2012年2月～2016年2月解放軍第518醫院骨科收治的骨肉瘤化療后Ⅳ度骨髓抑制的患者102例，采用隨機數字表法分為對照組和觀察組各51例。對照組采用化療后骨髓抑制的常規護理方法，觀察組在常規護理基礎上加強精細化護理。比較兩組患者臨床癥狀及護理滿意度。結果 經化療后均出現了Ⅳ度骨髓抑制的102例患者，其中白細胞Ⅳ度減少102例，血小板Ⅳ度減少19例，同時出現白細胞和血小板Ⅳ度減少19例，不同程度發熱16例，口腔潰瘍7例，皮膚粘膜出血3例，呼吸道感染0例，泌尿系感染2例，不同程度疼痛13例。所有患者均順利通過骨髓抑制期，血常規檢查正常，并完成治療。采用院方滿意度測評量表評估兩組患者的護理滿意度，觀察組患者滿意度為96.35%，對照組為79.11%，觀察組明顯優于對照組，兩組比較差異明顯，具有統計學意義（P<0.05）。結論 精細化護理是指個體化、整體化、創造性有效的護理模式。為降低化療后骨肉瘤患者的并發癥發生率，采取及時有效的精細護理措施，使患者安全、平穩的度過危險期，降低并發癥發生率，提高骨肉瘤化療的安全性和依從性。

關鍵詞：Ⅳ度骨髓抑制；骨肉瘤；化療；精細護理

中圖分類號：R473.73 文獻標識碼：A 文章編號：1006-1959（2017）13-0137-03

Abstract：Objective Fine nursing degree of myelosuppression of patients with osteosarcoma after chemotherapy，and to evaluate its clinical efficacy. Methods 102 cases of bone marrow suppression IV in February 2012～February 2016 osteosarcoma chemotherapy admitted to the Department of orthopedics，the 518th Hospital of PLA after patients were randomly divided into control group and observation group of 51 patients.The control group was treated with routine nursing after bone marrow suppression after chemotherapy，and the observation group strengthened the intensive care on the basis of routine nursing.The clinical symptoms and nursing satisfaction were compared between the two groups.Results After chemotherapy，there were 102 patients with grade Ⅳ myelosuppression，including 102 cases of grade Ⅳ decrease in white blood cells，19 cases of grade Ⅳ of platelets and 19 cases of grade IV decrease of white blood cells and platelets，16 cases of fever of different degrees，7 cases of oral ulcers，3 cases of skin and mucous membrane hemorrhage，0 cases of respiratory infections，2 cases of urinary tract infection，13 cases of varying degrees of pain.All patients were successfully through the bone marrow suppression period，blood routine examination and complete the treatment.Using the hospital satisfaction evaluation scale assessment of two groups of patients and nursing satisfaction，patient satisfaction of the observation group was 96.35%，79.11% in the control group，the observation group was significantly better than the control group，the difference between the two groups was statistically significant （P<0.05）.Conclusion Fine care refers to individual，holistic，creative and effective nursing model.To reduce the incidence of complications of osteosarcoma after chemotherapy，to take timely and effective fine care measures to enable patients to safely and steadily through the dangerous period， reduce the incidence of complications，improve the safety and compliance of osteosarcoma chemotherapy.

Key words：Grade IV myelosuppression；Osteosarcoma；Chemotherapy；Fine care

化療是骨肉瘤治療的主要手段之一，但化療的實施會導致骨髓抑制，患者會出現白細胞、中性粒細胞和血小板減少，口腔和身體各部位的皮膚粘膜都易感染[1]。Ⅳ度骨髓抑制，即為血常規中WBC≤1.0×109/L，中性粒細胞絕對計數（ANC）≤0.5×109/L，PLT≤25×109/L。Ⅳ度骨髓抑制的發生，不僅影響化療療程的進展還影響化療效果，還可能導致一些并發癥的發生而危及其患者生命。因此，及時發現骨髓抑制和積極治療是化療的重要環節[2]。……