异基因造血干细胞移植并发口腔黏膜炎的危险因素分析-现代医学

异基因造血干细胞移植并发口腔黏膜炎的危险因素分析

单位：1. 江苏大学附属人民医院护理部, 江苏镇江 212000;
2. 江苏省军区徐州第四离职干部休养所, 江苏徐州 221000

分类号：R473.73

出版年·卷·期（页码）：2024·52·第一期（127-133）

摘要：

目的：分析异基因造血干细胞移植并发口腔黏膜炎的危险因素，为临床制定口腔黏膜炎的防治方案提供参考。方法：选取2022年3月至2023年3月江苏省徐州市某三甲医院骨髓移植中心收治的107例患者进行临床资料分析，采用Logistic回归分析方法研究各因素与移植并发口腔黏膜炎的关系。结果：将患者按照预后结局分为口腔黏膜炎组和无口腔黏膜炎组，两组在性别、造血干细胞移植前是否有口腔疾患、口腔pH值、口腔护理方式、预处理方案、是否用甲氨蝶呤、中性粒细胞植入时间等变量间，差异具有统计学意义(P<0.05)。进一步Logistic回归分析显示，性别、口腔护理方式、预处理方案、中性粒细胞植入时间是成人异基因造血干细胞移植并发口腔黏膜炎的影响因素。结论：异基因造血干细胞移植并发口腔黏膜炎的发生率较高，其中女性患者、单一的漱口方式、执行清髓性预处理方案、中性粒细胞植入延迟为移植后并发口腔黏膜炎的独立危险因素。护理人员应针对性别差异、预处理药物性质，尤其是在中性粒细胞未成功植入期间，明确口腔护理的方式及时机，为患者制定个性化防治策略，从而减少或减轻移植并发口腔黏膜炎的发生率及严重程度。

Objective: To analyze the risk factors of adult allogeneic hematopoietic stem cell transplantation complicated with oral mucositis, and to provide reference for clinical development of prevention and treatment measures of oral mucositis after transplantation. Methods: A total of 107 patients admitted to the bone marrow transplant Center of a tertiary Grade-A hospital in Xuzhou, Jiangsu Province from March 2022 to March 2023 were selected for clinical data analysis. Binary Logistic regression analysis was used to study the relationship between various factors and the occurrence of cavity mucositis complicated by transplantation. Results: Patients were divided into oral mucositis group and no oral mucositis group according to the prognosis. There were statistically significant differences between the two groups in gender, oral disease before HSCT, oral PH value, oral nursing style, preconditioning regimen, use of methotrexate, neutrophil implantation time and other variables(P＜0.05). Further logistic regression analysis showed that gender, oral care style, preconditioning regimen, and neutrophil implantation time were the factors affecting oral mucositis in adult patients after allogeneic hematopoietic stem cell transplantation. Conclusion: The incidence of allogeneic hematopoietic stem cell transplantation complicated with oral mucositis is high, among which female patients, single gargle, implementation of myeloablative preconditioning regimen, and neutrophil implantation delay are independent risk factors for postoperative oral mucositis. According to the gender difference, the nature of pre-treatment drugs, especially during the unsuccessful implantation of neutrophils, nursing staff should clarify the way and timing of oral care, and formulate personalized prevention and treatment strategies for patients, so as to reduce the incidence and severity of oral mucositis complicated by transplantation.

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