循证医学视角下的预见性护理在CAR-T免疫治疗复发/难治性B细胞淋巴瘤患者中的应用

doi:10.16138/j.1673-6087.2025.03.10

摘要/Abstract

摘要：

目的：探讨基于循证医学的预见性护理在嵌合抗原受体T细胞（chimeric antigen receptor T cell, CAR-T）免疫治疗复发/难治性B细胞淋巴瘤患者中的临床效果。 方法：方法：纳入2022年1月至2023年5月在我院接受CAR-T治疗的80例复发/难治性B细胞淋巴瘤患者。采用信封法随机分为对照组和观察组各40例。对照组接受常规护理，观察组由循证医学小组实施预见性护理，主要通过收集问题、明确问题、确定证据，采用循证医学指导下的预见性护理。比较2组患者在不同护理模式下心理状态评分、疲乏程度及并发症发生情况。 结果：护理干预前，2组患者焦虑、抑郁评分差异无统计学意义。观察组焦虑、抑郁评分均显著低于对照组，差异有统计学意义（P<0.05）。在疲乏程度方面，2组患者护理前疲乏程度、行为、情感、认知与情绪、感觉评分均无显著差异，观察组干预后各项评分均显著高于对照组（P<0.05）。对照组细胞因子释放综合征（cytokine release syndrome, CRS）和免疫效应细胞相关神经毒性综合征(immune effector cell-associated neurotoxicity syndrome, ICANS)发生率分别为82.50%和27.50%，显著高于观察组（65.00%和15.00%）。2组整体不良反应发生率无显著差异，但观察组仅1例3-4级CRS，对照组则为3例，观察组未发生3-4级ICANS，而对照组1例。 结论：基于循证医学的预见性护理可有效改善复发/难治性B细胞淋巴瘤患者CAR-T治疗过程中的不良情绪，减轻疲乏程度，减少高级别不良反应发生率，提升患者生活质量，具有临床推广价值。

关键词: 循证医学, 预见性护理, CAR-T细胞免疫治疗, 复发/难治性B细胞淋巴瘤, 应用效果

Abstract:

Objective To explore the clinical application and effectiveness of evidence-based predictive nursing on patients with relapsed/refractory B-cell lymphoma undergoing chimeric antigen receptor (CAR) T-cell therapy. Methods Eighty patients with relapsed/refractory B-cell lymphoma who underwent CAR T-cell therapy at Ruijin Hospital between January 2022 and May 2023 were enrolled in the study. Using the envelope method, the patients were randomly assigned to either a control group (n=40), receiving standard nursing care, or an intervention group (n=40), receiving predictive nursing based on evidence-based practice. The intervention included structured problem identification, targeted evidence collection, and implementation of proactive nursing strategies. Clinical outcomes which were compared between the two groups included psychological status, fatigue severity, and treatment-related complications. Results Before nursing intervention, there were no significant differences in anxiety or depression scores between the two groups. After intervention, the intervention group showed significantly lower anxiety and depression scores (P<0.05). Fatigue levels and related dimensions (behavioral, emotional, cognitive, and sensory) also improved significantly in the intervention group compared with the control group (P<0.05). The incidence of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) was lower in the intervention group (65.00% and 15.00%, respectively) than that in the control group (82.50% and 27.50%). There was no significant difference in the overall rate of adverse events between the two groups. There was one case of grade 3-4 CRS and none grade 3-4 ICANS in the intervention group, while there were three cases of grade 3-4 CRS and one case of grade 3-4 ICANS in the control group. Conclusions Evidence-based predictive nursing demonstrates clear clinical value in the management of patients undergoing CAR T-cell therapy with relapsed/refractory B-cell lymphoma. It effectively alleviates psychological distress, reduces fatigue, lowers the risk of severe toxicities, and enhances overall safety and quality of care. These findings support its broader implementation in clinical practice.

Key words: Evidence-based nursing, Predictive nursing, Chimeric antigen receptor T-cell therapy, Relapsed/refractory B-cell lymphoma, Application effect

中图分类号:

R733.4

郑欣, 陈恋. 循证医学视角下的预见性护理在CAR-T免疫治疗复发/难治性B细胞淋巴瘤患者中的应用[J]. 内科理论与实践, 2025, 20(03): 248-253.

ZHENG Xin, CHEN Lian. Application in evidence-based predictive nursing on patients with relapsed/refractory B-cell lymphoma receiving chimeric antigen receptor T-cell immunotherapy[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(03): 248-253.

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量表	阶段	对照组	观察组	t	P
HAMD	护理前	11.55±3.21	11.62±3.15	0.098 4	0.921 8
HAMD	护理后	6.78±1.57	4.89±1.21	6.030 4	<0.00 1
HAMA	护理前	14.69±2.09	14.76±2.03	0.151 9	0.879 6
HAMA	护理后	7.98±1.67	5.78±1.28	6.612 7	<0.00 1

评估内容	对照组	观察组	t	P
疲乏行为及程度
护理前	25.21±4.75	25.24±4.71	0.028 3	0.977 4
护理后	21.09±3.98	15.68±3.22	6.683 4	<0.001
情感
护理前	26.24±5.12	26.29±5.09	0.043 8	0.965 2
护理后	22.78±4.32	15.24±3.58	8.499 4	<0.001
认知与情绪
护理前	20.56±4.67	20.68±4.56	0.116 2	0.907 7
护理后	17.31±4.09	12.98±3.45	5.118	<0.001
感觉
护理前	24.25±5.17	24.26±5.11	0.008 7	0.993 1
护理后	20.11±4.21	17.38±4.07	2.948 5	0.004 2

并发症	观察组	对照组	χ²	P
CRS
1-2级	25/62.50	30/75.00
3-4级	1/2.50	3/7.50
任何级别发生率	26/65.00	33/82.50	3.164	0.075
ICANS
1-2级	6/15.00	10/25.00
3-4级	0/0	1/2.50
任何级别发生率	6/15.00	11/27.50	1.867	0.172