CAJ | 학술논문

目的分析美司钠联合水化、强迫利尿、碱化对造血干细胞移植(HSCT)出血性膀胱炎(HC)的预防效果.方法 32例接受HSCT的患者,2例重型再生障碍性贫血(SAA)采用全身照射+环磷酰胺(TBI-CTX)预处理方案,其余30例均采用经典的白消安+CTX(BU-CTX)预处理方案,所有患者均采用美司钠联合水化、强迫利尿、碱化预防HC,并给予更昔洛韦和阿昔洛韦预防巨细胞病毒(CMV)和其他病毒感染,监测移植前后血CMV-IgM水平.鼓励患者每小时排尿,检测尿pH值并计算尿量,每6 h复查一次尿常规并测中心静脉压(CVP),每8 h检测血电解质.结果仅1例患者移植后6个月出现迟发型Ⅱ级HC,经过水化、碱化、利尿、止血、抗移植物抗宿主病(GVHD)及更昔洛韦抗病毒治疗,35 d后患者HC治愈,其余31例均未出现HC.患者均未出现循环负荷过重造成的不良后果,未出现明显的水电解质及酸碱平衡紊乱.结论美司钠联合水化、强迫利尿、碱化预防HC是安全、有效的.
목적 분석미사납연합수화、강박이뇨、감화대조혈간세포이식(HSCT)출혈성방광염(HC)적예방효과.방법 32례접수HSCT적환자,2례중형재생장애성빈혈(SAA)채용전신조사+배린선알(TBI-CTX)예처리방안,기여30례균채용경전적백소안+CTX(BU-CTX)예처리방안,소유환자균채용미사납연합수화、강박이뇨、감화예방HC,병급여경석락위화아석락위예방거세포병독(CMV)화기타병독감염,감측이식전후혈CMV-IgM수평.고려환자매소시배뇨,검측뇨pH치병계산뇨량,매6 h복사일차뇨상규병측중심정맥압(CVP),매8 h검측혈전해질.결과 부1례환자이식후6개월출현지발형Ⅱ급HC,경과수화、감화、이뇨、지혈、항이식물항숙주병(GVHD)급경석락위항병독치료,35 d후환자HC치유,기여31례균미출현HC.환자균미출현순배부하과중조성적불량후과,미출현명현적수전해질급산감평형문란.결론 미사납연합수화、강박이뇨、감화예방HC시안전、유효적.
Objective To explore the effect of prevention of hemorrhagic cystitis (HC) after hematopoietic stem cell transplantation (HSCT) with hyperhydration, forced diuresis and alkalinizing plus infusion mesna. Methods 32 cases of patients receiving HSCT were included in this study. 2 cases of severe aplastic anemia (SAA) received total body irradiation (TBI)+cyclophosphamide(CTX)(TBI-CTX) regimen,and the remaining 30 patients were using the classic busulfan+CTX (BU+CTX) regimen. All patients were treated with mesna combined with hydration, forced diuresis and alkalization to prevent HC. Ganciclovir and acyclovir were used to prevent cytomegalovirus (CMV) and other viral infections and monitor CMV-IgM levels of the blood. Encourage patients to urinate every hour, testing urine pH value and the calculation of urine output, every 6 h review and testing of urine routine,central venous pressure (CVP), each of 8 h of serum electrolytes. Results Only 1 patient at 6 months after transplantation appeared delayed grade Ⅱ HC after hydration, alkalization, diuretic, hemostatic, anti-graft-versus-host disease (GVHD), and ganciclovir antiviral therapy. The HC patients cured at 35 d. The remaining patients did not suffer HC. Adverse effects such as acid-base balance disturbance did not appear clear. Conclusion Mesna joint hydration, forced diuresis and alkalization was effective and safe to prevent HC.