首页|肿瘤免疫检查点抑制剂相关皮肤不良反应的护理策略

肿瘤免疫检查点抑制剂相关皮肤不良反应的护理策略

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免疫检查点抑制剂(ICIs)在晚期恶性肿瘤治疗中展示了显著的临床疗效,但其使用伴随着多种免疫相关不良反应(irAEs),尤其是皮肤不良反应(irCAEs).本研究旨在综述ICIs引起的皮肤不良反应的流行病学、临床表现及护理管理策略.利用中国知网和 PubMed 数据库,以"Immune Checkpoint Inhibitors""Immune-related Adverse Events""Cutane-ous Adverse Events"和"Management Strategies"为关键词,检索 2019-01-01-2023-12-31 相关文献.纳入标准:(1)关于ICIs引起的皮肤不良反应的研究;(2)详细描述护理策略的研究;(3)样本量大且数据详实的研究.排除标准:(1)年份较远的综述类文献;(2)文章质量较差或数据不完整的文献.最终纳入45篇文献进行分析.结果表明,irCAEs是ICIs治疗中最常见且最早发生的免疫相关不良反应.常见的irCAEs包括非特异性斑丘疹、瘙痒、银屑病样、湿疹和苔藓样皮肤病.其发生机制主要涉及自身反应性T细胞和B细胞的活化,以及细胞因子的变化.护理策略主要包括:(1)针对非特异性斑丘疹和瘙痒的治疗;(2)心理护理;(3)饮食指导;(4)生活护理.通过科学的护理管理,可以显著提高患者的生活质量和治疗依从性.提示,通过深入了解irCAEs的临床病理特征并制定有效的管理策略,可以有效提高ICIs治疗的成功率和患者的长期受益.未来需进一步研究和实践,以优化护理策略,最大限度地减少不良反应,造福更多的肿瘤患者.
Nursing strategies for cutaneous adverse events related to tumor immune checkpoint inhibitors
Immune Checkpoint Inhibitors(ICIs)have shown significant clinical efficacy in the treatment of advanced ma-lignancies,but their use is accompanied by various immune-related adverse events(irAEs),particularly cutaneous adverse events(irCAEs).This study aims to review the epidemiology,clinical manifestations,and nursing management strategies of irCAEs induced by ICIs.We utilized the China National Knowledge Infrastructure(CNKI)and PubMed databases to search for relevant literature from January 1,2019,to December 31,2023,using the keywords"Immune Checkpoint In-hibitors,""Immune-related Adverse Events,""Cutaneous Adverse Events,"and"Management Strategies."Inclusion cri-teria were:(1)studies on ICIs-induced cutaneous adverse events;(2)studies that detailed nursing management strate-gies;and(3)studies with large sample sizes and comprehensive data.Exclusion criteria were:(1)older review articles;(2)studies with poor quality or incomplete data.A total of 45 articles were included for analysis.The results indicated that cutaneous irAEs are the most common and earliest occurring irAEs during ICIs treatment.Common irCAEs include non-specific maculopapular rashes(MPR),pruritus,psoriasis-like dermatitis,eczema,and lichenoid dermatitis.The underlying mechanisms primarily involve the activation of autoreactive T cells and B cells,as well as changes in cytokine profiles.The nursing management strategies mainly include:(1)treatment for non-specific maculopapular rashes and pruritus;(2)psychological care;(3)dietary guidance;(4)lifestyle care.Scientific nursing management can significantly improve patients'quality of life and treatment adherence.By thoroughly understanding the clinicopathological characteris-tics of irCAEs and formulating effective management strategies,the success rate of ICIs therapy and long-term patient benefits can be effectively improved.Further research and practice are needed to optimize nursing strategies,minimize ad-verse effects,and benefit more cancer patients.

immune checkpoint inhibitorsimmune-related adverse eventscutaneous adverse eventsmanagement strate-gies

王桂英、陈小徵

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临清市人民医院居家护理服务中心,山东临清 252699

山东大学齐鲁医院放疗科,山东济南 250012

免疫检查点抑制剂 免疫相关不良反应 皮肤不良反应 护理策略

中国博士后科学基金山东省自然科学基金山东省博士后创新项目专项资金山东第一医科大学青年科学家基金

2022M711976ZR202112030101SDCX-ZG-202202024202201-109

2024

10.19790/j.cnki.JCM.2024.18.07

社区医学杂志
中华预防医学会

社区医学杂志

影响因子：0.588
ISSN：1672-4208
年,卷(期)：2024.22(18)