新医学2025，Vol.56Issue(8)：785-793,9.DOI:10.12464/j.issn.0253-9802.2025-0026
蛋白A免疫吸附治疗急性期自身免疫性脑炎的临床观察与防护策略
Clinical observation and protective strategies of protein A immunoadsorption in the treatment of acute-phase autoimmune encephalitis
摘要
Abstract
Objective To establish and validate a standardized nursing assessment and management system for protein A immunoadsorption(IA)therapy in acute-stage autoimmune encephalitis(AE),and to investigate its clinical efficacy and safety.Methods Through a case series analysis,data were retrospectively collected from 21 acute-phase AE patients who received protein A IA therapy between January 2022 and December 2024(17 cases with anti-NMDAR antibody positivity,2 with anti-GABABR antibody positivity,1 with anti-IgLON5 antibody positivity,and 1 with anti-LGI1 antibody positivity).All patients completed 5 to 10 sessions of IA therapy(median:7 sessions).Pre-and post-treatment scores on the modified Rankin Scale(mRS),Glasgow Coma Scale(GCS),Activities of Daily Living(ADL)scale,serum IgG levels,and serum antibody titers were statistically compared.Peri-procedural care was implemented based on the constructed standardized nursing assessment and management system,including:1)Dynamic risk assessment(coagulation function,humoral immunity,neurological/mental status);2)Standardized operating procedures(blood flow/plasma separation parameter settings,transmembrane pressure monitoring);3)Complication warning and precision intervention strategies(hypotension,membrane rupture/hemolysis,psychiatric symptoms,etc.);4)Multi-dimensional infection prevention and control;5)Nursing process optimization and quality control.Key nursing management effectiveness indicators were observed:pre-procedural assessment completion rate,assessment standardization compliance rate,incidence of hypotension,incidence of membrane rupture/hemolysis,infection rate,and unplanned extubation rate.Nursing-related indicators(adverse events and management outcomes)were recorded and analyzed.Results After treatment,patients showed reductions in serum IgG levels and antibody titers,along with neurological improvement:significant improvement in mRS,GCS,and ADL scores(all P<0.001).The nursing management system demonstrated high effectiveness:pre-procedural assessment completion rate was 100%(152/152),assessment standardization compliance rate was 100%(152/152),incidence of hypotension was 1.3%(2/152),incidence of membrane rupture/hemolysis was 0.7%(1/152),infection rate was 0.7%(1/152),and unplanned extubation rate was 0%(0/152),respectively.Peri-procedural nursing complications included hypotension(n=2,given with fluid resuscitation/pressors),membrane rupture(n=1,treated with emergency blood return protocol),psychiatric symptoms(n=3,given with physical restraint and sedation management),thrombocytopenia(n=1,drug intervention+protection),IgG decrease(n=2,given with intravenous immunoglobulin supplementation),and respiratory infection(n=1,given with anti-infection treatment+isolation nursing).All events were controlled with appropriate management,with no severe complications.Conclusions Protein A IA rapidly eliminates pathogenic antibodies and improves neurological deficits in AE patients.Its efficacy and safety are highly dependent on standardized nursing assessment and management system established in this study.This system effectively reduces treatment-related risks through dynamic risk assessment,precise complication prevention/management,and process optimization,providing effective evidence-based nursing practice for IA therapy in acute-phase AE patients.关键词
蛋白A免疫吸附/自身免疫性脑炎/神经功能评分/动态护理管理/治疗安全性Key words
Protein A immunoadsorption/Autoimmune encephalitis/Neurological function scoring/Dynamic nursing management/Treatment safety引用本文复制引用
沈利平,李慧娟,阮恒芳,李盈,朱春泞..蛋白A免疫吸附治疗急性期自身免疫性脑炎的临床观察与防护策略[J].新医学,2025,56(8):785-793,9.基金项目
广东省医学科研基金(A2022299) （A2022299）
