Construction of nursing pathways and rapid response protocols for immune-related adverse reactions in tumor patients
肿瘤患者免疫治疗相关不良反应的护理路径与快速反应方案构建

摘要

目的 构建肿瘤患者免疫治疗相关不良反应（Immune-related Adverse Events, irAEs）全周期、标准化的护理路径与分级快速反应方案，为临床irAEs的精准防控、早期识别及高效干预提供实操性护理指引。方法 结合免疫治疗相关不良反应多系统累及、发病隐匿、进展异质性强的临床特点，围绕治疗前、治疗中、治疗后全流程，从风险评估、早期识别、分级干预、专科护理、长期随访5个核心维度，构建标准化护理路径；并依据不良反应严重程度制定Ⅰ、Ⅱ、Ⅲ级分级快速反应方案，明确各层级响应主体、处置流程及时限要求。结果 该护理路径与快速反应方案实现了irAEs从风险预判到长期管理的全流程闭环管理，可有效提升护理人员对irAEs的早期识别能力和干预及时性，降低严重不良反应发生率，提高患者护理依从性与满意度。结论 构建的irAEs护理路径与快速反应方案具有较强的临床实操性和系统性，可规范肿瘤科护理人员的临床操作行为，为肿瘤免疫治疗的安全实施提供护理保障，值得在临床肿瘤专科护理中推广应用。

Abstract

Objective To construct a full-cycle and standardized nursing pathway and hierarchical rapid response protocol for immune-related adverse events (irAEs) in tumor patients receiving immunotherapy, so as to provide practical nursing guidance for the precise prevention and control, early identification and efficient intervention of clinical irAEs.
Methods Combined with the clinical characteristics of irAEs (involving multiple systems, insidious onset and high heterogeneity in progression), a standardized nursing pathway was constructed from five core dimensions including risk assessment, early identification, hierarchical intervention, specialized nursing and long-term follow-up, covering the whole process of pre-treatment, intra-treatment and post-treatment. A three-level (Grade Ⅰ, Ⅱ and Ⅲ) hierarchical rapid response protocol was formulated according to the severity of adverse events, clarifying the responsible subjects, disposal procedures and time limit requirements for each level.
Results This nursing pathway and rapid response protocol realized the full-cycle closed-loop management of irAEs from risk prediction to long-term management, which could effectively improve nurses' ability of early identification of irAEs and the timeliness of intervention, reduce the incidence of severe adverse events, and enhance patients' nursing compliance and satisfaction.
Conclusion   The constructed nursing pathway and rapid response protocol for irAEs have strong clinical practicability and systematicness, which can standardize the clinical operation behaviors of oncology nurses, provide nursing guarantee for the safe implementation of tumor immunotherapy, and is worthy of popularization and application in clinical oncology specialized nursing.