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Article(id=1322168223831806749, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322167871413796899, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.03.006, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1745596800000, receivedDateStr=2025-04-26, revisedDate=1767715200000, revisedDateStr=2026-01-07, acceptedDate=null, acceptedDateStr=null, onlineDate=1793159069258, onlineDateStr=2026-10-28, pubDate=1770652800000, pubDateStr=2026-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793159069258, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793159069258, creator=13701087609, updateTime=1793159069258, updator=13701087609, issue=Issue{id=1322167871413796899, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='3', pageStart='353', pageEnd='528', issueExtLink='null', onlineDate='null', pubDate='1770652800000', pubDateStr='2026-02-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793158985236, creator='13701087609', updateTime=1793158985236, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=390, endPage=395, ext={EN=ArticleExt(id=1322168225375310623, articleId=1322168223831806749, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Influencing factors and survival analysis of hospital infection in patients with allogeneic hematopoietic stem cell transplantation, columnId=1220689484526572183, journalTitle=Chinese Nursing Research, columnName=Original Articles, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the influencing factors and survival analysis of hospital infection during the period from pre-treatment to hematopoietic reconstitution in patients undergoing allogeneic hematopoietic stem cell transplantation,and to provide reference basis for nosocomial infection and continuous care of hematopoietic stem cell transplant patients.

Methods

Retrospective cohort study design was used to collect clinical data and interventable nursing variables in the occurrence and development of infection from 57 patients with allogeneic hematopoietic stem cell transplantation at the Second Hospital of Shanxi Medical University from January 2017 to May 2020.The main influencing factors of infection were analyzed through multivariate Logistic regression.Survival analysis was carried for follow up data of patients until July 1,2023.

Results

During the transplantation period,9 patients did not experience hospital infections,while 48 patients developed hospital infections.Before pre-treatment,there was no statistically significant difference in baseline data between the infected and uninfected groups.As the transplantation protocol progressed,the nutritional and psychological status of the two groups of patients changed,and the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that nutritional status and psychological status were influencing factors for hospital infection in hematopoietic stem cell transplant patients.Follow up until July 1,2023,24 cases died and 33 cases survived,the longest survival time is 79 months.Despite the fact that continuous care outside the hospital has targeted nutritional and psychological interventions,the survival rate of patients with good nutritional and psychological status was still higher than that of the control group.

Conclusions

Nutritional status and psychological status are intervenable nursing factors in hospital infection of patients undergoing allogeneic hematopoietic stem cell transplantation.They are closely related to infection and survival of patients.Emphasizing patients' nutritional status and improving their psychological status not only helps to reduce the risk of hospital infection,but also is one of the factors in improving the quality of continuous nursing outcomes.

, authors=Jianli GUO1, Xiaobin LI2, Xinrui PANG3, Ya GAO3, Huimin LIU1, Zhaoxia WANG1, Lingyu LIU1, 3, authorsList=Jianli GUO, Xiaobin LI, Xinrui PANG, Ya GAO, Huimin LIU, Zhaoxia WANG, Lingyu LIU, authorCompany=null, correspAuthors=Lingyu LIU, authorNote=null, correspAuthorsNote=
LIU Lingyu, E-mail:
, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322168226985923364, articleId=1322168223831806749, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=异基因造血干细胞移植病人医院感染的影响因素及生存分析, columnId=1220689484681761433, journalTitle=护理研究, columnName=科研论著, runingTitle=null, highlight=null, articleAbstract=
目的

探究异基因造血干细胞移植病人预处理至造血重建期间医院感染的影响因素，并进行生存分析，为造血干细胞移植病人医院感染的预防及延续性护理提供参考依据。

方法

采用回顾性队列研究设计，收集2017年1月—2020年5月山西医科大学第二医院57例异基因造血干细胞移植病人的临床资料及感染发生发展中可干预性护理学变量，通过多因素Logistic回归分析感染主要影响因素；并收集至2023年7月31日病人的随访资料进行生存分析。

结果

移植期间9例病人未发生医院感染，48例病人发生了医院感染。预处理前，感染组与未感染组基线资料差异无统计学意义，随着移植方案的推进，两组病人营养状况与心理状态发生改变，差异均有统计学意义（P<0.05）。多因素Logistic回归分析显示，营养状况与心理状态是造血干细胞移植病人医院感染的影响因素。至2023年7月31日，24例病人死亡，33例存活，最长生存时间为79个月。尽管院外延续性护理针对营养与心理进行了干预，但是出院移植期间营养状况佳与心理状态好的病人生存率仍高于对照组。

结论

营养状况与心理状态是异基因造血干细胞移植病人医院感染中可干预性护理学因素，其与病人感染密切相关，对病人生存有着深远的影响。重视造血干细胞移植病人住院期间的营养状况及改善心理状态有助于降低医院感染风险，是提高延续性护理质量结局的因素之一。

, authors=郭建利1, 李晓宾2, 庞新蕊3, 郜雅3, 刘慧敏1, 王朝霞1, 刘玲玉1, 3, *, *, authorsList=郭建利, 李晓宾, 庞新蕊, 郜雅, 刘慧敏, 王朝霞, 刘玲玉, authorCompany=null, correspAuthors=刘玲玉, authorNote=

郭建利，主管护师，本科

, correspAuthorsNote=
刘玲玉，E-mail：
LIU Lingyu, E-mail:
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language=EN, label=Figure 1, caption=Relationship between nutritional status and survival in patients undergoing allogeneic hematopoietic stem cell transplantation, figureFileSmall=YT2jUyTeF1xEw5QicfyIJQ==, figureFileBig=Biw+lzmzcPea6dFNsYmfEQ==, tableContent=null), ArticleFig(id=1322529948431143793, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168223831806749, language=CN, label=图1, caption=异基因造血干细胞移植病人营养状况与生存之间的关系, figureFileSmall=YT2jUyTeF1xEw5QicfyIJQ==, figureFileBig=Biw+lzmzcPea6dFNsYmfEQ==, tableContent=null), ArticleFig(id=1322529948540195698, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168223831806749, language=EN, label=Figure 2, caption=Relationship between mental state and survival in patients undergoing allogeneic hematopoietic stem cell transplantation, figureFileSmall=FsuPkG5QJ+1U4NN5U0u9lA==, figureFileBig=KDWzgHp6uT0ysitCiIyMbg==, tableContent=null), ArticleFig(id=1322529948603110259, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168223831806749, language=CN, label=图2, caption=异基因造血干细胞移植病人心理状态与生存之间的关系, figureFileSmall=FsuPkG5QJ+1U4NN5U0u9lA==, figureFileBig=KDWzgHp6uT0ysitCiIyMbg==, tableContent=null), ArticleFig(id=1322529948666024820, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168223831806749, language=EN, label=Table 1, caption=

Univariate analysis results of factors influencing hospital infection in patients undergoing allogeneic hematopoietic stem cell transplantation

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类感染组（n=48）未感染组（n=9）统计值P
性别（例）男313χ2=3.0750.137
女176
年龄（例）≤35岁328χ2=1.7880.254
>35岁161
HLA相合（例）全相合155χ2=1.9640.253
半相合334
免疫重建时间（例）≤14 d409χ2=1.7450.332
>14 d80
aGVHD（例）有611.000①
无428
预处理方案（例）标准预处理101.000①
高强度预处理479
中心静脉导管留置时间（例次）≤3个月92χ2=0.4040.610
>3个月415
病程（例）≤6个月264χ2=0.2870.722
>6个月225
个人卫生习惯（分）13.33±2.1815.62±1.12t=-1.7350.088
营养状况（分）预处理前3.83±0.973.55±0.88t=0.7950.430
预处理后2周19.77±3.7915.89±2.98t=2.8990.005
预处理后4周16.17±3.3912.22±2.53t=3.3150.002
心理状态（分）预处理前3.64±1.083.44±1.13t=0.5090.613
预处理第2周7.14±3.035.00±1.66t=2.0520.045
预处理第3周7.35±4.333.11±1.62t=5.140<0.001
), ArticleFig(id=1322529948754105205, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168223831806749, language=CN, label=表1, caption=

异基因造血干细胞移植病人医院感染影响因素的单因素分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类感染组（n=48）未感染组（n=9）统计值P
性别（例）男313χ2=3.0750.137
女176
年龄（例）≤35岁328χ2=1.7880.254
>35岁161
HLA相合（例）全相合155χ2=1.9640.253
半相合334
免疫重建时间（例）≤14 d409χ2=1.7450.332
>14 d80
aGVHD（例）有611.000①
无428
预处理方案（例）标准预处理101.000①
高强度预处理479
中心静脉导管留置时间（例次）≤3个月92χ2=0.4040.610
>3个月415
病程（例）≤6个月264χ2=0.2870.722
>6个月225
个人卫生习惯（分）13.33±2.1815.62±1.12t=-1.7350.088
营养状况（分）预处理前3.83±0.973.55±0.88t=0.7950.430
预处理后2周19.77±3.7915.89±2.98t=2.8990.005
预处理后4周16.17±3.3912.22±2.53t=3.3150.002
心理状态（分）预处理前3.64±1.083.44±1.13t=0.5090.613
预处理第2周7.14±3.035.00±1.66t=2.0520.045
预处理第3周7.35±4.333.11±1.62t=5.140<0.001
), ArticleFig(id=1322529948842185590, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168223831806749, language=EN, label=Table 2, caption=

Variable assignment status

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变量赋值方式
感染情况感染=1，未感染=0
营养状况原值输入（3次测量均值）
心理状态原值输入（3次测量均值）
), ArticleFig(id=1322529948921877367, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168223831806749, language=CN, label=表2, caption=

变量赋值情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值方式
感染情况感染=1，未感染=0
营养状况原值输入（3次测量均值）
心理状态原值输入（3次测量均值）
), ArticleFig(id=1322529948993180536, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168223831806749, language=EN, label=Table 3, caption=

Multivariate Logistic regression analysis results of factors influencing hospital infection in patients undergoing allogeneic hematopoietic stem cell transplantation

, figureFileSmall=null, figureFileBig=null, tableContent=
项目回归系数标准误Wald χ2值POR值95%CI
常量-4.7412.4993.5980.058
营养状况0.5480.2564.5630.0331.729[1.046，2.857]
心理状态1.2090.4377.6670.0063.351[1.424，7.887]
), ArticleFig(id=1322529949056095097, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168223831806749, language=CN, label=表3, caption=

异基因造血干细胞移植病人医院感染影响因素的多因素Logistic回归分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
项目回归系数标准误Wald χ2值POR值95%CI
常量-4.7412.4993.5980.058
营养状况0.5480.2564.5630.0331.729[1.046，2.857]
心理状态1.2090.4377.6670.0063.351[1.424，7.887]
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异基因造血干细胞移植病人医院感染的影响因素及生存分析
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郭建利 1 , 李晓宾 2 , 庞新蕊 3 , 郜雅 3 , 刘慧敏 1 , 王朝霞 1 , 刘玲玉 1, 3, *, *
护理研究 | 科研论著 2026,40(3): 390-395
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护理研究 |科研论著 2026 , 40 (3) : 390 -395
异基因造血干细胞移植病人医院感染的影响因素及生存分析
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郭建利1, 李晓宾2, 庞新蕊3, 郜雅3, 刘慧敏1, 王朝霞1, 刘玲玉1, 3, *, *
作者信息
  • 1山西医科大学第二医院，山西 030001
  • 2山西国际旅行卫生保健中心（太原海关口岸门诊部）
  • 3山西医科大学
通讯作者:
刘玲玉，E-mail：
LIU Lingyu, E-mail:
作者简介:

郭建利，主管护师，本科

Influencing factors and survival analysis of hospital infection in patients with allogeneic hematopoietic stem cell transplantation
Jianli GUO1, Xiaobin LI2, Xinrui PANG3, Ya GAO3, Huimin LIU1, Zhaoxia WANG1, Lingyu LIU1, 3
Affiliations
  • 1Second Hospital of Shanxi Medical University, Shanxi 030001 China
  • 2Shanxi International Travel Health Care Center(Taiyuan Customs Port Outpatient)
  • 3Shanxi Medical University
    • Corresponding Author:
    LIU Lingyu, E-mail:
出版时间: 2026-02-10 doi: 10.12102/j.issn.1009-6493.2026.03.006
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摘要
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目的

探究异基因造血干细胞移植病人预处理至造血重建期间医院感染的影响因素，并进行生存分析，为造血干细胞移植病人医院感染的预防及延续性护理提供参考依据。

方法

采用回顾性队列研究设计，收集2017年1月—2020年5月山西医科大学第二医院57例异基因造血干细胞移植病人的临床资料及感染发生发展中可干预性护理学变量，通过多因素Logistic回归分析感染主要影响因素；并收集至2023年7月31日病人的随访资料进行生存分析。

结果

移植期间9例病人未发生医院感染，48例病人发生了医院感染。预处理前，感染组与未感染组基线资料差异无统计学意义，随着移植方案的推进，两组病人营养状况与心理状态发生改变，差异均有统计学意义（P<0.05）。多因素Logistic回归分析显示，营养状况与心理状态是造血干细胞移植病人医院感染的影响因素。至2023年7月31日，24例病人死亡，33例存活，最长生存时间为79个月。尽管院外延续性护理针对营养与心理进行了干预，但是出院移植期间营养状况佳与心理状态好的病人生存率仍高于对照组。

结论

营养状况与心理状态是异基因造血干细胞移植病人医院感染中可干预性护理学因素，其与病人感染密切相关，对病人生存有着深远的影响。重视造血干细胞移植病人住院期间的营养状况及改善心理状态有助于降低医院感染风险，是提高延续性护理质量结局的因素之一。

异基因造血干细胞移植  /  医院感染  /  影响因素  /  生存分析  /  延续性护理
Objective

To explore the influencing factors and survival analysis of hospital infection during the period from pre-treatment to hematopoietic reconstitution in patients undergoing allogeneic hematopoietic stem cell transplantation,and to provide reference basis for nosocomial infection and continuous care of hematopoietic stem cell transplant patients.

Methods

Retrospective cohort study design was used to collect clinical data and interventable nursing variables in the occurrence and development of infection from 57 patients with allogeneic hematopoietic stem cell transplantation at the Second Hospital of Shanxi Medical University from January 2017 to May 2020.The main influencing factors of infection were analyzed through multivariate Logistic regression.Survival analysis was carried for follow up data of patients until July 1,2023.

Results

During the transplantation period,9 patients did not experience hospital infections,while 48 patients developed hospital infections.Before pre-treatment,there was no statistically significant difference in baseline data between the infected and uninfected groups.As the transplantation protocol progressed,the nutritional and psychological status of the two groups of patients changed,and the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that nutritional status and psychological status were influencing factors for hospital infection in hematopoietic stem cell transplant patients.Follow up until July 1,2023,24 cases died and 33 cases survived,the longest survival time is 79 months.Despite the fact that continuous care outside the hospital has targeted nutritional and psychological interventions,the survival rate of patients with good nutritional and psychological status was still higher than that of the control group.

Conclusions

Nutritional status and psychological status are intervenable nursing factors in hospital infection of patients undergoing allogeneic hematopoietic stem cell transplantation.They are closely related to infection and survival of patients.Emphasizing patients' nutritional status and improving their psychological status not only helps to reduce the risk of hospital infection,but also is one of the factors in improving the quality of continuous nursing outcomes.

allogeneic hematopoietic stem cell transplantation  /  hospital infection  /  influencing factors  /  survival analysis  /  continuous care
郭建利, 李晓宾, 庞新蕊, 郜雅, 刘慧敏, 王朝霞, 刘玲玉. 异基因造血干细胞移植病人医院感染的影响因素及生存分析. 护理研究, 2026 , 40 (3) : 390 -395 . DOI: 10.12102/j.issn.1009-6493.2026.03.006
Jianli GUO, Xiaobin LI, Xinrui PANG, Ya GAO, Huimin LIU, Zhaoxia WANG, Lingyu LIU. Influencing factors and survival analysis of hospital infection in patients with allogeneic hematopoietic stem cell transplantation[J]. Chinese Nursing Research, 2026 , 40 (3) : 390 -395 . DOI: 10.12102/j.issn.1009-6493.2026.03.006
正文
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异基因造血干细胞移植（allogeneic hematopoietic stem cell transplantation，allo-HSCT）作为治疗中高危白血病及其他复发性血液病的有效治愈手段，目前在血液疾病治疗上占有重要地位[1-2]。感染作为移植病人死亡的独立危险因素，是疾病治愈的最大威胁之一[3-5]。既往关于异基因造血干细胞移植病人医院感染影响因素的研究多集中在医疗领域范围[6-8]，基于护理学视角下影响因素的研究较为缺乏。因此，本研究探讨异基因造血干细胞移植病人医院感染可干预性护理影响因素以及其与病人生存时间的关系，为移植病人延续性护理提供理论依据。
1　对象与方法
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1.1　研究对象
采用便利抽样法[9]，选取2017年1月—2020年5月在山西医科大学第二医院行异基因造血干细胞移植病人为研究对象。纳入标准：1）经专业医师诊断，符合血液病诊断疗效与标准[10]；2）首次接受异基因造血干细胞移植术；3）重要脏器均未合并严重的基础疾病、活动性感染及功能衰竭等并发症[11-12]。排除标准：1）不具备良好的书写及语言沟通能力者；2）未按照移植方案完成造血干细胞移植者；3）随访脱落者。本研究通过山西医科大学第二医院伦理委员会医学研究伦理审批（编号：〔2025〕YX第019号）。
1.2　资料收集方法
采用回顾性队列研究设计，研究者对收集资料人员进行统一培训，内容包括研究目的、研究方案、数据收集时注意事项等，确保数据收集标准的同质性。一般资料由1名护理学硕士研究生及2名造血干细胞移植专科护士负责采集，个人卫生习惯、心理状态、营养状况、随访记录由课题组5名主管护师进行采集。
1.3　调查问卷
1.3.1　一般资料调查问卷
由调查者文献分析后自行编制条目池，经课题小组讨论后制定而成，包括人口学资料、预处理至骨髓造血重建期间发生医院感染情况、医院感染发生发展中医疗与护理学因素3部分，具体内容包括性别、年龄、原发疾病、预处理至骨髓造血重建期间发生医院感染情况、人类白细胞抗原（human leukocyte antigen，HLA）相合情况、病程、预处理方案、营养状况、心理状态、免疫重建时间、急性移植物抗宿主病（aGVHD）、个人卫生习惯、中心静脉置管留置时间等。
1.3.2　个人卫生习惯问卷
个人卫生习惯调查表包括生活、饮食、运动、手卫生、用眼、口腔、会阴7个维度，共20个条目，问卷内容效度采用专家判断法，由6名专家打分。专家纳入标准：1）主管护师以上职称；2）血液科临床一线工作10年以上或研究生学历临床工作5年以上；3）有2年承担造血干细胞移植病人直接护理经历。本问卷内容效度指数为0.85。各条目选项为很少做到和经常做到，分别计0、1分，总分为0~20分，得分越高说明病人卫生习惯越好。由5名责任护士在病人出舱时进行评价后取均分。
1.3.3　广泛性焦虑障碍自评量表（GAD-7）
采用GAD-7评价病人过去2周的焦虑症状，该量表由7个条目组成，各条目“没有”“有几天”“一半以上时间”“几乎天天”分别计0、1、2、3分。总分≤4分表示没有焦虑，>4分提示病人存在焦虑[13]。收集病人入舱当天、预处理后2周及4周。
1.3.4　主观整体营养评估量表（PG-SGA）
采用PG-SGA评估病人营养情况，包括病人自评量表和医护评估部分。病人自评量表包括体重、摄食、症状、活动和身体功能等，总分0~1分为营养良好，2~3分为可疑营养不良，4~8分为中度营养不良，≥9分为重度营养不良；医护评估部分包括营养相关的疾病状态、代谢状态、体格检查等，分为营养良好、可疑/中度营养不良，重度营养不良3个等级[1]。收集病人预处理前、预处理后2周及4周的营养评估数据。
1.3.5　随访记录表
包括病人的一般资料、延续性护理措施及存活状态。
1.4　统计学方法
采用Excel表格双人录入整理数据，并进行数据脱敏处理，采用SPSS 22.0软件进行数据统计学分析，符合正态分布的定量资料采用均数±标准差（x±s）表示，定性资料采用例数、百分比（%）表示；采用单因素和多因素Logistic回归分析影响因素，采用Kaplan-Meier进一步分析影响因素与生存的关系，以P<0.05为差异有统计学意义。
2　结果
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2.1　异基因造血干细胞移植病人一般资料
共纳入57例异基因造血干细胞移植病人，其中男34例，女23例；年龄（29.46±9.48）岁；移植前病程（10.39±7.07）个月；其中急性髓系白血病（AML）30例，急性淋巴性白血病（ALL）17例，慢性粒细胞性白血病急淋变2例，骨髓增生异常综合征5例，骨髓增生异常综合征转急性T淋巴细胞白血病1例，再生障碍性贫血1例，遗传性铁粒幼细胞性贫血1例；移植方式分为HLA配型全相合移植20例，配型部分相合移植37例；供者来源为血缘性56例，非血缘性1例。
2.2　异基因造血干细胞移植病人医院感染影响因素的单因素分析
在异基因造血干细胞移植期间，9例病人未发生医院感染，纳入未感染组；48例病人发生医院感染，纳入感染组。至2023年7月31日，24例死亡，33例存活，最长生存时间为79个月。感染组和未感染组病人性别、年龄、HLA相合、免疫重建时间、aGVHD、预处理方案、中心静脉留置时间、病程、个人卫生习惯差异均无统计学意义（P>0.05），具有可比性。随着移植方案的推进，两组病人营养状况、心理状态差异有统计学意义（P<0.05）。详见表1。
2.3　异基因造血干细胞移植期间病人医院感染影响因素的多因素Logistic回归分析
鉴于样本量较小，为保证统计分析质量，将有统计学意义的自变量纳入回归方程，以是否出现医院感染为因变量进行多因素Logistic回归分析，变量赋值方式见表2。结果显示，营养状况、心理状态进入回归方程，回归方程-2对数似然值为24.134，相对较小，说明模型拟合效果尚可，Cox & Snell R2与Nagelkerke R2分别为0.362,0.621，说明模型方程能解释的回归变异很大，模型拟合较理想。因此，营养状况、心理状态是异基因造血干细胞移植病人移植期间医院感染的影响因素，详见表3。
2.4　异基因造血干细胞移植病人营养状况、心理状态与生存之间关系
至2023年7月随访资料显示，57例异基因造血干细胞移植病人中24例死亡，其中1例未发生过医院感染；33例存活，其中8例未发生过医院感染。存活组与死亡组在移植不同阶段，营养状况与心理状态差异均有统计学意义（P<0.05）。出院后给予相应延续性护理后，发现生存病人在移植期间的营养状况与心理状态优于死亡病人。详见图1、图2。
3　讨论
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3.1　异基因造血干细胞移植病人医院感染的影响因素
本研究结果显示，感染组与未感染组性别、年龄、HLA相合、免疫重建时间、aGVHD、预处理方案、中心静脉留置时间、个人卫生习惯、病程比较，差异无统计学意义，控制上述因素后，不同阶段营养状况、心理状态差异有统计学意义（P<0.05），同时，多因素Logistic回归分析结果显示，营养状况与心理状态是异基因造血干细胞移植病人感染主要的影响因素。由此可见，在医疗条件相同情况下，营养状况与心理状态是医院感染因素中可干预性护理学因素。粒细胞缺乏病人是医院内感染最主要的人群之一，这与粒细胞缺乏时全身免疫功能低下有关[14]，由于中心层流舱硬件设施的完善及近年来对症支持治疗的进步，粒细胞缺乏已转变为可控威胁因素[15]。而性别、年龄、HLA相合、免疫重建时间、aGVHD、预处理方案、中心静脉留置时间、个人卫生习惯、病程均为医生在控制感染方面需要考量的因素[16]，护理作为病人治疗过程中重要组成部分，从护理学角度分析影响医院感染的因素，进而通过护理措施去干预，方能体现护理的专业价值[17]。
3.1.1　营养状况
本研究证实，营养状况差的病人更容易获得医院感染，是医院感染发生的高危因素，预处理前感染组与未感染组营养状况差异无统计学意义（P>0.05），随着预处理的进行，第2周与第4周感染组与未感染组营养状况差异有统计学意义（均P<0.05）。究其原因，移植病人预处理间随着化疗药物的叠加副作用，胃肠道反应随预处理进行加重，病人基本在移植至10 d开始，逐渐出现进食困难的现象，尽管护理人员鼓励病人少食多餐[18]，但临床经验显示，病人在胃肠道极度不适的情况下，少食多餐也较难实现，这就需要护理人员能够采取更有效的护理措施提高病人营养状况，如中医穴位贴敷、按摩推拿、针灸等，必要时补充胃肠外营养，保证机体的营养供应[19-20]。
3.1.2　心理状态
研究已证实，由于血液疾病本身、大剂量化疗、移植并发症及其他不可预知事件等多重因素的影响，病人在移植期间承受了较大的心理压力，普遍存在焦虑、抑郁、疲乏等不良情绪[21-22]。心理状态又通过对机体内分泌及免疫系统的影响介导疾病的发生发展[23]。本研究结果显示，病人在预处理第2周与预处理第3周时，感染组与未感染组心理状态差异有统计学意义（均P<0.05），感染组病人心理状态处于较低水平，心理状态不佳会影响病人有效应对移植及其躯体症状和治疗的能力。张婷等[24]对造血干细胞移植病人心理困扰影响因素与干预的研究进展进行综述，证实心理状态对生活质量有一定的影响。
3.2　异基因造血干细胞移植后存活病人营养状况、心理状态优于死亡病人
本研究结果表明，存活病人与死亡病人在营养状况与心理状态方面无论在预处理前还是预处理后，差异均有统计学意义（P<0.05）。鉴于营养与心理为较稳定的身心特质，尽管出院后延续性护理已给予针对性的干预，但随访资料发现，营养状况佳、心理状态好的病人长期生存率明显高于营养状况、心理状态差的病人。因此，在异基因造血干细胞移植移植期间，营养与心理护理的意义不仅仅局限于降低医院感染的益处，对今后病人的生活质量，甚至是生存期限均有着重要意义。
4　小结
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医院感染是异基因造血干细胞移植病人最常见的严重并发症，关乎干细胞植入效果，甚至危及病人生命。营养状况与心理状态是异基因造血干细胞移植病人医院感染的可干预性护理因素，提高病人住院期间营养状况及改善心理状态不仅有助于降低医院感染风险，对病人的长期生存也有着深远影响。本研究从护理专业角度切入医疗领域难题，挖掘护理干预的潜在价值，有利于高级护理实践的落实，为护理工作的长远发展开拓了新思路。

文献
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doi: 10.12102/j.issn.1009-6493.2026.03.006
  • 接收时间：2025-04-26
  • 首发时间：2026-10-28
  • 出版时间：2026-02-10
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  • 收稿日期：2025-04-26
  • 修回日期：2026-01-07
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    1山西医科大学第二医院，山西 030001
    2山西国际旅行卫生保健中心（太原海关口岸门诊部）
    3山西医科大学

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刘玲玉，E-mail：
LIU Lingyu, E-mail:
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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