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中性粒细胞缺乏伴发热的处理 PowerPoint PPT Presentation


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中性粒细胞缺乏伴发热的处理. 四川省医学科学院 . 四川省人民医院 血液科 甘茂周. 主要内容. 中性粒细胞缺乏伴发热的定义及危害 肿瘤病人感染风险分级 中性粒细胞缺乏伴发热的处理. 中性粒细胞缺乏伴发热的定义. 发热: 单次口温≥ 38.3℃ 或≥ 38℃ 超过 1 小时 中性粒细胞缺乏: < 500/mcL 或 < 1,000/mcL 并预计在 48 小时下降至≤ 500/mcL. 亚太地区中性粒细胞减少伴不明原因发热患者的抗生素应用规范 (2005) NCCN 癌症相关感染防治指南. 中性粒细胞减少是血液科感染的主要危险因素.

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中性粒细胞缺乏伴发热的处理

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6620170

.


6620170


6620170

    • 38.3381

    • 500/mcL

    • 1,000/mcL48500/mcL

  • (2005)

  • NCCN


6620170

  • 50%77%

  • 58230>30

, ... 2007;109-111 .

, .. 2005; 15(1): 96-99.


6620170

91.82

(146/159)

, P<0.05

100

80

60

(%)

29.60

(37/125)

40

16.03

(21/131)

20

0

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0

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=/

  • 415 < 0.5 109/L 1.0 109/L

, . 2005;5(11):40-42.

Huang XJ, et al. International Journal of Antimicrobial Agents 26S (2005) S128-S132.


6620170

(Sepsis)

2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer


6620170

1523

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Lin MY,et al. Antimicrob Agents Chemother. 2008;52(9):3188-94.


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P < 0.001

60

52

P < 0.001

50

42

40

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30

24

18

20

24

18

10

0

  • ICU (n=655)

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6620170

80

p<0.001

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70

60

50

40

(%)

30

20

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2

3

4

    • 1-4

    • 5

  • Ibrahim EH et al, Chest 2000; 118:146-155.

  • Valles J et al, Chest 2003; 123:1615-1624.

  • Khatib R et al, Eur J Clin Microbiol Infect Dis 2006; 25:181-185.

  • Teixeira PJZ et al, J Hosp Infect 2007; 65:361-367.

  • The American Thoracic Society and the Infectious Diseases Society of America,

  • Am J Respir Crit Care Med 2005; 171:388-416.


6620170


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    • CLL

    • 2-CdA

    • 7-10


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      • GVHD

      • 10


    6620170


    6620170


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      • /

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    6620170

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      • PLTBUNLFT

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      • /

      • //

      • /


    6620170

    • /


    6620170

    • 100/mcL7

    • 5

    • 30mL/

    • /

    • 3-4

    • MASCC21


    6620170

    • 100/mcL7

    • ECOG 0-1

    • MASCC21


    6620170

    MASCC

      • 5

      • 3

    • 5

    • COPD4

    • 4

    • 3

    • 3

    • 602

    Klastersky J, et al. J Clin Oncol 2000; 18(16): 3038-51.


    6620170

      • G+

      • G-

      • HSVRSVAB


    6620170

    NCCN

      • /1

      • 1

      • /1

      • 1

      • 2B


    6620170

    NCCN

      • 1-1

      • 1

      • /


    Imipenem monotherapy for fever and neutropenia in cancer patients

    Imipenem monotherapy for fever and neutropenia in cancer patients

    Freifeld AG, Walsh T, Marshall D, et al. J Clin Oncol. 1995 Jan;13(1):165-76.


    6620170

    A Randomized, Open-Label, Multicenter Comparative Study of the Efficacy and Safety of Piperacillin-Tazobactam and Cefepime for the Empirical Treatment of Febrile Neutropenic Episodes in Patients with Hematologic Malignancies

    Clin Infect Dis. 2006 Aug 15;43(4):447-59. Epub 2006 Jul 10.


    6620170

    Clinical experience with single agent and combination regimens in the management of infection in the febrile neutropenic patient.

    Am J Med. 1996 Jun 24;100(6A):83S-89S


    2010 idsa

    2010 IDSA

    +

    +

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    +

    (

    ?

    +

    /


    6620170

    • Yahav D,et al. Lanct Infect Dis 2007; 7(5): 338-348

    • /


    6620170


    6620170


    6620170


    6620170


    6620170

    • LFT2


    6620170

    3-5

    • 500/mcL


    6620170

    /7-14

    10-14

    7-14

    2

    2


    6620170

    14-21

    10-21

    2

    12


    6620170

    • G-G+

    • G-CSFGM-CSF2B

    3-5


    6620170

    3-5

    • 4

    • 2B


    6620170


    6620170


    6620170


    6620170

    • 500mg Q8h/500mg Q8h

    • 7-142B

    500/mcL

    500/mcL


    6620170

    G+

    • G+

    • /MRSA

    • 2B

    • TMP-SMX


    6620170

    G+

    • GramMRSA2-3

    • /VRE

    • MRSA


    6620170

    • G-CSF/GM-CSF2B

    • 2B

      G-

    • IVIG2B


    6620170

    • -


    6620170


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