急淋诊断治疗-课件.ppt

病例讨论伴文献回顾 临床案例—病例简介和诊断 病史：患者，男，27岁。主因周身瘀点瘀斑入院。完善相关检查后考虑急性淋巴细胞白血病诊断明确。随即开始VDCP方案化疗。化疗进行至d4天，患者出现高热寒战，伴转移性腹痛固定至右下腹麦氏点。停用化疗，给予泰能加万古联合抗感染治疗，抗炎治疗四天后体温正常。目前为粒缺第七天。 查体：体温37.7℃，血压100/70mmHg，脉搏84/min，呼吸19/min。精神弱，浅表淋巴结未扪及，颈软，双肺呼吸音粗，双肺未闻及干湿性罗音。胸骨压痛阴性。腹平软，肝脾肋下未及。右下腹压痛及反跳痛弱阳性。双下肢散在陈旧瘀斑，无水肿。 辅助检查：血白细胞0.1ⅹ109/L，中性粒细胞1/5，淋巴细胞 4/5，红细胞1.3ⅹ1012/L ，血红蛋白60g/L，血小板12ⅹ109/L 。 诊断：急性淋巴细胞白血病 化疗后骨髓抑制期 粒细胞缺乏伴发热 急性阑尾炎 肿瘤患者常因化疗而导致中性粒细胞缺乏 中性粒细胞绝对计数 (ANC)0.5ⅹ109/L或预估未来48小时内 ANC将减少到0.5ⅹ109/L以下称为中性粒细胞缺乏，简称粒缺. 肿瘤患者常因化疗而导致中性粒细胞缺乏. GUIDELINE RECOMMENDATIONS FOR THEEVALUATION AND TREATMENT OF PATIENTSWITH FEVER AND NEUTROPENIA GUIDELINE RECOMMENDATIONS FOR THEEVALUATION AND TREATMENT OF PATIENTSWITH FEVER AND NEUTROPENIA VII. What is the role of empirical antifungal therapy and what antifungals should be used? VIII. When should antifungal prophylaxis or preemptive therapy be given and with what agents? IX. What is the role of antiviral prophylaxis and how are respiratory viruses diagnosed and managed in the neutropenic patient? X. What is the role of hematopoietic growth factors (G-CSF or GM-CSF) in managing fever and neutropenia? XI. How are catheter-related infections diagnosed and managed in neutropenic patients? XII. What environmental precautions should be taken when managing febrile neutropenic patients? The Multinational Association for Supportive Care in Cancer Risk-Index Score MASCC Burden of febrile neutropenia with no or mild symptomsa 5 No hypotension (systolic blood pressure .90 mmHg) 5 No chronic obstructive pulmonary diseaseb