困惑的肿瘤患者：一种合理的临床处理方法。
The confused oncologic patient: a rational clinical approach.
作者信息
Nolan Craig, DeAngelis Lisa M
机构信息
Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
出版信息
Curr Opin Neurol. 2016 Dec;29(6):789-796. doi: 10.1097/WCO.0000000000000392.
PURPOSE OF REVIEW
The purpose of this review is to provide a practical clinical approach to confusion in the patient with cancer. Confusion in the cancer population has a broader differential diagnosis than in the general medical population. The clinician must consider the usual differential diagnoses as well as causes unique to the cancer patient including direct complications from the cancer and indirect complications related to cancer treatment.
RECENT FINDINGS
In the recent age of precision medicine, the oncologist now utilizes the genomic profile of both the patient and the tumor to provide advanced biologic therapies including targeted anticancer drugs, antiangiogenic agents, and immunotherapy. Such advances carry with them an emerging pattern of neurotoxicity which, although less well described in the literature, is now an important consideration to the clinical approach to confusion in cancer patients.
SUMMARY
Confusion is the most common neurologic complication in cancer and is associated with significant morbidity, mortality, and prolonged hospital stays resulting in increased healthcare costs. Early recognition and treatment of delirium is essential to improve clinical outcomes.
综述目的
本综述旨在为癌症患者的意识模糊提供一种实用的临床处理方法。癌症患者意识模糊的鉴别诊断范围比普通内科患者更广。临床医生必须考虑常见的鉴别诊断以及癌症患者特有的病因，包括癌症的直接并发症和与癌症治疗相关的间接并发症。
最新发现
在精准医学的时代，肿瘤学家现在利用患者和肿瘤的基因组特征来提供先进的生物疗法，包括靶向抗癌药物、抗血管生成药物和免疫疗法。这些进展伴随着一种新出现的神经毒性模式，尽管在文献中对此描述较少，但现在它是癌症患者意识模糊临床处理中的一个重要考虑因素。
总结
意识模糊是癌症最常见的神经并发症，与显著的发病率、死亡率以及延长住院时间相关，从而导致医疗费用增加。早期识别和治疗谵妄对于改善临床结局至关重要。
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