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[急诊科的癌症患者]

[Cancer patients in the emergency department].

作者信息

Liebregts Tobias, Lueck Catherina, Mohring Annemarie, Riße Joachim, Tzalavras Asterios

机构信息

Klinik für Hämatologie und Stammzelltransplantation, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland.

Klinik für Hämatologie und Stammzelltransplantation, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.

出版信息

Med Klin Intensivmed Notfmed. 2024 Feb;119(1):3-9. doi: 10.1007/s00063-023-01055-2. Epub 2023 Sep 2.

Abstract

A growing number of patients are living with cancer or have a history of cancer leading to increasing adverse effects of treatment or disease necessitating emergency department (ED) consultation. Long-term cancer survivors are at higher risk of comorbidities causing a substantial increase in health care resource utilization. The most frequent reasons for cancer-related ED visits are dyspnea, fever, pain, gastrointestinal or neurological symptoms leading to high hospital and intensive care unit admission rates. Acute respiratory failure in cancer patients necessitates timely diagnostic testing, whereby computed tomography is superior to chest X‑ray. Delay in intensive care unit (ICU) admission or mechanical ventilation increases mortality. Febrile neutropenia is an emergency with urgent need for antibiotic treatment. Treatment of neutropenic and nonneutropenic patients with sepsis does not differ. Cardiovascular disease is now the second leading cause of long-term morbidity and mortality among cancer survivors. Immunotherapy can lead to substantial and in some patients life-threatening complications that may not easily be recognized in the ED. Cancer-specific emergencies such as leukostasis, tumorlysis or hypercalcemia rarely present to ED and require interdisciplinary care. The constantly growing cancer population is likely to increase ED utilization. Knowledge about cancer treatment and disease-associated complications is crucial for emergency physicians. Palliative care education should secure appropriate end-of-life care avoiding futile interventions.

摘要

越来越多的患者患有癌症或有癌症病史,这导致治疗的不良反应或疾病不断增加,需要到急诊科(ED)就诊。长期癌症幸存者患合并症的风险更高,这导致医疗资源的使用大幅增加。与癌症相关的急诊科就诊的最常见原因是呼吸困难、发热、疼痛、胃肠道或神经症状,导致较高的住院率和重症监护病房入住率。癌症患者的急性呼吸衰竭需要及时进行诊断检查,计算机断层扫描优于胸部X光。重症监护病房(ICU)入院或机械通气的延迟会增加死亡率。发热性中性粒细胞减少是一种紧急情况,急需抗生素治疗。中性粒细胞减少和非中性粒细胞减少的脓毒症患者的治疗没有区别。心血管疾病现在是癌症幸存者长期发病和死亡的第二大主要原因。免疫疗法可能导致严重的、在某些患者中甚至危及生命的并发症,而这些并发症在急诊科可能不容易被识别。诸如白细胞淤滞、肿瘤溶解或高钙血症等癌症特异性紧急情况很少出现在急诊科,需要多学科护理。不断增长的癌症患者群体可能会增加急诊科的利用率。了解癌症治疗和疾病相关并发症对急诊医生至关重要。姑息治疗教育应确保提供适当的临终护理,避免无效的干预措施。

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