Freifeld A G, Pizzo P A
Division of Clinical Sciences, National Cancer Institute, Bethesda, Maryland, USA.
Oncology (Williston Park). 1996 Apr;10(4):599-606, 611-2; discussion 615-6.
Treatment of fever and neutropenia in cancer patients has been recognized for 30 years as a medical emergency, requiring prompt in-hospital evaluation and institution of broad-spectrum intravenous (i.v.) antibiotics. This action was deemed necessary due to the high frequency of life-threatening infections in febrile neutropenic patients, with no way to distinguish patients who are infected from those who are not. In recent years, it has become clear that not all neutropenic cancer patients are at the same level of risk for developing severe infections or life-threatening complications during neutropenia. Those who are at low risk may be candidates for treatment outside the hospital setting, either with i.v. regimens or potent oral antibiotics. The identification of low-risk febrile neutropenic patients and the specific outpatient approaches that have been tested to date are discussed. Outpatient management of fever during neutropenia could obviously be much less costly than standard inpatient care and could improve quality of life for low-risk patients undergoing cancer therapy.
癌症患者发热和中性粒细胞减少的治疗在30年来一直被视为医疗紧急情况，需要在医院内迅速进行评估并使用广谱静脉注射抗生素。由于发热性中性粒细胞减少患者发生危及生命感染的频率很高，且无法区分感染患者和未感染患者，因此采取这一行动被认为是必要的。近年来，已经明确并非所有中性粒细胞减少的癌症患者在中性粒细胞减少期间发生严重感染或危及生命并发症的风险处于同一水平。低风险患者可能适合在医院外接受治疗，可采用静脉注射方案或强效口服抗生素。本文将讨论低风险发热性中性粒细胞减少患者的识别以及迄今为止经过测试的特定门诊治疗方法。中性粒细胞减少期间发热的门诊管理显然比标准住院治疗成本低得多，并且可以改善接受癌症治疗的低风险患者的生活质量。
