中性粒细胞缺乏伴发热与感染鉴别诊断及治疗  

Differentiation between neutropenia complicated by fever and infections and the treatment

作　　者：盖绿华[1] 冯其梅[2] 左大鹏[2] 翟红岩[2] 

机构地区：[1]解放军第307医院肿瘤微创科,北京100071 [2]解放军第307医院感染控制科,北京100071

出　　处：《中华医院感染学杂志》2013年第5期1027-1029,共3页Chinese Journal of Nosocomiology

摘　　要：目的将中性粒细胞缺乏伴发热的3种类型进行鉴别,为临床诊治提供参考依据。方法对医院2012年1-8月166例中性粒细胞缺乏伴发热患者进行回顾性分析。结果 166例中性粒细胞缺乏伴发热患者中,仅46例进行了影像学检查,21例肺部影像学有动态变化;126例进行了血培养检查,送检3次的病例仅23例,4例血培养呈阳性;9例进行了尿常规检查,结果均呈阴性;经治疗,病情好转153例,恶化9例,死亡4例。结论对于粒细胞缺乏伴发热的病例,应及时寻找感染灶和病原体,能明确诊断的应按照卫生部医院感染诊断标准进行诊断,确实找不到感染灶和病原菌的中性粒细胞缺乏伴发热,给予抗感染治疗。OBJECTIVE To differentiate the three types of neutropenia complicated with fever so as to provide evidence for the clinical treatment.METHODS The clinical data of 166 neutropenia patients complicated by fever,collected in the hospital from Jan to Aug 2012,were retrospectively analyzed.RESULTS Of totally 166 cases of neutropenia patients complicated by fever,the imaging examination was done in 46 cases,blood culture examination was done in 126 cases and only 23 cases was done for 3 times.Dynamic changes on pulmonary imaging were found in 21 cases,positive blood cultures were showed in 4 cases;urine routine examination was performed in 9 cases,the result showed all positive;after the treatment there were 153 cases improved,9 cases exacerbated,and 4 cases died.CONCLUSION For the patients with neutropenia complicated with fever,it′s a suitable approach to seek for focal infections and pathogens,if the focal infections or pathogens are found,definite diagnosis should be done according to diagnostic criteria for hospital infection of the Ministry of Health,otherwise,the antimicrobial therapy should be given.

关 键 词：感染性 发热 鉴别诊断 

分 类 号：R181.3[医药卫生—流行病学]