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Indwara ya Neutropenique mugihe cya chimiotherapie no kuvura kanseri byihutirwa

Emergency numbers differ by country. This page uses 911, the number for the United States and Canada. Many other countries use 112, 999, or another number. Find the number for your country.

Kubantu bose bahabwa chimiotherapie, bagamije kuvura amagufwa, cyangwa guhinduranya ingirangingo, ** umuriro woroheje ntushobora "gukonja gusa": ni ubutabazi bwangiza ubuzima bwitwa Febrile Neutropenia (Neutropenic Fever) **. Chimoterapi isenya byihuse ingirabuzimafatizo zamaraso zizwi ku izina rya ** neutrophile **, ingabo z’imbere z’umubiri zirwanya bagiteri na fungi, cyane cyane mu idirishya rya ** "nadir" ($ 7 inyandiko {kugeza} 14 inyandiko {iminsi} $ nyuma yo gushiramo imiti) **. Iyo ibara rya neutrophil rigabanutse kugera kuri zeru cyangwa hafi ya zeru, bagiteri zitagira ingaruka zibaho mu kanwa, mu mara, cyangwa ku ruhu ruzengurutse icyambu cyo hagati gishobora gutera amaraso kandi zikikuba kabiri mu minota 20 idatanga ibibyimba, umutuku, cyangwa inkorora. Iyo itavuwe murugo amasaha make, umuriro wa neutropenique uratera imbere vuba sepsis na septique. Kurokoka biterwa nisaha ya ** Zahabu "Door-to-Antibiotic" Itegeko **: kugera mu ishami ryihutirwa ako kanya bityo antibiyotike yimitsi yagutse itera ** muminota 60 ya triage **, kandi ntizigere ihisha umuriro mwinshi hamwe na acetaminofeni (paracetamol) cyangwa ibuprofen mbere yo guhamagara itsinda rya oncology.

Ntuzigere ufata Tylenol (acetaminofen), parasetamol, ibuprofen, cyangwa aspirine mbere yo guhamagara oncologue wawe

Kubera ko umurwayi wa chimiotherapie ufite selile nke zamaraso yera (** neutropenia **) adashobora gukora ibibyimba cyangwa gutwikwa kwaho, umuriro wa ** akenshi ni ikimenyetso cyo kuburira GUSA mumubiri wose ko indwara ya bagiteri yica itangiye **. Kumira acetaminofeni (paracetamol), ibuprofen, naproxen, cyangwa aspirine kugirango "umanure umuriro hanyuma usubire kuryama" uhisha ibihimbano umuriro mugihe cyamasaha 4 kugeza kuri 6 mugihe bagiteri zigwira zitagenzuwe mumaraso, bigatuma habaho ihungabana ridasubirwaho. Kandi, ntuzigere winjizamo ibipimo bya termometero **, suppository ya rectal, cyangwa enema ** mumurwayi wa chimiotherapie: gutanyagura urukiramende rworoshye rusunika bagiteri zo munda mu maraso kandi birashobora gutera kuva amaraso adashobora kugenzurwa niba platine ari nke.

Kora ubu

  1. ** Reba umunwa (umunwa) cyangwa tympanic / ubushyuhe bwigihe gito hanyuma ukoreshe $ 38.3 ^ umuzenguruko inyandiko {C} $ ($ 101.0 ^ umuzenguruko inyandiko {F} $) / $ 38.0 ^ umuzenguruko inyandiko {C} $ ($ 100.4 ^ (ESMO), hamwe nu Bwongereza NICE amabwiriza, ** Neutropenic Fever ** isobanurwa ngo:
  2. ** Ubushyuhe bumwe bwo mu kanwa bwa $ 38.3 ^ umuzenguruko inyandiko {C} $ ($ 101.0 ^ umuzenguruko inyandiko {F} $) cyangwa hejuru ya **, ** CYANGWA **
  3. ** Ubushyuhe bwo mu kanwa bwa $ 38.0 ^ umuzenguruko inyandiko {C} $ ($ 100.4 ^ umuzenguruko inyandiko {F} $) cyangwa irenga ikomeza isaha 1 (cyangwa igapimwa kabiri byibuze isaha 1 itandukanye) **.
  4. *.
  5. ** Hamagara nimero yawe yihutirwa ako kanya niba umurwayi afite ibicurane / bikabije, umutwe, urujijo, guhumeka neza, cyangwa umuvuduko ukabije wamaraso. ** Hamagara 911 muri Amerika na Kanada, 112 mu bihugu by’Uburayi, 999 mu Bwongereza, cyangwa urebe byose nimero yihutirwa niba umurwayi afite ** guhinda umushyitsi (rigors) **, akumva acitse intege iyo ahagaze, afite umuvuduko wumutima wihuse ($> 100 inyandiko {bpm} $), afite umuvuduko wamaraso wa systolique uri munsi ya $ 100 inyandiko {mmHg} \(, cyangwa ugasa n'umuhondo, uhindagurika, cyangwa urujijo, nubwo termometero yabo isoma ** bisanzwe cyangwa bikabije (\) <36.0 ^ circ text C) sepsis nuburyo bubi cyane bwa septique.
  6. ** Niba uhagaze neza hamwe na feri, hamagara umurongo wawe wamasaha 24 Oncology Tage Line hanyuma uhite ujya mubiro byihutirwa. ** Ntutegereze amasaha yakazi ya mugitondo. Saba umuntu guhita atwara umurwayi mubitaro, hanyuma usabe umuhamagaye oncologue guhamagara imbere yintebe yicyumba cyihutirwa kugirango ** imico yamaraso hamwe na antibiotike zinjira mumaraso biteguye kuhagera **.
  7. ** Ntugatange ibinini bigabanya umuriro (nta acetaminofeni, parasetamol, ibuprofen, cyangwa aspirine) kandi ntuzigere ukoresha termometero igororotse. ** $ 37.8 ^ umuzenguruko inyandiko {C} $ [$ 100.0 ^ umuzenguruko inyandiko {F} $] ** bingana n'umuriro wo mu kanwa).
  8. ** Shira umurwayi wo kubaga cyangwa N95 / FFP2 mask yubuhumekero kumurwayi mbere yo kwinjira mucyumba cyo gutegereza gishinzwe ubutabazi. Shikiriza ** "Chemotherapy Neutropenic Sepsis Alert Card" ** ako kanya umuforomo wa triage hanyuma usabe gushyirwa mubyumba by’ibizamini bya ** byitaruye ** ako kanya.
  9. ** Reba ku bindi Byihutirwa Byihutirwa Byinshi. na ** Hypercalcemia ya Malignancy ** (inyota ikabije, inkari nyinshi, kuribwa mu nda, no kwitiranya ibintu).

Ibihe byihutirwa hamwe na kanseri yo kuvura ikibazo cyibiti

Koresha iyi clinique yerekana ibimenyetso byose bikaze kumurwayi uri kuvura kanseri cyangwa mugihe cyibyumweru 6 nyuma ya chimiotherapie.

flowchart TD
    Start["Umurwayi wa Kanseri kuri Chimiotherapie, Immunotherapy, <br/> cyangwa Imirasire Itera Ibimenyetso Bikomeye"] --> SepsisFlags{"Intambwe ya 1: Reba ako kanya Septike Shock / Crisis Ibendera ritukura <br/> 1. Kunyeganyega (rigors), nubwo nta bushyuhe bwo hejuru? <br/> 2. Hypothermia: Ubushyuhe <36.0 ° C (96.8 ° F)? <br/> 3. Kuzunguruka, gucika intege, urujijo, cyangwa kuvuga nabi? <br/> 4. Kubura umwuka, guhumeka vuba, cyangwa kubabara mu gatuza? <br/> 5. Umutuku, pus, cyangwa ububabare hejuru ya Port-a-Cath / PICC / Hickman?"}

    SepsisFlags -->|"YEGO: Umuntu wese uhari"| Call911["SEPSIS YO KUNYAZA / CRISIS: <br/> 1. Hamagara 911/112/999 Ako kanya kuri Ambulance <br/> 2. Menyesha 'Chimiotherapie Neutropenic Sepsis Yihutirwa' <br/> 3. Shimangira iminota 60-Urugi-kuri-IV-Intego ya Antibiotique <br/> 4. Komeza kuryama neza (cyangwa ugororotse niba ubuze umwuka); NPO"]

    SepsisFlags -->|"OYA"| TempCheck{"Intambwe ya 2: Reba Ubushyuhe bwo mu kanwa <br/> (NTUKIGERE UKORESHEJE URUGENDO RUGENDE)"}

    TempCheck -->|"YEGO: Umuriro urenze"| NeutFever["NEUTROPENIQUE YIHUTIRWA: <br/> 1. NTIBAHA Tylenol / paracetamol, ibuprofen, cyangwa aspirine <br/> 2. Hamagara amasaha 24 ya Oncology Tage Line NONAHA mugihe ugenda <br/> 3. Shira mask kumurwayi; jya mu ishami ryihutirwa NONAHA <br/> 4. Erekana ikarita ya Chemo Alert kuri triage: saba kwigunga + <br/> Imico Yamaraso (Port + Peripheral) & IV Antibiyotike <60 min"]

    TempCheck -->|"OYA: Nta bimenyetso cyangwa ibimenyetso bya sepsis"| OncEmerg{"Intambwe ya 3: Reba Kanseri Yubatswe & Metabolic Yihutirwa: <br/> A. Kubabara umugongo / ijosi + intege nke zamaguru, kunanirwa, cyangwa guhinduka uruhago? <br/> B. Kubyimba mu maso / ijosi / amaboko + inkorora / dyspnea nabi kuryama? <br/> C. Chemo iheruka (iminsi 1-7) + kubabara, isesemi, inkari zijimye? <br/> D. Inyota ikabije, urujijo, kuribwa mu nda, kubabara amagufwa?"}

    OncEmerg -->|"Igisubizo: Kubabara umugongo + ibimenyetso bya neuro"| MSCC["BITEKEREZO BIKURIKIRA MALIGNANT SPINAL CORD Compression: <br/> Umugongo wihutirwa MRI + Dose-Dose IV Dexamethasone NONAHA"]

    OncEmerg -->|"B: Kubyimba mu maso / mu ijosi + dyspnea"| SVCS["UMUKUNZI WA VENA CAVA (SVC) SYNDROME: <br/> Icara neza (45-90 deg); Isanduku Yihutirwa CT + Kwita kuri Oncology"]

    OncEmerg -->|"C cyangwa D: Ikibazo cya metabolike"| Metabolic["BITEKEREZO TUMOR LYSIS CYANGWA HYPERCALCEMIA: <br/> Ishami ryihutirwa NONAHA kuri ECG, Electrolytes, & IV Fluids"]

Igice cya 1: Sobanukirwa na Neutropenic Fever na "Nadir" Akadirishya

1. "Umubare wa Neutrophil Absolute" (ANC) na Chemo Nadir ni iki?

Uturemangingo twamaraso yera (leukocytes) harimo ubwoko butandukanye, ariko ** neutrophile ** nizo selile zambere zica bagiteri. Abaganga babara ** Absolute Neutrophil Count (ANC) ** bagwiza umubare wamaraso yera yose hamwe nijanisha rya neutrophile ("segs") hamwe nitsinda ridakuze: - ** Ubuzima busanzwe ANC: ** $ 1.500 inyandiko {kugeza} 8,000 inyandiko {selile kuri microliter} ( mu inyandiko {L}) $ (cyangwa $ 1.5 inyandiko {kugeza} 8.0 inshuro 10 ^ 9 / inyandiko {L} $). - ** Neutropenia: ** ANC munsi ** $ 1.500 inyandiko {selile} / mu inyandiko {L} $ ** ($ <1.5 inshuro 10 ^ 9 / inyandiko {L} $). - ** Neutropenia Ikabije (Ibyago Byinshi byo Kurwara): ** ANC munsi ya ** $ 500 inyandiko {selile} / mu umwandiko {L} $ ** ($ - ** Neutropenia Yimbitse (Ingaruka Zikabije): ** ANC munsi ya ** $ 100 inyandiko {selile} / mu inyandiko {L} $ ** ($ <0.1 inshuro 10 ^ 9 / inyandiko {L} $), bikunze kugaragara mugihe cyo kwinjiza leukemia ikabije cyangwa kwimura ingirabuzimafatizo.

** "Nadir" ibera ryari? ** Nyuma yumuti usanzwe wa chimiotherapie winjiza mumunsi wa 1, neutrophile yamaze kuzenguruka mumaraso ibaho iminsi mike mugihe uruganda rwamagufwa rwumiwe byigihe gito. Kubwibyo, ibara ryamaraso yera yibera hasi cyane (** nadir **) mubisanzwe hagati yumunsi wa 7 numunsi wa 14 nyuma ya chimiotherapie ** (nubwo ishobora kubaho igihe icyo aricyo cyose mugihe cyo kuvura umunwa burimunsi, imishwarara, cyangwa kanseri ya hematologiya nka leukemia, lymphoma, na myeloma myinshi).

2. Kuki kwandura bisa nkaho bitagaragara mugihe ufite Neutrophile Zeru

Ku muntu ufite sisitemu isanzwe yubudahangarwa, infection iragaragara kuko ** miriyoni za neutrophile zihutira kurubuga zipfa **, zitera ibibyimba byumuhondo mwinshi, uruhu rutukura rwabyimbye, umuhogo ubabara mu muhogo, cyangwa ibibyimba byera byera ku gituza X-ray: - ** Nta Neutrophile = Nta Pus na Nta bimenyetso bya kera: ** Mu murwayi wa neutropenique ukabije: - Umusonga wica ** bagiteri ** urashobora gutera ** inkorora zeru, flegm zeru, nigituza cyuzuye X-ray **, byerekana umuriro gusa no guhumeka vuba. - Indwara ikabije yinkari yinkari (urosepsis) ** irashobora gutera ** zeru gutwika mugihe cyo kwihagarika ** no kwerekana ** zeru zeru zera zera (pyuria) kuri dipstick yinkari **, ikerekana gusa umuriro. - Uruhu rwica ** cyangwa selileire ya perirectal ** ikikije anus cyangwa icyambu cyo hagati rwagati rushobora kwerekana ** zeru pus cyangwa ibibyimba bihindagurika **, bikerekana gusa ubushyuhe bworoshye, ibara ryijimye, cyangwa ubwuzu bwaho hamwe numuriro. - ** Iburira kuri Corticosteroide Guhisha umuriro: ** Abarwayi ba kanseri benshi bafata burimunsi cyangwa buri cyumweru ** dexamethasone cyangwa prednisone ** (kubyimba ubwonko, lymphoma, myeloma nyinshi, ingaruka zubudahangarwa, cyangwa isesemi). Corticosteroide ihagarika cyane ubwonko bwa hypothalamus thermostat. ** Umurwayi ufata dexamethasone ashobora kugira septi yuzuye ya neutropenique yamaraso hamwe nubushyuhe busanzwe bwa $ 37.0 ^ umuzenguruko inyandiko {C} $ ($ 98.6 ^ umuzenguruko inyandiko {F} \(). (\) 96.8 ^ umuzenguruko inyandiko {F} $) **.

3.

Iyo bagiteri zimaze kwinjira mumaraso yumurwayi udafite neutrophile (kenshi ** Gram-negative inkoni ** nka * Escherichia coli , * Klebsiella pneumoniae , cyangwa * Pseudomonas aeruginosa * ihinduranya ibisebe byangiza umunwa [ mucositis **] cyangwa amara yo mu nda *, * ** Gram-positif cocci ** catheters), impfu ziyongera cyane hamwe na buri saha yo gutinda. - ** Manda y’ibitaro mpuzamahanga: ** Amabwiriza yatanzwe na ASCO, IDSA, ESMO, Ubukangurambaga bwa Surviving Sepsis, hamwe n’Ubwongereza NICE (CG151) ategeka ko buri shami ryihutirwa ritanga igipimo cya mbere cya ** empirike anti-pseudomonal intravenous beta-lactam antibiotic ** (nka ** cefepime, piperacillin-tazobactam [60) iminota yumurwayi akandagira mumuryango wibitaro **, ** adategereje ** kugirango laboratoire yera yamaraso ibara (CBC) igaruke niba neutropenia ikekwa. - Ibibera muri iyo minota 60 yambere: Abaforomo bahita bashushanya ** ibice bibiri byumuco wamaraso ** (imwe yashushanyijeho muri buri lumen yumurwayi watewe ** Port-a-Cath, umurongo wa PICC, cyangwa Hickman catheter **, hamwe nigice kimwe cyakuwe mumitsi ya periferique), shushanya Amaraso Yuzuye (CBC hamwe na maraso ya metabolike, hanyuma amaraso ya langate **, amaraso ya metabolike, na maraso ya ** **. - ** Ikibazo Cyinshi Cyane Cyane Cyane (Amanota ya MASCC): ** Igipimo cya mbere cya antibiotique ya IV kirangiye, abaganga ba oncologue nabaganga byihutirwa babara ishyirahamwe ry’ibihugu byinshi byita ku barwayi ba kanseri (MASCC) amanota y’ibyago ** na ** CISNE amanota ** kugira ngo bamenye niba umurwayi agomba kuguma mu cyumba cy’akato kitari gito, gitera umuvuduko ukabije w'amaraso, umuti w'inda, umuti w'inda, indwara ya selile; mucosite) cyangwa irashobora guhinduka mugukurikiranira hafi imiti.

Igice cya 2: Kumenya Ibindi Bitanu Byangiza Ubuzima Byihutirwa Oncologic

Ndetse iyo umurwayi wa kanseri adafite umuriro, ububi bukabije hamwe nubuvuzi bwa kanseri bugezweho (chimiotherapie, imirasire, na ** igenzura ry’umudugudu **) birashobora gukurura ibibazo bitanu byimiterere cyangwa metabolike bisaba ubuvuzi bwihutirwa:

Ibihe byihutirwa bya Oncologic Impamvu yibanze Ibendera ritukura Iburira Ibimenyetso Murugo Ako kanya Imfashanyo Yambere & Kuvura Ibitaro
** 1. Kwangirika k'umugongo mubi (MSCC) ** Tumor metastasis (cyane cyane uhereye kumabere, prostate, ibihaha, impyiko, cyangwa myeloma) ikura muri vertebra yumugongo no gukanda kumugongo cyangwa cauda equina. ** Ikimenyetso cya 1 (90% byimanza): Ububabare bushya cyangwa bubabaza umugongo cyangwa ijosi ** ibyo ni bibi cyane iyo uryamye neza muburiri nijoro ** cyangwa iyo gukorora / kunaniza.
** Ibimenyetso byatinze: ** Amaguru aremereye / adakomeye, kugenda adahagaze, kunanirwa kunyerera amaguru / inda, cyangwa ** ingorane zo kwihagarika / kutagira amara **.		 ** Hamagara 911/112/999 cyangwa ujye kuri ER ako kanya ** (iyo amaguru amaze kumugara rwose $ $ 24 inyandiko {kugeza} 48 inyandiko {amasaha} \(, kugenda gake ugaruka).<br/>** Ibitaro: ** Ako kanya ** Dose-Dose IV Dexamethasone (\) 10 inyandiko {kugeza} 16 umwandiko {mg} $) ** + ** Ibihe Byose byihutirwa-umugongo MRI ** + imirasire yihutirwa cyangwa decompression ya neurosurgical.
** 2. Indwara ya Vena Cava (SVC) Syndrome ** Ikibyimba cy'ibihaha, misa ya lymphoma, cyangwa catheter yamaraso mu gituza cyo hejuru kunyunyuza imitsi nini (** isumba vena cava **) itwara amaraso kuva mumutwe, ijosi, n'amaboko asubira mumutima. ** Mu maso, kubyimba mu maso, mu ijosi, no mu jisho (cyane cyane mu gitondo) **; umukufi w'ishati; ** imitsi iva mu ijosi no mu gituza ; isura itukura / ubururu iyo yunamye imbere ( Ikimenyetso cya Pemberton **); ijwi ritontoma, inkorora, kubabara umutwe, cyangwa umuhanda. ** Icara umurwayi uhagaze kuri dogere 45 kugeza kuri 90 ** (ntuzigere ubirambika neza, byongera umutwe / umwuka wo mu mitsi).
** Hamagara 911/112/999 ** niba umuhanda, urujijo, cyangwa guhumeka gukabije.
** Ibitaro: ** Itandukaniro Isanduku CT, endovascular SVC stenting, steroid / chemo / imirasire.
** 3. Indwara ya Tumor Lysis (TLS) ** Isenyuka ryihuse rya miriyoni za kanseri ya kanseri ** Amasaha 12 kugeza ku minsi 7 nyuma yo gutangira imiti ya chimiotherapie, steroid, venetoclax, cyangwa CAR-T ivura ** (cyane cyane muri leukemia cyangwa lymphoma yo mu rwego rwo hejuru), guta potasiyumu yo mu nda ** potasiyumu, fosifore, na acide uric ** mu maraso mugihe uta ** calcium **. Isesemi ikabije, kuruka, impiswi, ubunebwe bukabije, ** kubabara imitsi cyangwa kurwara intoki / ibirenge (tetany kuva calcium nkeya) , umwijima / ibicu cyangwa guhagarika inkari ( kunanirwa kw'impyiko zikabije **), gufatwa, hamwe na ** umutima utera umutima (kuva kuri potasiyumu nyinshi) **. ** Hamagara 911/112/999 cyangwa ujye muri ER ako kanya ; kwima ibiryo byose birimo potasiyumu / inyongera hamwe na NSAIDs.
 Ibitaro: ** Ako kanya 12-bayobora ECG, hydrasiyo ya IV, ** rasburicase ** (ishonga kristu ya acide ya uric ako kanya), allopurinol, hamwe na potasiyumu / calcium.
** 4. Hypercalcemia yo Kurwara nabi ** Kumeneka amagufa cyangwa ibibyimba bya parathiyide ya hormone ifitanye isano na poroteyine (PTHrP) itwara calcium yamaraso hejuru cyane ($> 3.0 inyandiko {kugeza} 3.5 inyandiko {mmol / L} $ cyangwa $> 12 inyandiko {kugeza} 14 inyandiko {mg / dL} $). ** "Amagufa, Groans, Indwara zo mu mutwe": ** Inyota ikabije idashira (** polydipsia ), inkari nyinshi cyane ( polyuria ** iganisha ku kubura umwuma mwinshi), kuribwa mu nda cyane, isesemi / kuruka, ububabare bukabije bw'amagufwa, na ** urujijo rugenda rwiyongera, gusinzira, cyangwa koma **. ** Jya mu ishami ryihutirwa ako kanya ; komeza umurwayi uhindurwe namazi gusa niba mugari maso kandi ukamira neza.
 Ibitaro: ** Birakaze ** 0.9% Ubusanzwe Saline IV hydrasiyo ** + imitsi ** acide ya zoledronic / pamidronate **, ** calcitonin **, cyangwa ** denosumab **.
** 5. Neutropenic Enterocolitis (Typhlitis) & Immunotherapy Colitis / Pneumonitis ** ** Tiflitis: ** Gutera bacteri kwibasira colon yiburyo (* cecum ) mugihe cya neutropenia ikabije.
* Inhibitori ya Immune (Pembrolizumab, Nivolumab, Ipilimumab): ** Igitero cya Autoimmune yibihaha, amara, umutima, umwijima, cyangwa pitoito / tiroyide.		 ** Tiflite: ** Umuriro + ** iburyo bwo mu nda hepfo ** (mimics appendicitis) + impiswi y'amazi cyangwa yamaraso.
** Immunotherapy: ** Impiswi ikabije ($> 4 inyandiko {kugeza} 6 inyandiko {intebe / umunsi} $), inkorora nshya yumye / guhumeka neza, guhonyora umunaniro / BP nkeya (ikibazo cya adrenal), cyangwa kubabara mu gatuza (myocarditis).		 ** NTUKIGERE ufata ibinini birwanya anti-diarrheal (loperamide / Imodium) niba ufite umuriro, impiswi yamaraso, cyangwa uri kuri immunotherapie ** utabigaragaje neza (gufata uburozi mumitsi yaka umuriro bishobora gutera megacolon yuburozi no gutobora amara). Jya kuri ER ako kanya kuri antibiyotike ya IV cyangwa dose nyinshi ya methylprednisolone.

Intambwe ku yindi mbere yo kwita kubitaro mugihe witegura ishami ryihutirwa

Intambwe ya 1: Nigute Ufata Ubushyuhe Bwuzuye Mumurwayi wa Chimiotherapie

  1. ** Koresha umunwa wa digitale (munsi y'ururimi), tympanic (ugutwi), cyangwa imiyoboro y'agateganyo (agahanga) ya termometero. **
  2. Niba umurwayi yanyoye icyayi gishyushye cyangwa amazi ya barafu, tegereza ** iminota 15 kugeza kuri 20 ** mbere yo gufata ubushyuhe bwo mu kanwa kugirango gusoma bidahindurwa kubeshya.
  3. ** Birabujijwe rwose: Ntuzigere ukoresha Thermometre igororotse. **
  4. Chimoterapi yangiza ingirabuzimafatizo zigabanya vuba umurongo wa gastrointestinal yose kuva kumunwa kugeza kuri anus (** mucosite ). Gusunika urwego rukomeye rwa termometero (cyangwa suppository, enema, cyangwa tampon) murukiramende birashobora gutera amarira ya microscopique mumurongo woroshye urukiramende, bigatuma miriyoni * E. coli * na bacteri zo mu nda ya anaerobic kugirango zinjire mumaraso ako kanya ( bacteremia ) hanyuma bigatera ibisebe byangiza perirectal cyangwa kuva amaraso adashobora kugenzurwa niba platine iba mike ( trombocytopenia **).

Intambwe ya 2: Kugenzura imbuga zinjira "Zihishe Batanu"

Mugihe uvugana numuforomokazi wa oncology cyangwa utegereje ubwikorezi, reba neza iyi myanya itanu (ntuzigere ucogora, pop, cyangwa ngo utere igisebe icyo aricyo cyose) hanyuma utange raporo kubyo ubona: 1. ** Igikoresho cyo hagati cyinjira mu mitsi (Port-a-Cath, Umurongo wa PICC, cyangwa Catheter ya Hickman): ** Reba uruhu hejuru yicyambu cyigituza cyangwa ukuboko kwa PICC utarinze gukuramo imyambarire iboneye. Haba hari ** umutuku, kubyimba, ubushyuhe, ubwuzu, cyangwa igikonjo cy'umuhondo ** kumurongo wa tunnel? Ese umuriro cyangwa guhinda umushyitsi byatangiye ** muminota 30 kugeza kuri 60 nyuma yo koza cyangwa gukoresha icyambu ? . 2. ** Umunwa, amenyo, n'umuhogo (Mucosite yo mu kanwa): ** Shira itara rya terefone mu kanwa. Hariho ibisebe bitukura bibabaza, ibara ryera rimeze nkibishishwa ( thrush / candidiasis ), amenyo ava amaraso, cyangwa ingorane zo kumira amazi? 3. ** Ibihaha no guhumeka: ** Bara umubare uhumeka umurwayi afata mumasegonda 60 kuruhuka (igipimo cyubuhumekero ** hejuru yumwuka uhumeka 20 kugeza 22 kumunota ** nikimenyetso cyo kuburira hakiri kare sepsis cyangwa umusonga nubwo nta nkorora) hanyuma urebe oximeter yintoki niba ihari. 4. ** Inda ninda ya Perirectal: ** Baza umurwayi niba afite ububabare bwo munda bwiburyo bwiburyo ( typhlitis **) cyangwa ** ububabare ubwo aribwo bwose, gutwika, cyangwa ubwuzu hafi ya anus cyangwa umurizo igihe wicaye cyangwa unyuze kuntebe ** (selilitis perianal ni isoko yihishe yubuzima bwa Gram-negative na anaerobic sepsis kubarwayi ba neutropenique). 5. ** Inkari n'uruhu: ** Baza niba inkari zumva zitameze neza, zisa n'ibicu cyangwa umutuku, cyangwa zagabanutse cyane mubunini mu masaha 12 ashize.

Intambwe ya 3: Gucunga icyarimwe Thrombocytopenia (Plateletes yo hasi) icyarimwe

Kubera ko chimiotherapie ihagarika igufwa ryose, umurwayi ufite selile yera yera (** neutropenia ) akenshi aba afite ibyago bike byamaraso ( trombocytopenia , cyane cyane iyo platine igabanutse munsi y $ 10,000 inyandiko {kugeza kuri 20.000 / mu inyandiko {L} $) mugihe kimwe: - Reba uruhu rwa shitingi, amaguru, nintoki kugirango utudomo duto duto duto cyangwa umutuku wijimye udashira iyo ukanze ( petechiae ), ibikomere byijimye bidasobanutse ( ecchymose ), cyangwa ibisebe byamaraso imbere mumunwa ( wet purpura **). - Niba umurwayi afite amaraso yizuru cyangwa amenyo yamaraso hamwe numuriro, iyicare ugororotse yegamiye imbere, shyira izuru ryoroheje ryo hepfo ubudahwema muminota 20 (reba kuva amaraso), hanyuma ubwire icyumba cyihutirwa ako kanya kuko bashobora gukenera guterwa byihutirwa ** platelet ** hamwe na antibiotike yabo ya IV.

Intambwe ya 4: Imenyekanisha ryihutirwa ryihuse rya CAR-T Cell na Bispecific Antibody abarwayi (CRS na ICANS)

Niba umurwayi aherutse kwakira ** CAR-T ivura selile ** (chimeric antigen reseptor T-selile therapy) cyangwa ** bispecific T-selile enger antibody ** ya leukemia, lymphoma, cyangwa myeloma nyinshi mubyumweru 4 bishize, umuriro utunguranye ufite impamvu ebyiri zihitana ubuzima icyarimwe: 1. ** Neutropenic Bacterial Sepsis ** (bisaba antibiyotike yiminota 60 ako kanya), ** NA ** 2. ** Indwara ya Cytokine irekura (CRS) hamwe na Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS): ** Gukora ubudahangarwa bukabije butera umuriro mwinshi ($> 38.0 ^ umuzenguruko {inyandiko {C} $ kugeza $ 40.5 ^ - ** Igikorwa gitegekwa: ** Buri gihe werekane umurwayi wa ** CAR-T / Ikarita ya Wallet Ikarita ** mugihe cyihutirwa ako kanya; usibye antibiyotike yagutse ya IV, aba barwayi bakeneye ubuyobozi bwihutirwa bwa interleukin-6 reseptor antagonist ** tocilizumab ** na / cyangwa ** corticosteroide ** ihujwe nikigo cyabo cyo kuvura selile.

Inyandiko y'itumanaho neza kuri 911/112/999 hamwe no gutabaza byihutirwa

Ubushakashatsi bwerekana ko abarwayi ba kanseri ya neutropenique bakunze guhura n’ubukererwe buteye ubwoba aho abantu bategereje ibyumba byihutirwa keretse umurwayi cyangwa umwe mu bagize umuryango bavuze amagambo y’ubuvuzi ** "Chemotherapy Neutropenic Sepsis: 60-Minute Antibiotic Window" ** bahuye bwa mbere. Koresha iyi nyandiko ijambo ijambo:

  • ** Iyo uhamagaye 911/112/999 (niba bikonje, umutwe, guhumeka neza, cyangwa urujijo birahari): **

    • hashyizweho [igituza Port-a-Cath / ukuboko PICC umurongo] Ntabwo twahaye Tylenol cyangwa ibuprofen. "*

  • ** Iyo uzamutse ku biro bishinzwe ubutabazi byihutirwa (niba uhageze n'imodoka): **

    • "Uyu murwayi ari kuri chimiotherapie ikora (Umunsi [X] nyuma yo gushiramo, imbere mu idirishya rya nadir) kandi afite ** Neutropenic Fever ya [X.X ° C / XXX.X ° F] **. antibiyotike yimitsi yagutse muminota 60 ya triage *. "

  • ** Niba umurwayi ari kuri Immunotherapy (Inhibitori ya Checkpoint nka Pembrolizumab / Keytruda, Nivolumab / Opdivo, cyangwa Ipilimumab / Yervoy): **

    *

Ibyo gufata muminota 2 kubiro byihutirwa Go-Bag

  • ** Ikarita yumurwayi "Chemotherapy / Immunotherapy Wallet Alert Card" ** (yerekana uburyo nyabwo bwibiyobyabwenge, itariki yumunsi wanyuma, oncologue wamasaha 24 ya pager / numero ya terefone, nubwoko bwicyambu).
  • ** Ikarita iranga Port-a-Cath cyangwa icyuma cyinjizwamo ingufu fob ** (ibwira abaforomo byihutirwa niba icyambu cyo mu gatuza ari "Imbaraga-Injiza" kubitandukanya na CT scan nubunini bwa urushinge rwa Huber [$ ¾ inyandiko {-inch} $ v.
  • ** Numbing cream (lidocaine / prilocaine EMLA cream) ** iyo byateganijwe: gushira dab ya cream yandikiwe hejuru yigituza Port-a-Cath itwikiriwe nigitambaro cya pulasitike mugihe ugenda mumodoka ujya mubitaro binaniza uruhu muminota 30 kuburyo kugera ku cyambu nurushinge rwa Huber nta bubabare.
  • ** Imiti yose yo murugo iriho ubu (cyane cyane antibiyotike ya profilaktike nka levofloxacin cyangwa trimethoprim-sulfamethoxazole, antifungali nka fluconazole / posaconazole, antiviral nka acyclovir, inshinge ziterwa no gukura nka ** pegfilgrastim [Neulasta] cyangwa filgrastim [Neupogen], Neupogen].
  • ** Amashanyarazi ya terefone hamwe na masike isukuye. **

Kwirinda kwandura buri munsi mugihe cya Chimiotherapie Nadir (Umunsi wa 7 kugeza 14)

Mugihe nta kwirinda birinda 100 ku ijana byindwara ya neutropenique (kubera ko kwandura kwinshi guturuka kumurwayi usanzwe wigifu wigifu), gukurikiza aya mategeko ashingiye kubimenyetso muminsi yawe mike yo kubara bigabanya ibitaro byakwirindwa: 1. ** Kwita ku munwa (Kurinda Mucosite Yinjira): ** Koza umunwa inshuro 4 kumunsi (nyuma yo kurya na mbere yo kuryama) ukoresheje igisubizo cyiza cya ** $ ½ umwandiko {ikiyiko} $ umunyu na $ ½ Koresha uburoso bwoza amenyo ya ultra-yoroshye, kandi wirinde koza inzoga zishingiye ku nzoga zumye kandi zimena umunwa. 2. ** Kwirinda impatwe & Anal Fissures: ** Chimiotherapie n'imiti irwanya isesemi (nka ondansetron / Zofran) itera impatwe zikomeye. Kwihatira kunyura ku ntebe ikomeye irira amarira yoroheje (** anal fissure **), ikora portal itaziguye ya bagiteri zo munda zinjira mumaraso. Fata oncologue wawe wasabwe no korohereza umunwa / korohereza hakiri kare, unywe amazi menshi, kandi ** ntuzigere ukoresha insimburangingo cyangwa inzitizi . 3. ** Ibiryo & Isuku yintoki: ** Karaba intoki n'isabune n'amazi ashyushye mumasegonda 20 mbere yo kurya na nyuma yo gukoresha ubwiherero. Teka inyama zose, inkoko, amafi, n'amagi neza kugirango ubushyuhe bwimbere bwimbere, kwoza imbuto n'imboga mbisi witonze, kandi wirinde amata adasukuye, imimero mbisi, shellfish mbisi / sushi, nibiryo bya bffet byicaye mubushyuhe bwicyumba. 4. ** Sobanukirwa na Pegfilgrastim (Neulasta) Kubabara Amagufwa na Fever Yukuri: ** Abarwayi benshi bahabwa inshinge yera-maraso-itera imbaraga ( pegfilgrastim cyangwa filgrastim **, G-CSF) nyuma yamasaha 24 ya chimiotherapie. Nkuko igufwa ryamagufa ribyara vuba neutrophile nshya muminsi 2 kugeza 5 iri imbere, abarwayi bakunze kumva ububabare bukabije mubibuno, amabere, ndetse no mugongo yo hepfo (akenshi byoroherwa na loratadine [Claritin] iyo byemejwe na oncologue). ** Ariko, ntuzigere na rimwe wibwira ko umuriro wa $ 38.0 ^ umuzenguruko inyandiko {C} $ ($ 100.4 ^ umuzenguruko inyandiko {F} $) cyangwa irenga ni "gusa uhereye ku isasu rya Neulasta" **: burigihe genzura ubushyuhe bwawe hanyuma uhamagare oncologiya ako kanya kugirango umuriro wose.

Fata inzira

Gufata ibyemezo byambere byemewe na CPR bivuye muri Croix-Rouge, Ishyirahamwe ry’umutima ry’Abanyamerika, Ambulance ya St John, cyangwa umutanga waho wigisha abarezi n’abagize umuryango kumenya ibimenyetso bya kare bya sepsis, ihungabana ry’imitsi, hamwe no guhumeka byihutirwa no guhuza ibikorwa byihutirwa bikiza ubuzima.

Ibibazo bikunze kubazwa

Kuki gufata Tylenol (acetaminophen / paracetamol) cyangwa ibuprofen kubwumuriro woroheje cyangwa kubabara umutwe biteje akaga mugihe cya chimiotherapie?

Iyo chimiotherapie igabanije ingirangingo z'amaraso yawe yera (neutrophile), umubiri wawe ntushobora gukora ibibyimba, umutuku, cyangwa kubyimba kwaho mugihe bagiteri zateye, bityo umuriro uzamuka akenshi ni ikimenyetso cyerekana gusa ko kwandura ubuzima byangiza ubuzima. Gufata acetaminofeni, parasetamol, ibuprofen, cyangwa aspirine bigabanya ubushyuhe bwawe bwamasaha menshi kandi bigahisha icyo kimenyetso cyo kuburira mugihe bagiteri zigwira vuba mumaraso yawe. Ntuzigere na rimwe ufata imiti igabanya umuriro mugihe cya chimiotherapie utabanje gusuzuma ubushyuhe bwawe no kubona neza neza itsinda ryawe rya oncology.

Ni ubuhe buryo busomeka bwa termometero bubarwa nkubuvuzi bwihutirwa mugihe cya chimiotherapie?

Ukurikije amabwiriza mpuzamahanga ya onkologiya (ASCO, IDSA, na ESMO), ibyihutirwa bya neutropenique ni ubushyuhe bumwe bwo mu kanwa bwa 38.3 ° C (101.0 ° F) cyangwa burenga, CYANGWA ubushyuhe bwo mu kanwa bwa 38.0 ° C (100.4 ° F) cyangwa burenga bumara isaha 1 yuzuye (ibitaro byinshi byo mu Bwongereza NHS bikoresha itegeko rikomeye ryo gusoma rimwe rya 38.0 ° C / 100.). Byongeye kandi, niba umurwayi wa chimiotherapie afite ubukonje (rigors), umutwe, urujijo, guhumeka neza, cyangwa ubushyuhe budasanzwe buri munsi ya 36.0 ° C (96.8 ° F), nibyihutirwa byihuse nubwo bidasomwe na termometero nyinshi.

Ni ukubera iki amabwiriza yihutirwa abuza gukoresha ikigereranyo cya termometero cyangwa urukiramende rwumurwayi wa chimiotherapie?

Chimiotherapie inanutse kandi igabanya ururenda rworoshye ruri mu mara no mu mara mugihe icyarimwe igabanya ingirabuzimafatizo zera zandura zanduye hamwe na platine yuzuye amaraso. Kwinjiza ibipimo bya termometero, suppository, cyangwa enema birashobora gutobora byoroshye cyangwa gusenya urukuta rwurukiramende rworoshye, kwinjiza miriyoni za bagiteri zo munda zinjira mumaraso (bitera Gram-negative sepsis yica) kandi bigatera amaraso menshi.

Kuki kubabara umugongo umurwayi wa kanseri bisaba kwisuzumisha byihutirwa kugirango umugongo ugabanuke?

Kanseri nyinshi zisanzwe (cyane cyane amabere, prostate, ibihaha, impyiko, na myeloma nyinshi) zirashobora gukwirakwira mu magufwa y'umugongo. Niba ikibyimba kibaye gikuze mu muyoboro wumugongo, ikimenyetso cya mbere cyane mubarwayi barenga 90 ku ijana ni gishya cyangwa cyiyongera kubabara umugongo cyangwa ijosi (mubisanzwe bikabije iyo uryamye neza muburiri cyangwa inkorora) iminsi cyangwa ibyumweru mbere yuko amaguru acika intege cyangwa akananirwa. Gufata uruti rw'umugongo rwangirika hakiri kare hamwe na MRI yihutirwa hamwe na dose nyinshi ya IV dexamethasone mugihe umurwayi ashobora kugenda bikomeza ubushobozi bwabo bwo kugenda no gukomeza uruhago.

Inkomoko yagenzuwe

  • ** Umuryango w’Abanyamerika w’ubuvuzi bwa Oncologiya (ASCO) n’umuryango w’indwara zandura muri Amerika (IDSA, Amerika): ** * Gucunga indwara z’umuriro na Neutropenia mu bantu bakuru bavuwe nabi: ASCO na IDSA Clinical Practice Guideline Kuvugurura * (Taplitz et al., * Journal of Clinical Oncology *) na * IDSA Abarwayi ba Neutropenic bafite Kanseri * (Freifeld et al.).
  • ** Ikigo cy’igihugu gishinzwe ubuzima n’ubuvuzi (NICE, Ubwongereza): ** * Neutropenic Sepsis: Kwirinda no gucunga abantu barwaye Kanseri * (NICE Clinical Guideline CG151, iminota 60 y’umuryango kugeza kuri antibiotique) na * Metastatic Spinal Cord Compression mu bakuze: Isuzuma ry’ingaruka, Gusuzuma no Gucunga * (NICE Guideline NG234).
  • ** Umuryango w’ibihugu by’i Burayi Ushinzwe Ubuvuzi (ESMO): ** * Ubuyobozi bwa Febrile Neutropenia: Amabwiriza y’ubuvuzi bwa ESMO * (Klastersky et al., * Annals of Oncology *) na * Amabwiriza ya ESMO yerekeye gucunga uburozi buturuka kuri Immunotherapy *.
  • ** Urwego rw’igihugu rushinzwe kanseri (NCCN, Amerika): ** * Amabwiriza y’ubuvuzi bwa NCCN muri Oncologiya: Kwirinda no kuvura indwara ziterwa na kanseri * na * Ubuyobozi bw’uburozi bujyanye n’uburozi *.
  • ** Sosiyete y'abaforomo ya Oncologiya (ONS) & Sosiyete y'abaforomo ya Oncology yo mu Bwongereza (UKONS): ** * Amabwiriza akomeye yo gucunga Oncology Amabwiriza ya mbere yo gucunga no gukoresha amasaha 24 yo gutwara byihuse.

Kuyobora