腫瘤學(xué)-犬淋巴瘤

BabushkaSignalment 特征Female,8yearold,poodle

雌性，8歲，貴賓犬History病史PU/PDforthelastfewweeks

前幾周多飲多尿Acutecollapse-immediatelypresentedtotheemergencyservice

嚴重虛脫－立刻送至急救PhysicalExam 體檢Weakness 虛弱5%dehydration 5％脫水Nootherabnormalities 無其他異常DiagnosticPlan 診斷計劃CBC 血常規(guī)Biochemistry 生化Urinalysis 尿檢Results-CBC 全血細胞計數(shù)結(jié)果WBC-10.09白細胞計數(shù)RBC-6.26紅細胞PCV-42紅細胞壓積容量Plts-159血小板Ts-6.8Results-Biochemistry生化結(jié)果Glu-101谷氨酸Creat-2.19Na+-151鈉離子K+-3.9鉀離子Ca++-1.91鈣離子Results-UA尿檢結(jié)果SG-1.018Ph-6.0Nosedimentorotherfindings

無沉淀，無其他異常ProblemList 問題列表Acutecollapse-weakness

急性虛脫－虛弱Hypercalcemia-PU/PD

高鈣血癥－多飲多尿Dehydration

脫水DDsforHypercalcemia

高鈣血癥鑒別診斷1 Laberror-alwaysmakesureitisrepeatable 實驗錯誤－需要重復(fù)確認2 Physiologicgrowthofyounganimals年輕動物生長3 Dehydration(hyperproteinemia)脫水（高蛋白血癥）4 Malignancytumors惡性腫瘤Lymphoma淋巴瘤,apocrineglandanalsacadenocarcinoma頂漿分泌腺和肛門腺癌,adenocarcinoma腺癌(thyroid甲狀腺,mammarygland乳腺,nasal鼻,pulmonary肺),thymoma胸腺癌,squamouscellcarcinoma鱗狀細胞癌,andprimaryhyperparathyroidism原發(fā)性甲狀旁腺機能亢進.(Metstobone-rare成骨素－少見)5 Hypoadrenocortcism(Addison‘s)

腎上腺皮質(zhì)功能不全（阿迪森）ConditionsAssociatedWithHypercalcemia(Cont.)高鈣血癥相關(guān)的情況6.Renalfailure腎衰7.HypervitaminosisD(cholecalciferolVD3)

高VD癥d/tincreasedintestinalabsorptionofcalcium

幫助鈣在腸內(nèi)吸收8.

Primaryhyperparathyroidism-.

原發(fā)性甲狀旁腺機能亢進olderdogsandcats,KeeshondandSiamesepredisposed.老齡犬貓，基絲犬，仙羅貓易得hypercalcemia,hypophosphatemia,ca-/pratio>33. 高鈣血癥，低磷血癥（鈣/鱗大于33）PTHlevel-usuallyelevated.甲狀旁腺素水平－通常升高ConditionsAssociatedWithHypercalcemia(Cont.)9.

Skeletallesions(non-neoplastic)–骨骼損傷（無增生物）osteomyelitis–inflammation骨髓炎－炎癥Boneresorbingfactorsproducedbymonocytesandactivatedlymphocytes單核細胞和核激活淋巴細胞產(chǎn)生各種骨吸收因子hypertrophicosteodystrophy肥大性骨營養(yǎng)不良disuseosteoporosis(immobilization)-萎縮性骨質(zhì)疏松Increasedresorption,decreasedboneformation吸收增加，生成減少10.

Blastomycosis酵母病/Granulomatousdisorders肉芽腫病D/textrarenalproductionofcalcitriolbymononuclearcell,possiblyproductionof1,25-dihydroxyvitaminDbymononuclearcells鈣三醇通過單核細胞后的腎外產(chǎn)物很可能就是1，25羥基維生素D3。DiagnosticPlan 診斷計劃Thoracicradiographs

胸腔放射影像Abdominalultrasound

腹部超聲ThoracicRadiographs胸部X光AbdominalUltrasound腹部超聲Mesenteric,iliaclymphadenopathy

腸系膜，髂骨下淋巴結(jié)病Splenomegaly脾腫大Kidneys-rimsign腎－邊緣明顯Mediastinalmass縱隔塊狀DiagnosticPlan(Cont.)診斷計劃Aspiratethemesentericlymphnode 抽吸腸系膜淋巴結(jié)Diagnosis診斷Lymphoma淋巴瘤Lymphoma淋巴瘤Origin-lymphoreticularcells

來源－淋巴網(wǎng)狀內(nèi)皮細胞Usuallyariseinlymphoreticulartissue-

通常在淋巴網(wǎng)狀內(nèi)皮細胞組織形成Lymphnodes,spleen,bonemarrow

淋巴結(jié)，脾臟，骨髓Mayariseinanytissue

可能在任何組織中形成Oneofthemostcommonneoplasms

最常見的腫瘤之一Primarily-middleagedtoolderdogs原發(fā)性：中年－老年犬Breeds–somearemorecommonlyaffected

種類：某些品種更易發(fā)Lymphoma淋巴瘤Etiology-unknown病因?qū)W－不明Pathology-病理學(xué)Classificationcanbebasedonanatomiclocationandhistologiccriteria

分類基于解剖學(xué)和歷史標準Mostcommonforms最常見的形式-(inorderofdecreasingprevalence根據(jù)發(fā)病率由高到低)Multicentric(80%)多中心瘤,cranialmediastinal縱膈前腫瘤,GI胃腸,cutaneous表皮Arisefromclonalexpansionoflymphoidcellswithdistinctivemorphologicandimmunophenotypicfeatures.Classifications-grading,immuno根據(jù)克隆淋巴細胞形態(tài)學(xué)和免疫學(xué)特征，分為增生性和免疫性

Vallietal-2006Canineindolentnodularlymphoma

犬無痛結(jié)節(jié)狀淋巴瘤Lymphomaswithalowmitoticrateandslowrateofclinicalprogression

淋巴瘤有絲分裂和臨床癥狀發(fā)展均緩慢Usuallyariseafteralongperiodofbenignhyperplasia通常在良性的超常增生一段時間后產(chǎn)生Treatmentrequiresaspecific,ratherthangeneraldiagnosis,basedoncellmorphology,architecture,andphenotype治療應(yīng)該根據(jù)特異性而非一般診斷，即細胞形態(tài)，結(jié)構(gòu)和免疫表型Classification分類Anatomic解剖學(xué)Multicentric多中心的Alimentary胃腸器官Mediastinal縱隔Cutaneous皮膚Other其他Cytologic細胞學(xué)Histologic組織學(xué)Immunophenotypic 免疫表型Anteriormediastinallymphoma.縱膈前淋巴瘤Anatomicclassificationassistsclinicianinunderstandingsigns.解剖學(xué)的分類有助于醫(yī)師了解病癥Multicentriclymphoma多中心淋巴瘤Dogswithmulticentriclymphomaareexaminedbecauseofgeneralizedperipherallymphadenopathy.由于全身性的淋巴結(jié)病而被檢出患有多中心淋巴瘤的犬Mediastinallymphoma縱膈淋巴瘤DogswithmediastinallymphomahaveupperGIsignsorrespiratorysigns.Thereisofteneffusionandtumorsareoftenlargeatdiagnosis.有縱膈淋巴瘤的犬會有上消化道或呼吸道癥狀。診斷時，通常有滲出，腫瘤通常已很大

Alimentarylymphoma消化道淋巴瘤DogswithalimentarylymphomapresentwithGIsigns.TumorsariseinlymphoidtissuesofGItractandspreadtoabdominalnodes.有消化道腫瘤的犬通常表現(xiàn)消化道癥狀。腫瘤產(chǎn)生在胃腸道淋巴結(jié)，且可擴展至腹部淋巴結(jié)Cutaneouslymphoma皮膚淋巴瘤Epitheliotropic趨上皮的--TcellsT細(Mycosisfungoides真菌病)Nonepitheliotropic非趨上皮的--BcellsB細胞EpitheliotropiclymphomaisatumorderivedfromCD3andCD8+cellsinthedog.Non-epitheliotropiclymphomaaffectsthemid-deepdermis.在犬，趨上皮的淋巴瘤是來源于CD3和CD8＋的細胞。非趨上皮的淋巴瘤影響到真皮中層Cutaneouslymphoma皮膚淋巴瘤Clinicalappearancesofcutaneousormucosallymphomainthedog.犬皮膚或粘膜淋巴瘤臨床表現(xiàn)Othersites其他部位CNS,ocular,renalandsplenicsitesoflymphoma.Virtuallyanyorganorsitemaybeaffected.中樞神經(jīng)系統(tǒng)，眼，腎和脾淋巴瘤。事實上任何部位都可能發(fā)生Lymphoma淋巴瘤-ClinicalSigns臨床癥狀Variableanddependontheextentofthelocationofthetumor.可見，腫瘤部位腫大Multicentric多中心-usuallygeneralizedpainless全身通常無痛Lymphadenopathy淋巴結(jié)病.Also-hepatosplenomegalyandbonemarrowinvolvementmayoccur.也有，肝脾大和骨髓受累Nonspecificsigns非特征性癥狀-anorexia,weightloss,vomiting,diarrhea,emaciation,ascites,dyspnea,PU,PD,andfevercanoccur.厭食，體重減輕，嘔吐，腹瀉，消瘦，腹水，呼吸困難，多飲，多尿，發(fā)燒GIoralimentary消化道–usuallynonspecificGIsigns.通常沒有特征性的消化道癥狀Vomiting,diarrhea,weightlossandmalabsorption.嘔吐，腹瀉，體重減輕，吸收不良Mediastinal縱膈-Repiratorydistressassociatedwiththeextentofdisease,PU/PD.與疾病程度有關(guān)的呼吸困難，多飲，多尿Lymphoma淋巴瘤Differentialsforlymphadenopathy.與淋巴結(jié)病的鑒別Dependsonthesize,consistency,andthelocationoftheaffectednodes.依賴于大小，堅固程度和發(fā)病淋巴結(jié)的部位Infections.感染Bacterial,viral,rickettsial,parasitic,fungal.細菌，病毒，立克次氏體，寄生蟲，真菌Metastatictumors轉(zhuǎn)移性腫瘤(notgeneralized非全身性)Immunemediateddiseases.免疫介導(dǎo)性疾病Dermatopathies,vasculitis,polyarthritis,lupus.皮膚病，血管炎，多關(guān)節(jié)病，紅斑狼瘡Hematopoietictumors.造血系統(tǒng)腫瘤Lymphoma,leukemia,multiplemyeloma,histiocyticdisease.淋巴瘤，白血病，多發(fā)性骨髓瘤，組織細胞病Lymphoma-Diagnostics

淋巴瘤－診斷Afteradiagnosishasbeenmadetheextentofdiseaseshouldbedeterminedandcorrelatedtothestageofdisease疾病診斷后，要弄清疾病的程度和階段CBC血常規(guī)Biochemistrypanel生化Urinalysis尿檢Thoracicradiographs胸部X光Abdominalultrasound腹部超聲Bonemarrowaspiration骨髓抽吸檢查Lymphnodeaspirate淋巴結(jié)抽吸檢查Immunohistochemistry免疫組織化學(xué)CanineLymphoma犬淋巴瘤-Staging疾病分期StageI-onelymphnode一個淋巴結(jié)StageII-morethanonelymphnodeonthesamesideofthediaphragm在膈膜的同一邊有不止一個淋巴結(jié)StageIII-peripherallymphadenopathy,bothsidesofthediaphragm外周淋巴結(jié)病，膈膜的兩邊StageIV-liver,splenicinvolvement肝脾受累StageV-bonemarrow,otherunusualorgans其他不常見的器官AorBA或BLymphoma淋巴瘤-Treatment治療Withouttreatmentmostdogsdieoftheirdiseasein4-6weeks.不治療，大多數(shù)犬4-6周后死于疾病Consideredasystemicdiseaseandthereforerequiressystemictherapyinordertoachieveremissionandprolongedsurvival.應(yīng)該當(dāng)成全身疾病治療，為了全身疾病得以緩和，延長壽命Therapyofchoice-systemicchemotherapy.全身化療Manyprotocolshavebeendevelopedoverthelast15-20years.在最近15-20年里，出現(xiàn)了許多治療方案Lymphoma淋巴瘤-Treatment治療ImportantConsiderations商量很重要-youandtheclient你和寵物主人Examples例如-Prednisone潑尼松Cop強的松COPA環(huán)磷酰胺UWMadisonMediansurvivaltimes平均存活時間Treatment治療Singleagentvs.Combinationchemotherapy簡單用藥，還是聯(lián)合化療Shortvs.Longwithmaintenance維持時間長，還是短Simon-JVIM.200612weekprotocol,77dogs.Sig.toxicosis.77只犬，治療12周，明顯中毒Median1stremission幾乎第一天就緩和-243days(CR-76%)243天后（76％抗糖皮質(zhì)激素）Siedlecki–CanVetJ.2006extendedmaintenancetherapy.39dogs.Min.toxicosis延長維持治療時間，39只犬輕微中毒Mediansurvival-461days,CR-97%.平均存活時間461天（97％抗糖皮質(zhì)激素）Treatment治療Drugsused應(yīng)用藥物-L-asparginase,prednisone,cyclophosphamide,vincristine,adriamycin左旋阿胞糖苷，潑尼松，環(huán)磷酰胺，長春新堿，阿霉素MacDonaldetal-2005-doesElsparinfluenceefficacyortoxicity?左旋門冬酰胺酶能夠改變藥效或毒性嗎？HalfBodyRadiation半體輻射Gustafsonetal-VCO,2004HalfBodyradiationinterposedwithinachemotherapyprotocolforcaninelymphoma(6dogs)犬淋巴瘤化療過程中，插入半體輻射（6只犬）Theprotocolwasconsideredsafe治療被認為是安全的Medianremissiontimefordogscompletingtheprotocol-455days完成治療后犬的平均存活時間未455天Higherd/tadditionalcellkillfromRT輻射療法會殺死其他細胞，所以死亡率較高ChemobeforeRT-topreventATLS在輻射治療前給予化療有助于阻止急性腫瘤溶解綜合征AnotherStudy-WilliamsJVIM2004-52dogs.MedianOverallRemission-486days另外一項研究--WilliamsJVIM2004-52只犬。平均完全緩和時間—486天AutologousBoneMarrowTransplant自體骨髓移植Frimbergeretal.JVIM.2006Autologousbonemarrowtransplantforsupportofhighdosechemotherapychemotherapyattheendofa12week,5drugprotocol高劑量化療12周，應(yīng)用了5種藥物后，只能采取自體骨髓移植28dogs28只犬Alldogs-CR所有犬—抗糖皮質(zhì)激素Medianremissionduration-26.6weeks中數(shù)緩解期—26.6周Medianoverallsurvival-84.1weeks平均總存活天數(shù)---84.1周Lymphoma-PrognosticFactors淋巴瘤－影響預(yù)后的因子Immunophenotype免疫表型-mostimportantprognosticfactor最重要的影響因子TvsBT細胞，還是B細胞Immunhistochemistry免疫組化-CD3positive-TcellsCD3陽性－－T細胞CD79apositive-BcellsCD79a陽性－細胞Lymphoma-PrognosticFactorsStage階段I-IIIbetterresponsetotreatmentthanV1-3階段比4期治療反應(yīng)好Substage亞階段systemicmanifestations-morelikelytofail全身表現(xiàn)的更易失敗Histopathology組織病理學(xué)Highgradevslowgrade程度輕重Hypercalcemia高鈣血癥Gender性別Intactmaledogs-higherriskofdeath.Possibleroleoftestosteroneonchemosensitivity未去勢的死亡的危險性高?？赡苁遣G酮對化療敏感性的影響Prolongedsteroidpretreatment延長的類固醇預(yù)處理P-glycoproteinexpressionP-糖蛋白的表達Cranialmediastinallymphadenomegaly縱膈前側(cè)淋巴結(jié)病Anatomiclocation解剖學(xué)位置Lymphoma-PrognosticFactorsBreed-Boxers-品種—拳獅Lurieetal-VCO.Sept.2004TissuesectionsfromBoxerswerestainedforTandBlymphocytedistinction(50)對拳獅拳的組織切片進行T細胞和B細胞的鑒別染色FrequencyofTcelllymphomainboxers-82%T細胞的出現(xiàn)頻率占82％significantlyhigherthan明顯高于rottweilers-19%(37dogs)洛特維勒牧犬-19％（37只犬）goldenretrievers-50%(22dogs)金毛尋回獵犬-50%（22只犬）HypercalcemiaofMalignancy惡性腫瘤的高鈣血癥Themostcommonmetabolicemergencyinoncology腫瘤學(xué)上，最常見到代謝的急性紊亂Clinicalsigns臨床癥狀-PU/PD,vomiting,hyposthenuria,dehydration多飲多尿，嘔吐，低滲尿，脫水Interpretcalciuminrelationtoserumalbumin(ifitistotalCa)根據(jù)血清白蛋白計算鈣（如果是總鈣）Ca2+(mg/dl)-albumin(g/dl)+3.5(canine)EmergencyTreatmentforHypercalcemia高鈣血癥的緊急治療Basicgoals基本目的-Correctdehydration糾正脫水-NaCl-2-3Xmaintenance維持量的2-3倍NaClEnhancerenalexcretionofcalcium增加腎臟鈣的排泄-NaCl,Furosemide呋塞米,Glucocorticoids糖皮質(zhì)激素Inhibitacceleratedboneresorption限制加速的骨吸收-calcitonin降血鈣素,bisphosphonates二膦酸鹽Treatunderlyingdisorder治療根本疾病AcuteTumorLysisSyndrome急性腫瘤溶解綜合征Aconditionofacutecollapsethatmayleadtodeathsoonaftertheadministrationofachemotherapeuticagenttoananimalwithachemosensitivetumor.一種急性虛脫，把化療藥物投服給化學(xué)敏感的腫瘤病例后，引起的急性死亡Humans人-lymphoma,leukemia,smallcelllungcancer淋巴瘤，白血病，小細胞性肺癌.Dog犬-lymphomaandleukemia淋巴瘤和白血病.AcuteTumorLysisSyndrome急性腫瘤溶解綜合征Rapidtumorlysismaycauseanacutereleaseofintracellularphosphateandpotassium.Thisreleasecauseshypocalcemia,hyperkalemia,andhyperphosphatemia.Inhumans-hyperuricemiaisalsoseen.迅速的腫瘤溶解會引起細胞內(nèi)磷和鉀的釋放。這種釋放會導(dǎo)致低鈣血癥，高鉀血癥和高磷血癥。在人，還可見高尿酸血癥AcuteTumorLysisSyndrome急性腫瘤溶解綜合征History病史-acutepensation急性呼吸困難,anorexia食欲缺乏,andcollapseafterchemotherapy化療后虛弱Clinicalsigns臨床癥狀-palemm,decreasedCRT,evidenceofdecreasedcardiacoutput,arrhythmias,vomiting,diarrhea,andevidenceoflysisoftumor粘膜蒼白，心率、呼吸、脈搏減弱，心輸出量減少，心律不齊，嘔吐，腹瀉和腫瘤溶解Diagnostics診斷-evidenceofmulti-organfailure,metabolicacidosis,hyperkalemia,hypophosphatemia,andazotemia.多器官衰竭，代謝性酸中毒，高血鉀，低磷血癥和氮血癥AcuteTumorLysisSyndrome急性腫瘤溶解綜合征Therapy治療-preventionisessential.Restoretissueperfusionwithfluidsandstabilizecardiovascularsystem.Correctacid-basebalance,electrolyteimbalances,andazotemia.預(yù)防很重要。用液體恢復(fù)組織灌流，穩(wěn)定心血管系統(tǒng)。糾正酸堿平衡，電解質(zhì)平衡和氮血癥Babushka(Cont.)BabushkawastreatedwiththeDavisprotocolfromSept.02toFeb.03.在9月2號到2月3號用戴維斯方法治療BabushkaAtthatpointshepresentedforchemotherapy-notfeelingwell.一開始用化療－感覺不好Diagnosticplan??診斷計劃？？Babushka(Cont.)Ca++Significantlyelevated明顯增加Creatinine肌酐Thoracicradiographs胸部放射照片Babushka(Cont.)Babushka(Cont.)Treatmentwasinitiatedwith

ElsparL-天冬酰胺酶CCNU(Lomustine)環(huán)己亞硝脲Prednisone用左旋門冬酰胺酶，氯乙環(huán)己亞硝脲和潑尼松開始治療Potentialcomplications??潛在的并發(fā)癥？？？Babushka(Cont.)AfewminutesaftershereceivedtheElsparshecollapsedinthereceptionarea接受左旋門冬酰胺酶幾分鐘后，迅速虛弱AreactiontotheElspar對左旋門冬酰胺酶的反應(yīng)ShewastreatedwithfluidsandO2andrecoveredquickly用液體和氧氣治療后，迅速恢復(fù)ShewassenthomewithCCNUandprednisone給了些氯乙環(huán)己亞硝脲和潑尼松后帶回家ChemotherapyInducedAnaphylaxisandHypersensitivity化療導(dǎo)致過敏反應(yīng)和超敏反應(yīng)Anaphylaxisorananaphylaxis-likereactioncanoccurwithanydrug-mostcommon-Elspar.Duetoenzymeimmunogenicity.UsuallycausedbyIgE-mediatedmastcelldegranulation.Theexactmechanismisnotknown.AnaphylaxisusuallyoccurswithinsecondstominutesafteradministrationofElspar.過敏和過敏樣反應(yīng)可見于使用任何藥物-左旋門冬酰胺酶最常見。由于酶的免疫原性，通常引起IgE介導(dǎo)的肥大細胞脫顆粒。確切的機制不明。過敏反應(yīng)通常發(fā)生在左旋門冬酰胺酶投服后的幾秒到幾分鐘內(nèi)。ChemotherapyInducedAnaphylaxisandHypersensitivity化療導(dǎo)致過敏反應(yīng)和超敏反應(yīng)Hypersensitivityreactionscanoccurwithanydrug-mostcommonly-doxorubicin-itisbelievedtoberelatedtomastcelldegranulation.Also-taxolandetoposide-duetothecarriers.超敏反應(yīng)也可見于使用任何藥物－最常見于阿霉素－認為與肥大細胞脫顆粒有關(guān)。也可見于紫杉酚和依托撲沙－由于載體Predisposingfactors-Elspar-duetopriorexposuretothedrug.Therouteofadministrationmaybeacontributingfactor.患病因素--左旋門冬酰胺酶—由于先前接觸藥物。給藥途徑或許是因素之一ChemotherapyInducedAnaphylaxisandHypersensitivity化療導(dǎo)致過敏反應(yīng)和超敏反應(yīng)History病史-acutepensationandcollapsesoonaftertheadministrationofachemotherapeuticagent.化療藥物給藥不久，出現(xiàn)急性的呼吸困難和虛弱Clinicalsigns臨床癥狀-paleorcyanoticmm,decreasedCRT,evidenceofdecreasedcardiacoutput,alterationsinHRandcoolextremities.粘膜蒼白或發(fā)紺，CRT減弱，心輸出量減少，心律變化和四肢厥冷Diagnostics診斷-eliminateothercauses(CBC,C/S,U/A,cardiacevaluation).排出其他原因（CBC,C/S，尿液分析，心臟評估）ChemotherapyInducedAnaphylaxisandHypersensitivity化療導(dǎo)致過敏反應(yīng)和超敏反應(yīng)Therapy治療-.1.Eliminatetheunderlyingcause.排除潛在原因2.

Ensureapatentairwayandadequatecardiacoutput.確保氣道通暢和足夠的心輸出3.Establishvascularaccess建立血管通路.4.

Initiatefluidtherapy.液體療法5.

Treatwithdex,diphenhydramineandepinephrineifneeded.如果需要，用地塞米松，苯海拉明和腎上腺素治療Babushka(Cont.)Aweeklatershewasnotfeelingwell. 1周后，它感覺不適Shedidnotwanttogetup,appearedlameanddidnotwanttoeat.

它不愿意起床，跛行，不愿飲食Differentials???鑒別診斷Babushka(Cont.)Differentials-鑒別診斷Noresponsetotreatment對治療無反應(yīng)(stilloutofremission仍然沒有緩和)Sepsisduetotreatmentwithchemotherapy由于化療引起的膿毒癥CNSinvolvement中樞神經(jīng)系統(tǒng)受累Other其他Diagnosticplan(inhercase)診斷計劃Thoracicradiographs胸部放射照片Ca++CBCBabushka(Cont.)Results-結(jié)果CBC-WNL（withinnormallimits）正常Ca++-WNLTherefore-shehadmostlikelyrespondedtotreatment

因此，最可能是對治療的反應(yīng)Physicalexam-abscessonherleg 全身檢查－腿部有膿腫

Theabscesswastreated-shecontinuedtreatmentwithCCNUandprednisone治療膿腫－繼續(xù)以氯乙環(huán)己亞硝脲和潑尼松治療NeutropeniaandSepsis中性粒細胞減少癥和膿毒癥History病史-acutepensation,anorexia,andcollapseusually5-7daysafterthereceivingmyelosuppressivechemo.急性呼吸困難，厭食和治療后通常5-7天虛弱ClinicalSigns臨床癥狀-Pyrexia,brick-redmm,tachycardia,rapidCRT(hyperdynamicshock)ORpalemm,decreasedCRT,andevidenceofdecreasedcardiacoutput(hypodynamicshock).發(fā)燒，粘膜呈磚紅色，心動過速，CRT增強（肌肉震顫）或粘膜蒼白，CRT減弱和心輸出量減少（肌肉震顫）Diagnostics診斷-evidenceofneutropenia,multi-organfailure,hypoglycemia,positiveculturesofblood,urine,pulmonaryairways,orothertissuesandmetabolicacidosis.中性粒細胞減少，多器官衰竭，低血糖，血液、尿液、肺泡和其他組織培養(yǎng)陽性，以及代謝性酸中毒NeutropeniaandSepsis中性粒細胞減少癥和膿毒癥Therapy治療-1.Treattheunderlyingcause.治療原發(fā)病2.Restoretissueperfusionwithfluidsandstabilizecardiovascularsystem以液體恢復(fù)組織的灌注，穩(wěn)定心血管系統(tǒng)3.Correctacid-basebalance,electrolyteimbalances,andhypoglycemia糾正酸堿平衡和低血糖4.Initiateparenteralbactericidalantibiotictherapy使用殺菌性抗生素5.Considerhematopoieticgrowthfactorsupport,transfusionsoffreshwholeblood,(granulocytetransfusions)考慮補充造血因子和輸新鮮的全血（粒細胞成分輸血）Neu