癌症病人嗜中性白血球低下臨床照護指引第三版

Clinical Practice Guideline on Neutropenia in Cancer Patients Third Edition

洪敏瑛(Ming-Ying Hong) ； 邱文姿(Wen-Tzu Chiu) ； 戴仕卿(Shih-Ching Tai) ； 陳淑娟(Shu-Chuan Chen) ； 蕭逸美(Ye-Mei Hsiao) ； 楊琇玲(Hsiu-Ling Yang)

《腫瘤護理雜誌》 22卷增訂刊 (2022/10) Pp. 59-91

https://doi.org/10.6880/TJON.202210/SP_22.02

摘要

嗜中性白血球低下是腫瘤病人接受抗癌相關治療後常見的合併症，將會增加病人感染風險與死亡率，更加重醫療成本負擔。繼2011年台灣腫瘤護理學會制定本土「癌症病人嗜中性白血球低下臨床照護指引」後已超過10年，鑑於多年來臨床醫學研究發展，醫療照護知識進步與更新，本指引小組體認再度編修之重要性。制定小組依據各國相關文獻與指引，將嗜中性白血球低下之感染性風險分為三個等級（低危險性、中／高危險性、極高危險性），照護內容依據感染風險等級分為預防性照護和住院醫療與護理照護。在醫療照護上，除預防性藥物外，還有住院醫療處置；在護理照護原則有六大項，包含標準防護的手部衛生和防護裝備、照護環境、會客、飲食、個人衛生、居家寵物照護等原則；對於極高風險的造血幹細胞移植病人之護理照護標準相較於一般腫瘤病人有較高的照護規範。除此之外，因新冠肺炎肆虐，持續性照護評估新增腫瘤病人接受疫苗之相關注意事項，以提供臨床照護方向與提升護理品質，並使病人獲得完善照護環境。

關鍵字

癌症 ； 抗癌治療 ； 嗜中性白血球低下 ； 感染 ； 指引

並列摘要

Neutropenia, an unusually low level of white blood cells, is a common complication in oncology patients after receiving anti-cancer therapy. It increases the risk of infection and mortality, which inevitably burdens the medical resources. It's been more than ten years since the Taiwan Oncology Nursing Society published the ＂Clinical Practice Guideline on Neutropenia in Cancer Patient Care＂ in 2011. The revision of this guideline is warranted and deemed important in order to remain updated on the clinical medical research and the advances in the medical development. The levels of infection risks are classified into three areas (low, medium, and high risks) based on the literature and national guidelines. Accordingly, preventive care, inpatient treatment, and nursing interventions have been developed for each level. The inpatient treatments include not only the preventive medications but also inpatient care. The nursing interventions follow six principles to address the hand hygiene, standard protective equipment, the care environment, visitor rules, dietary guidelines , personal hygiene, and precautions regarding home pets. The standard care for high-risk hematopoietic stem cell transplant patients carries stricter clinical demands than that for the general oncology patients. Furthermore, the newly revised guideline also provides new information for the COVID-19 vaccination issues in the oncology patient. We anticipate this guideline will improve the quality of care and clinical practice for nurses who work with cancer patients.

並列關鍵字

cancer ； anti-cancer therapy ； neutropenia ； infection ； guideline

參考文獻

衛生福利部疾病管制署（2018，11版）。各項預防接種間隔時間一覽表。取自https://www.cdc.gov.tw/Category/List/IpWZqtnmkJfQPfgnaP4lnw，引用2021/01/18。

Recommendations of CDC tIDSoA, the American Society of Blood and Marrow Transplantation. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. MMWR Recomm Rep. 2000;49(Rr-10):1-125, ce121-127.

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