癌症病人嗜中性白血球低下臨床照護指引

Clinical Practice Guideline on Neutropenia in Cancer Patients

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

《腫瘤護理雜誌》 11卷增訂刊 (2011/12) Pp. 41-60

https://doi.org/10.6880/TJON.201112/SP_11.04

摘要

嗜中性白血球低下是癌症病人接受抗癌相關治療，如化學治療、放射線治療等，常見的骨髓功能被抑制反應，導致免疫力低下，有高風險之感染率與死亡率，臨床護理人員對此須有高度的評估與照護能力。有鑑於國內缺乏本土性之癌症護理照護指引，故本文主要目的為針對嗜中性白血球低下之癌症病人，提供護理人員一套本土的護理照護準則與護理指導方針，內容包含四大部分（一）評估：病史評估、身體評估、檢驗室檢查報告；（二）確認問題：針對感染風險分為低危險性、高危險性與極高危險性三級；（三）處置與照護：包括低危險性病人之預防性門診醫療處置及居家照護、高危險性與極高危險性病人住院醫療處置及護理照護；（四）持續照護。期望藉由本文能增進本土護理人員的專業知能及病人自我照護的處理能力，預防感染發生，減少醫療成本的支出，同時亦提升癌症病人的照護品質。

關鍵字

癌症 ； 化學治療 ； 嗜中性白血球低下 ； 感染 ； 指引

並列摘要

Neutropenia is a common and severe myelosuppressive side effect in patients receiving anti-cancer treatment, such as chemotherapy and radiotherapy. Neutropenia can result in immunecompromised effects, have the risks of infection rate and mortality rates. Nurses must have the abilities to assess the patients and provide nursing care for neutropenia. Clinical practice guideline in oncology nursing are needed in Taiwan. This paper is to provide nurses in Taiwan with the nursing care standards and practice guidelines for the neutropenia patients. There are four major parts: (1) patient assessment including physical assessment and laboratory data, (2) problem identification: three levels including low, high, and extremely high of risk of infection, (3) management and nursing care including the prevention of neutropenia in low risk patients at home care and the treatment of high risk patients at hospital, and the care of exteremely high risk patients, and (4) continued assessment and nursing care. It is expect that this paper can improve the oncology nurses' care competences and patients' self-care management abilities, reduce the infection rate and medical cost in patients with neutropenia, and improve the care quality in oncology nursing units.

並列關鍵字

cancer ； chemotherapy ； neutropenia ； infection ； guideline

參考文獻

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.

van Dalen EC, Mank A, Leclercq E, et al. Low bacterial diet versus control diet to prevent infection in cancer patients treated with chemotherapy causing episodes of neutropenia. Cochrane Database Syst Rev. 2016;4(4):Cd006247.

USFaD A. Safe Food Handling. https://www.fda.gov/food/buy-store-serve-safe-food/safe-food-handling. Published 2017. Accessed February 09, 2021.

Sonbol MB, Jain T, Firwana B, et al. Neutropenic diets to prevent cancer infections: updated systematic review and meta-analysis. BMJ Support Palliat Care. 2019;9(4):425-433.

de Sousa Lima CM, Fujishima MAT, de Paula Lima B, Mastroianni PC, de Sousa FFO, da Silva JO. Microbial contamination in herbal medicines: A serious health hazard to elderly consumers. BMC Complement Med Ther. 2020;20(1):17.