探讨恶性肿瘤化疗患者出现中性粒细胞缺乏症的有效治疗方案以及并发感染的预防与治疗。

收集江苏大学附属武进医院肿瘤内科2015年12月31日至2017年9月30日收治的25例化疗后出现中性粒细胞缺乏症恶性肿瘤患者资料，其中男性15例，女性10例；年龄39 ～ 72岁[(58.64±10.57)岁]。对其临床资料、合并细菌感染情况、治疗方案(升白细胞治疗、抗生素应用)以及疗效转归等进行回顾性病历分析。

主要临床表现为发热[64.0%(16/25)，其中发热性中性粒细胞缺乏症(FN)10例(40.0%)]、乏力[68.0%(17/25)]、腹泻[16.0%(4/25)]和咳嗽咳痰[8.0%(2/25)]。经治疗，12例(75.0%)伴有FN患者在治疗2～5 d后体温降至正常范围；12例(70.6%)患者乏力症状缓解；3例(75.0%)腹泻患者治愈，1例(25.0%)好转。21例(84.0%)患者在应用重组人粒细胞集落刺激因子(rhG-CSF)3～8 d后，中性粒细胞数回升至正常水平；3例(12.0%)患者在8～12 d后，中性粒细胞数升至正常水平。痰培养送检率为8%(2/25)，阳性率为4%(1/25)。血培养送检率为40%(10/25)，阳性率为8%(2/25)。17例(68.0%)患者接受了抗生素预防感染，其中6例(24.0%)接受了二联抗生素治疗。3例(12.0%)患者死亡(死因分别为感染性休克自动出院后死亡、急性心肌梗死和心包填塞)。

重组人粒细胞集落刺激因子治疗中性粒细胞缺乏症疗效确切，对于FN患者，应及时经验性使用抗菌药物，在确诊病原菌后，迅速调整抗菌药物，从而降低细菌感染所致的严重并发症和病死率。

To investigate the effective treatment of neutropenia in patients with malignant tumor chemotherapy and the prevention and treatment of concurrent infection.

A total of 25 patients with neutropenia after chemotherapy were enrolled in the Department of Oncology, Wujin Hospital Affiliated to Jiangsu University from December 31, 2015 to September 30, 2017. There were 15 males and 10 females, aged from 39 to 72 years old with a mean age of (58.64 ± 10.57) years. The clinical data, combined bacterial infections, treatment programs (treatment for increase the leukocyte, use of antibiotics), and outcome were retrospectively analyzed.

The main clinical manifestation was fever (64.0%, 16/25), of which 10 (40.0%) were febrile neutropenia (FN), fatigue [68.0% (17/25)], diarrhea [16.0% (4/25)] and cough and sputum [8.0% (2/25)]. The temperature of 12 (75.0%) patients with febrile neutropenia returned to the normal range after 2-5 days of treatment. After treatment, 12 (70.6%) patients had remission of fatigue; 3 (75.0%) cases of diarrhea were cured, 1 (25.0%) cases improved. Neutrophils recovered to normal levels in 21 (84.0%) patients with neutropenia after 3 to 8 days of recombinant human granulocyte colony-stimulating factor (rhG-CSF) administration, and the neutrophils of 3 (12.0% ) cases returned to normal level after using rhG-CSF 8 to 12 days. The rate of sputum culture was 8% (2/25), the positive rate was 4% (1/25). And the rate of blood culture was 40% (10/25), the positive rate was 8% (2/25). A total of 17 (68.0%) patients received antibiotic prophylaxis, of whom 6 (24.0%) received dual antibiotic therapy. 3 (12.0%) patients died (death caused by septic shock, acute myocardial infarction and pericardial tamponade).

rhG-CSF therapy for neutropenia was effective. For patients with febrile neutropenia, antimicrobial agents should be used empirically as soon as possible, and the antibacterial drugs should be rapidly adjusted after the pathogenic bacteria are diagnosed, thus reducing serious complications and mortality caused by bacterial infections.