The Asplenic Patient - What it Means For the Emergency Physician
无脾病人——对急诊医生意味着什么
Author 作者：EMedHome.com
翻译 ：于璐 何磊磊 校对： 陈都 肖锋
The asplenic patient population includes patients with surgical asplenia, congenital asplenia, and functional asplenia (as found in patients, for example, with sickle cell anemia, severe celiac disease, and untreated HIV infection).
无脾病人包括脾切除后患者、先天性无脾、和功能无脾(如病人患有镰状细胞性贫血，严重的腹腔疾病和未经治疗的艾滋病毒感染)。
Asplenic patients are at risk for episodes of rapidly progressive septicemia that are fatal in up to 50% of cases (1). Most commonly caused by Streptococcus pneumoniae, such episodes often have a sudden onset and a fulminant course.

无脾患者有迅速发展为脓毒症的风险, 50%的案例显示这都是致命的。最常见的是由肺炎链球菌引起的, 这些事件往往突然发作和病程险恶。


Postsplenectomy sepsis should be suspected in an asplenic patient presenting with severe illness or a febrile illness of any severity.
如一个无脾病人出现严重疾病或无论严重程度如何但发热，就要考虑有脾切除后脓毒症的可能。
If fever develops in an asplenic patient, immediate administration of empirical antimicrobial therapy is indicated, because fever can be the initial manifestation of a fulminant infection and prompt administration of an antibiotic may prevent the development of clinical sepsis (1).
如果无脾脏病人出现发烧，应立即根据经验给予抗菌治疗，因为发烧是暴发性感染的最初表现，及时抗生素治疗可以防止进一步发展成临床脓毒症。
Ceftriaxone administered IV or IM with or without vancomycin is a reasonable empirical choice. Outpatient management can be considered for the stable, non-toxic patient if follow-up is ensured and the patient can return promptly if the condition worsens.
头孢曲松静脉或肌肉注射单用或与万古霉素合用是一种合理的经验选择。如果病人稳定，没有严重毒性反应，只要有可靠的随诊，可以考虑门诊治疗。如病情恶化，病人可以立即返回治疗。
Asplenic persons who sustain a dog bite should receive a prophylactic antibiotic (e.g., penicillin). This may help prevent fulminant sepsis caused by C. canimorsus.
被狗咬过的无脾病人应该接受预防性抗生素(如青霉素)。这可能有助于防止由犬咬二氧化碳嗜纤维菌引起的暴发性脓毒症。
Of note, prophylactic antimicrobial therapy, typically oral penicillin given twice daily, is generally recommended for asplenic children < 5 years of age and may be considered for older patients during the initial 1 - 2 years after splenectomy, with lifelong prophylaxis for persons who have had an episode of postsplenectomy sepsis.
值得注意的是，对于< 5岁的无脾脏孩子，一般建议预防性抗菌，如青霉素每天两次口服。对脾切除术后1 - 2年的年龄稍大患者也要考虑。如病人有过一次脾切除后脓毒症，需要终生服用预防性抗生素。
References 参考文献：
Rubin LG, et al. N Engl J Med 2014; 371:349-356.

Long SS, et al, eds. Principles and practice of pediatric infectious diseases. 4th ed. Edinburgh: Elsevier Saunders, 2012:880-1.