postoperative fever
Introduction
Introduction Fever is the most common symptom after surgery. About 72% of patients have a body temperature above 37 °C and 41% above 38 °C. Postoperative fever generally does not necessarily indicate a concomitant infection. Non-infectious fever is usually earlier than infectious fever (average of 1.4 and 2.7 days after surgery, respectively).
Cause
Cause
The main causes of non-infectious fever: long operation time (> 2 hours), extensive tissue damage, intraoperative blood transfusion, drug allergy, liver poisoning caused by anesthetic (halothane or enflurane).
Risk factors for infectious fever include weakness, advanced age, poor nutritional status, diabetes, smoking, obesity, use of immunosuppressive drugs, or pre-existing infectious lesions. Surgical factors include hemostasis, residual dead space, and tissue trauma. The neglect of the proposed preventive antibiotic is also one of the factors.
Infectious fever In addition to wounds and other deep tissue infections, other common causes of fever include pulmonary insufficiency, pneumonia, urinary tract infections, chemical or non-chemical phlebitis.
Examine
an examination
Related inspection
Basal metabolic regression thermocoil (BR)
High fever (>39 °C) occurred in the first 24 hours after surgery. If the transfusion reaction can be ruled out, consider streptococcal or Clostridium infection, inhalation pneumonia, or an existing infection. There is often a cold feeling or even a chill. At this time, the body temperature has risen, and the skin small blood vessels contract to cause the skin temperature to be low, which stimulates the skin's cold sensory receptor and causes a cold feeling.
Diagnosis
Differential diagnosis
Infectious fever has the following characteristics:
1. Onset of illness with or without chills.
2, systemic and localized symptoms and signs.
3. Blood: The white blood cell count is higher than 1.2x109/L or lower than 0.5109/L.
4, tetrazolium blue test (NBT): such as neutrophil reduction NBT more than 20%, suggesting bacterial infection, help with the identification of viral infection and non-infectious fever (normal value <10%) application of hormones It can be false negative afterwards.
5, C-reactive protein determination (CRP): positive suggestive of bacterial infections and rheumatic fever, negative mostly viral infection.
6, neutrophil alkaline phosphatase score increased: normal value is 0 ~ 37, the higher the higher the higher the more favorable for the diagnosis of bacterial infection, when the exclusion of pregnancy cancer, malignant lymphoma more meaningful. It can be raised or false positive after application of hormones.
Non-infectious fever has the following characteristics:
1. The heat course is longer than 2 months, and the longer the heat stroke, the greater the possibility.
2, long-term fever is generally good, no obvious symptoms of poisoning.
3, anemia, painless multi-site lymphadenopathy, hepatosplenomegaly caused by central fever, cerebrovascular disease, brain trauma and brain surgery are more common, also seen in brain tumors, epilepsy, alcohol withdrawal And acute high intracranial pressure and so on. In addition, some scholars have classified malignant hyperthermia and neuroleptic malignant syndrome as thermoregulatory disorders.
Cancerous fever refers to cancer-related non-infectious fever that occurs in cancer patients with exclusion of infection and antibiotic treatment, and fever caused by treatment during tumor development.
High fever (>39 °C) occurred in the first 24 hours after surgery. If the transfusion reaction can be ruled out, consider streptococcal or Clostridium infection, inhalation pneumonia, or an existing infection.
