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臨床情境 一名 B 細胞前驅急性淋巴性白血病成人在持續輸注 blinatumomab 18 小時後出現發燒、低血壓、低血氧、意識混亂、找字困難與顫抖，疑似同時發生細胞激素釋放症候群與神經毒性。 審查趨勢並選擇最佳解釋和下一步計畫。

Trend

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Time	Data
Recognition	Temperature 39.3 C; BP 82/48 mm Hg; oxygen saturation 89%; confused with naming difficulty and tremor體溫 39.3 C；血壓 82/48 mm Hg；血氧飽和度 89%；意識混亂，有命名困難和顫抖
After interruption and authorized treatment	Temperature 37.8 C; BP 104/66 mm Hg; oxygen saturation 95% with low-flow oxygen; follows one-step commands體溫 37.8 C；血壓 104/66 mm Hg；低流量氧氣下血氧飽和度 95%；能遵循一步指令
Current reassessment	Afebrile and BP 112/70 mm Hg; persistent word-finding difficulty and worsening hand tremor無發燒，血壓 112/70 mm Hg；持續有詞語尋找困難和手部顫抖惡化

Q1. How should the trend be interpreted?應如何解釋此趨勢？

All medication toxicity has resolved所有藥物毒性均已解決 Systemic findings are improving but neurologic toxicity remains active全身性發現正在改善，但神經學毒性仍活躍 Only central-line irritation remains僅剩中心靜脈導管刺激

Q2. Which next plan is appropriate?哪個下一步計畫是適當的？

Keep blinatumomab interrupted and continue urgent neurologic evaluation and serial assessment保持 blinatumomab 中斷，並繼續緊急神經學評估和系列評估 Restart the infusion independently because the fever resolved因為發燒已解決，獨立重新開始輸注 Stop neurologic assessments and discharge immediately停止神經學評估並立即出院

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