重症寻常型天疱疮合并急性肺栓塞抢救成功1例  

A Case of Successful Rescue of Severe Pemphigus Vulgaris Complicated with Acute Pulmonary Embolism

作　　者：毛子慧 李昕[1] 张江安[1] 于建斌[1] 张娜[1] 陈莹莹[1] 程灵云 

机构地区：[1]郑州大学第一附属医院皮肤科,河南郑州450052

出　　处：《中国医学文摘（皮肤科学）》2017年第3期351-354,共4页China Medical Abstracts(Dermatology)

摘　　要：患者女,57岁。口腔及全身反复多发大疱、糜烂3年,加重3周。3年来,患者先后于外院及本院就诊,均诊断为"寻常型天疱疮",给予激素、雷公藤、霉酚酸酯等治疗,病情渐得到控制,多数皮损痊愈。3周前患者自行停药,皮损复发、加重;4d前,跌倒致右桡骨骨折。入院查体:精神欠佳,血压160/90 mmHg,体温、脉搏、呼吸正常。全身浮肿,头面、口腔、躯干及四肢泛发大小不等红斑、松弛性大疱,部分破溃,可见明显渗出。入院第3天,患者入厕后突发胸闷、呼吸困难及躁动不安等,心电监护示窦性心律,心率120次/min,BP 70/40 mmHg,血氧饱和度80%,随后意识丧失,颈动脉脉搏消失,心肺复苏成功后转呼吸ICU治疗。肺动脉造影示:双侧多发肺动脉栓塞,经溶栓等综合治疗后病情好转出院。现患者仍在随访中。A 57 year-old female was present with refractory bullae and erosions of the skin and mouth for three years,and the lesions aggravated for three weeks. After diagnosed aspemphigus vulgaris she was given corticosteroids,mycophenolate mofetil and tripterygium for almost three years,the lesions obviously improved and subsidised. Three weeks ago the lesions relapsed and aggravated because of drug withdrawal by herself.Four days ago she got the fracture of right radius after falling down. Physical examination showed a sick condition,but her blood pressure,body temperature,pulse and respiration were all within normal range. She had widespread bullae,erosions,effusions and edema. During the third days of hospitalization,the patient got chest pain,dyspnea and restlessness suddenly after going to the toilet. ECG monitoring showed ECG sinus rhythm,heart rate 120 beats/min,blood pressure 70/40 mm Hg and blood oxygen saturation 80%. Following she got loss of consciousness and carotid artery pulse. The patient got a successful cardiopulmonary resuscitation immediately and transferred to Respiratory ICU. Pulmonary angiography showed bilateral multiple pulmonary embolism. Finally she was successfully treated with thrombolytic therapy and other comprehensive treatments. Now the patient was followed up outside the hospital.

关 键 词：天疱疮 寻常型 急性肺栓塞 

分 类 号：R758.66[医药卫生—皮肤病学与性病学] R751.05[医药卫生—临床医学]