21例中毒性表皮坏死松解型药疹的临床分析  

Clinical Retrospective Study on 21 Patients with Toxic Epidermal Necrolysis

作　　者：毛笑非[1] 李峰[1] 晋红中[1] MAO Xiao-Fei;LI Feng;JIN Hong-Zhong(Peking Union Medical College Hospital, Beijing 100730, China)

机构地区：[1]中国医学科学院北京协和医院皮肤科,北京100730

出　　处：《生物技术通讯》2017年第5期657-660,693,共5页Letters in Biotechnology

摘　　要：目的:总结北京协和医院皮肤科收治的中毒性表皮坏死松解型药疹(TEN)患者的临床信息,探讨诊治经验,为今后更高效的重症药疹的诊断、治疗、护理提供参考依据。方法:收集2010年1月至2016年7月收治的共21例TEN患者的临床资料并进行回顾性研究,包括一般信息、发病、临床表现、治疗用药、护理方式、住院时间等数据的统计学分析。结果:21例患者中,男性10例,女性11例,性别比例1∶1.1;治愈率95.2%,死亡率4.8%,平均住院日13.8d。2例患者(9.5%)由于口服别嘌呤醇发病,6例(28.6%)系因口服抗癫痫药物发病,5例(23.8%)因口服非甾体类解热镇痛药物发病,4例(19.0%)因系统使用抗生素发病。皮损首发部位多位于头面部及口腔、眼部黏膜,平均皮肤受累面积为40%。21例患者(100%)采用糖皮质激素系统治疗,19例(90.5%)患者入院后使用静脉丙种球蛋白治疗。16例(76.2%)患者使用系统抗生素治疗。14例患者(66.7%)采用溃疡油纱封包治疗法,7例患者(33.3%)采用凡士林油纱封包治疗法。结论:抗癫痫药、抗生素、非甾体解热镇痛药物仍是引发TEN的最常见致敏药物。早期规范化治疗是保障疗效、降低死亡率、缩短住院时间的关键。护理方案的改进有助于患者提高生活质量。Objective:To summarize the experience of the treatment and nursing by exploring the clinical feature,involved drugs and factors relating to curative effect in patients with toxic epidermal necrolysis(TEN).Meth-ods:Clinical data from21cases of TEN patients were recorded and statistically analyzed,including age,sex,clini-cal manifestation,the descriptions of skin lesions,treatment,nursing and the length of hospital stay.Results:There were10male patients and11female patients with a male to female ratio of1∶1.1,cure rate reached95.2%,and mortality4.8%.Average hospitalization was13.8d.The cuasing of disease covered taking allopurinolorally(9.5%),taking anti-epileptic drugs(26.8%),non-steroidal anti-inflammatory drugs(23.8%),and antibioticssystematic administration(19.0%).Most lesions originally occurred in face and head,especially in eye and mouth.Mean surface area of epidermolysis reached40%body surface area.All these patients were treated with corticosteroids,companied with intravenous immunoglobulin(90.5%),systemic antibiotics(76.2%),ulcer oil gauze therapy(66.7%),and vaseline gauze(33.3%)therapy.Conclusion:Allopurinol,anti-epileptic drugs antibiotics and nonsteroidal antiinflammatory drugs had high possibility of leading to TEN.The curative effect may be better after early and sufficiently using corticosteroids and IVIg.Better nursing can improve the quality of life of patients.

关 键 词：药疹 中毒性表皮坏死松解症 回顾性研究 

分 类 号：R758.25[医药卫生—皮肤病学与性病学]