重症药疹32例回顾性分析  

Retrospective analysis of 32 cases of severe drug eruption

作　　者：赵文[1] 郭书萍[1] ZHAO Wen;GUO Shuping(Department of Dermatology,First Hospital of Shanxi Medical University,Taiyuan,Shanxi 030001,China)

机构地区：[1]山西医科大学第一医院皮肤科,山西太原030001

出　　处：《安徽医药》2020年第7期1480-1484,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨重症药疹的发生发展规律、治疗、临床特点和预后。方法回顾分析山西医科大学第一医院皮肤科2014年12月至2018年4月间收治的32例重症药疹(Severe Drug Eruption,SDE)病人相关资料。结果重症多形红斑型药疹是最常见重症药疹类型,共20例(62.50%)。潜伏期最长的重症药疹类型是剥脱性皮炎型药疹,为(22.44±13.97)d。最常见致敏药物为抗癫痫药。发热及黏膜损害发生率最高。激素联合静脉滴注丙种球蛋白治疗重症药疹病人在皮损控制时间(6.38±1.71)d、激素的最大用量(1.06±0.37)mg·kg-1·d-1、皮损控制时激素累积剂量(6.62±3.32)mg/kg、激素总累积剂量(8.40±3.39)mg/kg等方面均较单用激素组低(P<0.05)。结论各型重症药疹临床表现各有不同;且易对黏膜、肝肾等造成伤害,威胁到病人生命,临床医师应该谨慎使用易致敏药物,如卡马西平、中药/中成药、青霉素等;首选治疗方案仍然是静脉滴注糖皮质激素,早期联合丙种球蛋白疗效更佳。Objective To explore the occurrence,development,treatment,clinical characteristics and prognosis of severe drug eruption.MethodsThe clinical data of 32 patients with severe drug eruption admitted to the Department of Dermatology in the First Hospital of Shanxi Medical University from December 2014 to April 2018 were retrospectively analyzed.ResultsSevere erythema multiforme drug eruption is the most common type of severe drug eruption,witha total of 20 cases(62.50%).The type of severe drug eruption with the longest incubation period is exfoliative dermatitis,and its incubation period was(22.44±13.97)d.The most common sensitizing drugs were antiepileptic drugs.The incidence of fever and mucosal damage is the highest.Hormone combined with static point gamma globulin in patients with severe drug eruptionin terms of skin lesion control time(6.38±1.71)d,cumulative dose of hormone during skin lesion control(6.62±3.32)mg/kg,maximum amount of hormone(1.06±0.37)mg·kg-1·d-1,and total cumulative dose of hormone(8.40±3.39)mg/kg are lower than the single-use hormone group(P<0.05)Hormone combined with intravenous infusion of gamma globulin in the treatment of severe drug eruption had lower the skin lesion control time(6.38±1.71)d,the maximum dose of hormone(1.06±0.37)mg/kg 6.62±3.32)mg/kg and total cumulative dose of hormone(8.40±3.39)mg/kg than hormone alone(P<0.05).ConclusionsThe clinical manifestations of various types of severe drug eruptions are different,and it is easy to cause damage to the mucous membrane,liver and kidney,threatening the life of patients.Clinicians should be cautious about using susceptible drugs,such as carbamazepine,traditional Chinese medicine/Chinese patent medicine,penicillin,etc.The preferred treatment option is still intravenous infusion of glucocorticoids,and early combination with gamma globulin is more effective.

关 键 词：药疹 多形红斑 抗惊厥药 丙种球蛋白类 回顾性研究 

分 类 号：R758.25[医药卫生—皮肤病学与性病学]