摘要
目的探讨药物诱导的中毒性表皮坏死松解症的临床特点与临床治疗。方法对40例住院患者的临床资料进行回顾性分析。结果致敏药物中解热镇痛药18例(45%),抗生素类(以青霉素类为主)12例(30%),抗癫痫药6例(15%)。发热37例(92.5%),血常规异常24例(60%),肝功能异常18例(47.4%)。入院后糖皮质激素的平均初始量为地塞米松(DXM)(0.24±0.10)mg/(kg·d),最高剂量为(0.29±0.11)mg/(kg·d)。痊愈38例(95%)。全身皮肤水疱、糜烂基本吸收干燥时间(7.5±3.5)d,黏膜基本愈合时间(11.5±5.7)d,其中儿童组和成人组分别为(5.8±2.4)d、(9.1±3.6)d(P<0.01)和(10.3±5.7)d、(17.2±8.2)d(P<0.01)。6例(15%)发生并发症,分别为败血症、肺部感染、上呼吸道感染、中毒性心肌炎、类固醇性糖尿病、荨麻疹型药疹。结论解热镇痛药、青霉素类及抗癫痫药是引起中毒性表皮坏死松解症主要的药物。大剂量激素、支持治疗、抗感染、对症治疗及皮肤黏膜护理等综合疗法对于本病痊愈具有重要的作用。与成人相比,儿童的皮肤、黏膜损害愈合较快。
Objective To explore the clinical features and appropriate therapies of drug-induced toxic epidermal necrolysis/Stevens-Johnson syndrome （TEN/SJS）. Methods We reviewed clinical data of 40 hospitalized patients with drug-induced TEN/SJS between 1994 and 2003. Results The common causative drugs were anti-inflammatory drugs （45%）, antibiotics （30%）, and antiepileptics （15%）. Fever （92. 5% ）, blood system involvement （60%）and liver involvement （47.4%） were often seen. The mean initial dose of and the mean highest dose of corticosteroid were 0.24 ±0.10 mg/（ kg · d） and 0.29 ±0. 11 mg/（ kg· d） dexamethasone respectively. The cure rate was 95%. The mean cure time of skin lesions and mucosa lesions were 7.5 d ± 3.5 d and 11.5 d ±5.7 d respectively. The recovery times in children （5.8 d ±2. 4 d; 10. 3 d±5.7 d） were shorter than those in adults （9.1 d ±3.6 d; 17.2 d±8.2 d）. Six patients （ 15% ） were complicated with septics, infection of lung and upper respiratory tract, toxic myocarditis, diabetes, and urticaria. Conclusion The anti-inflammatory drugs, antibiotics, and antiepileptics are common drugs leading to TEN/SJS. The comprehensive therapeutics including high dose of corticosteroid, supportive treatment, effective antibiotics, timely management of complications, and adequate nursing care of skin and membrane are of utmost importance in TEN/SJS. Children often recover faster than adults.
出处
《安徽医科大学学报》
CAS
北大核心
2005年第6期570-571,共2页
Acta Universitatis Medicinalis Anhui
