儿童中毒性表皮坏死松解症15例临床分析

发布时间：2018-01-07 08:06

本文关键词：儿童中毒性表皮坏死松解症15例临床分析　出处：《中国皮肤性病学杂志》2015年05期 　论文类型：期刊论文

【摘要】：目的探讨儿童中毒性表皮坏死松解症(TEN)的临床特点,包括致病因素、临床表现、治疗措施及预后。方法对15例儿童TEN患儿的临床资料进行回顾性分析。结果引起儿童TEN的常见致敏药物依次为抗惊厥药、解热镇痛药和β-内酰胺酶抗生素。潜伏期平均(9.07±9.88)d,表皮剥脱面积平均(80.03±15.30)%,黏膜损害率为100.00%;内脏受累依次为心肌、肺脏、肝脏、肾脏、甲状腺和胰腺,3例患儿发生败血症。均予甲强龙联合丙种球蛋白治疗,同时予支持疗法及创面护理,病程9~27d,平均17.53d,痊愈11例,好转4例。结论药物是儿童TEN发病最主要的原因,及时停用可疑致敏药物,早期大剂量糖皮质激素联合丙球冲击治疗对于儿童TEN疗效较好,支持疗法、预防和控制感染、保护重要脏器功能以及联合多学科会诊对患儿预后非常重要。
[Abstract]:Objective to investigate the clinical features of toxic epidermal necrolysis (TEN) in children, including the pathogenic factors and clinical manifestations. Methods the clinical data of 15 children with TEN were retrospectively analyzed. Results the common sensitizers for TEN in children were anticonvulsants. Antipyretic analgesics and 尾 -lactamase antibiotics. The average incubation period was 9.07 卤9.88 days, and the average area of epidermal exfoliation was 80.03 卤15.30%. The mucosal damage rate was 100.00g. The visceral involvement followed by myocardial, lung, liver, kidney, thyroid and pancreatic lesions occurred in 3 children with septicemia. All of them were treated with methylprednisolone combined with gamma globulin, as well as supportive therapy and wound care. The course of disease was 927 days (average 17.53 days), 11 cases were cured and 4 cases were improved. Conclusion drugs are the main cause of TEN in children, and stop suspicious allergens in time. Early high-dose glucocorticoid combined with propofol impact therapy is effective in children with TEN. Supportive therapy, prevention and control of infection, protection of important organ function and combined multidisciplinary consultation are very important for the prognosis of children.
【作者单位】：首都医科大学附属北京儿童医院皮肤科;
【基金】：2013年北京市优秀人才培养A类项目(2013A003034000013)
【分类号】：R758.25
【正文快照】： 中毒性表皮坏死松解症(toxic epidermal necrolysis,TEN)是皮肤科危重症疾病,以体表、腔道和脏器上皮细胞凋亡坏死,发生皮肤/黏膜大面积剥脱为特点,可发生于各种年龄,致死率高达30%~40%[1]。80%~95%的TEN由药物致敏引发,因此将其归于重症药疹[2]。据统计,世界范围内TEN的年发

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