儿童葡萄球菌性烫伤样皮肤综合症135例临床回顾性研究

发布时间：2019-05-16 16:52

【摘要】： 前言葡萄球菌性烫伤样皮肤综合征(staphylococcal scalded skin syndrome, SSSS),是一种重症感染性皮肤病,起病急骤,以在全身泛发性红斑基础上发生松弛性烫伤样大疱及大片表皮剥脱为特征,好发于儿童,成人罕见。儿童病死率为3-4%。本病起病急,进展迅速广泛,常因不能及早确诊而延误诊治,严重时合并败血症、肺炎等并发症而危及生命。总结本病在儿童中的发病诱因、临床特点、误诊误治原因及治疗经验均非常必要,可为今后的临床工作提供有益的借鉴。实验方法回顾性分析临床确诊的135例SSSS患者的临床资料,应用SPSS17.0 forwindows软件,数据用t检验、x2检验、Kruskal-Wallis H检验及nemenyi法检验等,以a=0.05为检验水准。结果入院前仅有49例患者门诊诊断为SSSS,确诊率36.30%。疾病初期以误诊为“过敏性疾病”并行脱敏对症治疗的患者居多。 30例(14.8%)患者伴有不同程度体重低下。有33.3%的患者存在总蛋白降低,1.5%的患者存在白蛋白降低,65.9%的患者存在前白蛋白降低。检测了114例患者的血清免疫球蛋白水平,37.7%IGA水平和17.5%IGG水平降低,IgM水平降低不明显。对所有患儿的血清肌酐(SCr)和血清尿素氮(BUN)数据统计分析发现,有50例(37.0%)患者的尿素氮和103例(76.3%)患者的血清肌酐水平呈轻度降低。比较不同治疗组间住院天数的差异,结果显示：头孢组与大环内酯类组的住院天数有显著性差异,P0.005；头孢组与头孢+丙球组,头孢+丙球组与大环内酯类组之间,住院天数无明显差异。丙球+头孢组与头孢组比较结果：①丙球组患者体温峰值较头孢组更高,体温恢复、疼痛缓解需时更长,病情相对较严重；②丙球组与头孢组在病情好转时间、住院天数、最终疗效方面无差异。结论 1、体液免疫低下、低体重、营养不良可能是儿童易患SSSS的原因； 2、在SSSS治疗中头孢组优于大环内酯类组,住院时间明显缩短； 3、头孢联合丙球在SSSS重症患者的治疗中具有显著疗效,可以迅速控制症状、缓解病情。 4、SSSS主要发生于身体既往健康的1-6岁幼儿及学龄前儿童,农村多于城市,秋冬季节高发； 5、脓疱疮、上呼吸道感染、皮肤外伤、抓伤及皮肤局部感染是SSSS患病的主要诱因；
[Abstract]:(staphylococcal scalded skin syndrome, SSSS), is a severe infectious skin disease with acute onset. It is characterized by relaxation scalding bullae and large epidermis exfoliation on the basis of generalized erythema of the whole body, which is easy to occur in children and is rare in adults. The mortality rate of children was 3% or 4%. The disease is urgent and develops rapidly and extensively. It often delays the diagnosis and treatment because it can not be diagnosed early. In serious cases, it is complicated with septicemia, pneumonia and other complications, which is life-threatening. It is necessary to summarize the inducement, clinical characteristics, misdiagnosed and mistreated treatment and treatment experience of this disease in children, which can provide useful reference for clinical work in the future. Methods the clinical data of 135 patients with SSSS were analyzed retrospectively. the data were tested by t test, x2 test, Kruskal-Wallis H test and nemenyi test by SPSS17.0 forwindows software. Results before admission, only 49 patients were diagnosed as SSSS, 36. 30%. At the beginning of the disease, most of the patients were misdiagnosed as allergic diseases and desensitized. 30 patients (14.8%) were accompanied by different degrees of low weight. 33. 3% of the patients had a decrease in total protein, 1.5% had a decrease in albumin, and 65.9% had a decrease in prealbumin. The serum immunoglobulin level, 37.7%IGA level and 17.5%IGG level were decreased, but the IgM level was not significantly decreased in 114 patients. The data of serum creatinine (SCr) and serum urea nitrogen (BUN) in all children were statistically analyzed. It was found that the serum creatinine levels of 50 patients (37.0%) and 103 patients (76.3%) were slightly decreased. The difference of hospitalization days between different treatment groups was compared. the results showed that there was significant difference in hospitalization days between cephalosporin group and macrolide group (P0.005). There was no significant difference in hospitalization days between cephalosporin group and cephalosporin group, cephalosporin group and macrolides group. The results showed that: (1) the peak temperature of the patients in the group C was higher than that in the group of cephalosporins, the body temperature recovered, the pain relief took longer, and the condition was relatively serious. There was no difference in the improvement time, hospitalization days and final curative effect between the C-ball group and the cephalosporin group. Conclusion 1. Humoral immunity, low body weight and malnutrition may be the causes of SSSS in children. 2. In the treatment of SSSS, cephalosporin group is superior to macrolides group, and the hospitalization time is obviously shortened. 3. Cephalosporium combined with propene has a significant effect in the treatment of severe SSSS patients, which can quickly control the symptoms and alleviate the disease. 4, SSSS mainly occurred in 1 < 6 years old children and preschool children, which were more in rural areas than in urban areas, and the incidence was high in autumn and winter. 5. Pustulous, upper respiratory tract infection, skin trauma, scratch and local skin infection are the main causes of SSSS.
【学位授予单位】：中国医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R753.2

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