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中华临床医师杂志(电子版) ›› 2024, Vol. 18 ›› Issue (01) : 30 -34. doi: 10.3877/cma.j.issn.1674-0785.2024.01.006

临床研究

Stevens-Johnson综合征/中毒性表皮坏死松解症六例
崔子豪1, 阳跃1, 冯光1, 郝岱峰1, 庹晓晔1,()   
  1. 1. 100144 北京,北京大学首钢医院修复重建外科
  • 收稿日期:2023-09-27 出版日期:2024-01-15
  • 通信作者: 庹晓晔

Analysis of six cases of Stevens-Johnson syndrome/toxic epidermal necrolysis

Zihao Cui1, Yue Yang1, Guang Feng1, Daifeng Hao1, Xiaoye Tuo1,()   

  1. 1. Department of Reconstructive Surgery, Peking University Shougang Hospital, Beijing 100144, China
  • Received:2023-09-27 Published:2024-01-15
  • Corresponding author: Xiaoye Tuo
引用本文:

崔子豪, 阳跃, 冯光, 郝岱峰, 庹晓晔. Stevens-Johnson综合征/中毒性表皮坏死松解症六例[J]. 中华临床医师杂志(电子版), 2024, 18(01): 30-34.

Zihao Cui, Yue Yang, Guang Feng, Daifeng Hao, Xiaoye Tuo. Analysis of six cases of Stevens-Johnson syndrome/toxic epidermal necrolysis[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(01): 30-34.

目的

探讨Stevens-Johnson综合征(SJS)/中毒性表皮坏死松解症(TEN)的临床特征、皮肤创面表现及治疗方式。

方法

回顾性病例研究。对2022年8月至2023年8月于北京大学首钢医院修复重建外科收治确诊为SJS/TEN 6例患者的临床特征、皮肤创面表现及治疗进行回顾性分析。

结果

6例SJS/TEN主要的临床特征为全身皮肤不同程度剥脱、黏膜受累、肝肾功能异常、电解质紊乱、低蛋白血症等。其中SCROETEN评分≥3分者为3例(50%)。所有患者入院后均系统性应用糖皮质激素1.5~2 mg/kg/d,连用(7~10)d,丙种球蛋白400 mg/kg/d,连用(3~5)d,局部皮肤和黏膜受损区域予以系统性清创换药治疗,并加强皮肤创面管理。6例患者全部康复出院。

结论

SJS/TEN均表现为不同程度的全身皮肤及黏膜损害,在全身和局部应用足量糖皮质激素控制疾病的基础上,选择合适的皮肤创面治疗方式,加强皮肤护理,可有效提高疾病治疗效果,改善疾病预后。

Objective

To investigate the clinical characteristics, skin wound manifestations, and treatment methods of Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN).

Methods

A retrospective analysis was conducted on the clinical characteristics, skin wound manifestations, and treatment of six patients diagnosed with SJS/TEN at the Department of Reconstructive Surgery of the Peking University Shougang Hospital from August 2022 to August 2023.

Results

The main clinical features of the six cases of SJS/TEN were varying degrees of skin exfoliation, involvement of mucous membranes, abnormalities in liver and kidney function, electrolyte imbalance, and hypoproteinemia. Three cases (50%) had a SCROETEN score of ≥3. All patients received systemic glucocorticoid therapy at a dose of 1.5~2 mg/kg/day for 7~10 days, and gamma-globulin therapy at a dose of 400 mg/kg/day for 3~5 days after admission. Systemic debridement and dressing changes were performed on the affected areas of the skin and mucosa, and skin wound management was strengthened. All six patients recovered and were discharged.

Conclusion

Both SJS/TEN present with varying degrees of systemic skin and mucosal damage. On the basis of controlling the disease with sufficient systemic and local glucocorticoids, selecting appropriate skin wound treatment methods and strengthening skin care can effectively improve the therapeutic effect and prognosis.

图1 患者治疗前皮肤创面情况图。图a为全身皮肤受累情况;图b为出现发热症状后1天,背部皮肤出现大面积剥脱;图c为会阴部皮肤受累情况;图d、e为面颈部皮肤受累情况,可见大面积表皮剥脱,真皮外露,局部有大量组织液渗出
表1 6例SJS/TEN患者的SCORETEN评分
图2 患者治疗后皮肤创面。图a为面颈部皮肤愈合情况;图b为背部皮肤愈合情况;图c为会阴部皮肤愈合情况
表2 6例SJS/TEN患者的住院天数
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