1例卡马西平致中毒性表皮坏死松解症病例报道及文献分析

Case Report and Literature Analysis of 1 Case of Toxic Epidermal Necrosis Caused by Carbamazepine

目的:探讨卡马西平致中毒性表皮坏死松解症(TEN)的临床特征、相关因素及防治对策。方法:对1例卡马西平致TEN进行报道,并结合检索到的相关文献进行文献分析。结果:该例老年女性患者因"带状疱疹后遗症"服用卡马西平,在疼痛症状无好转的情况下自行加量,因此导致TEN,治疗27 d后痊愈出院。检索到的54例相关病例分析结果表明,卡马西平所致TEN有一定潜伏期,多出现在服药后2～14 d;其临床主要表现为由轻到重的皮损,多以颜面部首发并在1～2 d内迅速发展至全身,融合成片并形成大疱;该不良反应死亡率为9.3%,痊愈率74.1%;该不良反应与患者的过敏史及用药依从性有一定的相关性。结论:临床应重视和警惕卡马西平所致的TEN,临床药师应加强对服用卡马西平患者的用药教育。

OBJECTIVE： To investigate clinical characteristics, related factors and countermeasures of carbamazepine induced toxic epidermolysis bullosa （TEN）. METHODS： A case of carbamazepine induced TEN was reported, and analyzed on the basis of literatures retrieval. RESULTS： The elderly woman with herpes zoster sequela received carbamazepine, and added the quantity of drugs when the symptom of pain hadn＇t been improved. Finally, the patient suffered from TEN. The patient was discharged from the hospital after 27 days of treatment. The analysis results of 54 cases showed that TEN caused by carbamazepine had a certain incubation period and generally appeared within 2-14 days after medication. The clinical manifestation mainly were light to heavy skin lesions, starting from face and extending to the whole body within 1-2 d, merging into the stretch shape and forming bleb. The mortality of ADR was 9.3%, and recovery rate was 74.1%. The adverse drug reaction was correlated with allergy history and medication compliance. CONCLUSIONS： Great importance should be attached to carbamazepine-induced TEN; clinical pharmacists should strengthen medication education of patients taking carbamazepine.