79例重症药疹病例临床回顾

A clinical review on 79 cases of in-patient with severe drug eruption

分析我院皮肤科1993～1999年间住院重症药疹病例79例，其中大疱表皮坏死松解型药疹37例，重症多形红斑型药疹26例，剥脱性皮炎型药疹16例，死亡12例。解热镇痛药在致敏药物中占首位，其他依次为青霉素类、头孢菌素类，别嘌呤醇，卡马西平，磺胺药，中药，不明种类药物，痢特灵和鲁米那。死亡率以剥脱性皮炎型最高，大疱表皮坏死松解型次之，重症多形红斑型最低。死亡患者至少有3个以上脏器累及。因此认为患者年龄、药疹类型、从发病到正规足量皮质类固醇治疗的时间以及内脏累及的多少决定患者的预后；解热镇痛药、别嘌醇以及卡马西平等药物的应用应谨慎。

Seventy-nine cases of in-patient with severe drug eruption in the Department of Dermatology, Huashan Hospital from 1993 to 1999 were analysed. Among them there were 37 cases of epidermolysis bullosa, 26 cases of Stevens-Johnson syndrome, 16 cases of exfoliative dermatitis, and 12 cases died. The proportion of in-patients with drug eruption was increasing year by year, while the proportion of severe drug eruption decreasing comparatively.Twenty-two cases were caused by analgesics and antipyretics, 18 cases by penicillins and cephalosporins, 13 cases by allopurinol, 10 cases by carbamazepine, 6 cases by sulfonamides, 4 cases by Chinese traditional medicines and 4 cases by uncertain drugs, 1 case by furoxone and 1 case by luminal. With regard to the death rate, exfoliative dermatitis was the highest, next was epidermolysis bullosa and Stevens-Johnson syndrome was the lowest. All of died patients had at least 3 organs involved. It is suggested that the prognosis is determined by the age of the patient, the type of drug eruption, the duration from the eruption onset to the start of treatment, and the number of the organs involved. The indication of using analgesics and antipyretics, allopurinol and carbamazepine should be weighed further.