儿童中毒性表皮坏死松解症15例临床分析

Clinical Analysis of 15 Pediatric Cases with Toxic Epidermal Necrolysis

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。

Objective To analyze the clinical characteristics of toxic epidermal necrolysis in pediatric patients inclu- ding causative agents, clinical features, therapeutic measures and prognosis. Methods A retrospective study of clinical data of 15 pediatric cases with toxic epidermal necrolysis. Results The common drugs triggering TEN in these children were anticonvulsants, nonsteroidal anti-inflammation drugs and beta-lacta- mases antibiotics. The average latency period was （9.07 ± 9.88） days, the average percentage of detach- ment area of epidermis was （80.03 ± 15.30） %. All patients have mucous membranes involved in eyes, mouths and anogenital areas. Cases with internal organs involved were cardiac muscle damage, pulmonary damage, hepatic damage, renal damage, thyroid damage and 1 case with pancreatic damage. Septicemia oc- curred in 3 cases. All the patients treated with methylprednisolone combined with intravenous gammaglobu- lin（IVIG） and supportive and skin care. The course of disease was from 9 to 27 days,the average was 17.53 days. 11 cases got fully recovered and 4 cases significantly improved. Conclusion Drugs were the main cause of children with TEN. Prompt discontinuation of offending drugs, early treatments with large do- ses of glucocorticosteroid and IVIG were effective to pediatric TEN patients. Supportive care, prevention and control of infections, protection of important organs and muhidisciplinary consultation were significantly important to prognosis of pediatric TEN patients.