连续性血液净化联合免疫球蛋白救治20例重症药疹患者的临床分析

Efficacy of continuous blood purification combined with immunoglobulin in treating 20 ICU patients with severe drug eruptions

目的:探讨连续性血液净化联合免疫球蛋白对重症药疹的治疗效果。方法:回顾性分析2014年1月—2016年12月ICU收治的20例不能耐受糖皮质激素和或糖皮质激素不能控制病情的重症药疹患者,给予连续性血液净化联合免疫球蛋白治疗,观察患者皮损、血常规、肝肾功能转归情况及临床疗效。结果:所有20例患者除1例因患者家庭经济原因,皮损开始好转后即自动出院外,其余均转入皮肤科普通病房或痊愈出院。皮损开始好转时间为(7.56±1.93)d;联合治疗后,所有患者的血常规及肝肾功能均有改善。联合治疗后最大糖皮质激素用量明显低于治疗前最大糖皮质激素用量(P<0.05),差异有统计学意义;3例患者在血液净化治疗过程中出现血小板下降,治疗结束均恢复。结论:早期连续性血液净化联合静脉注射用人免疫球蛋白可降低重症药疹患者糖皮质激素使用量,提高疗效。

Objective： To explore the therapeutic efficacy of continuous blood purification combined with immunoglobulin for severe drug eruptions. Methods： A retrospective analysis was performed in 20 patients with severe drug eruptions who either intolerated or did not respond well to glucocorticoids in ICU from January 2014 to December 2016. Patients were treated with continuous blood purification combined with immunoglobulin therapy. Cutaneous lesions, results of routine blood tests, liver and kidney function, and therapeutic efficacy were analyzed. Results： Due to financial hardship, one patient was discharged after improvement in skin lesions. The rest were either transferred to the general ward in dermatology or discharged after complete recovery. Skin rashes began to improve after（7.56±1.93） d of treatments. After combination therapy, results of routine blood tests, liver and kidney function were improved in addition to a significant reduction in the maximum dosage of glucocorticoids（P〈0.05）. During the treatments 3 patients experienced low platelet counts, which returned to normal levels af- ter discontinuation of the treatments. Conclusions： Early continuous blood purification combined with human immunoglobulin can reduce the dosage of glucocorticoids and improve the therapeutic efficacy.