连续性静脉-静脉血液透析滤过联合血液灌流治疗哌拉西林钠舒巴坦钠所致中毒性表皮坏死松解症

Continuous veno-venous hemodiafiltration combined with hemoperfusion for toxic epidermal necrolysis caused by piperacillin sodium and sulbactam sodium

1例84岁男性维持性血液透析的尿毒症患者因合并肺炎给予哌拉西林钠舒巴坦钠5 g加入0.9%氯化钠注射液100 ml静脉滴注、2次/d。用药当晚患者出现发热(体温最高39.6℃),次日出现皮肤瘙痒。第4天,患者躯干和四肢皮肤出现片状红斑,伴糜烂渗出,皮肤压痛,尼氏征阳性。诊断为中毒性表皮坏死松解症。停用哌拉西林钠舒巴坦钠,改为莫西沙星;并在常规糖皮质激素联合小剂量免疫球蛋白治疗的基础上,更换透析模式为连续静脉-静脉血液透析滤过联合血液灌流隔日1次治疗;同时加强皮肤护理及支持治疗。3周后,患者皮损基本痊愈。

An 84-year-old male uremic patient treated with maintaining hemodialysis received IV infusion of piperacillin sodium and sulbactam sodium 5 g dissolved in 0.9%sodium choride 100 ml twice daily for pneumonia.The patient developed fever(the highest body temperature was 39.6℃)on the night of medication,and itchy skin the next day.On the 4th day,patchy erythema appeared on the skin of his trunk and limbs,accompanied by erosion,exudation,and tenderness.Nikolsky′s sign was positive.Toxic epidermal necrolysis was diagnosed.Piperacillin sodium and sulbactam sodium were discontinued and replaced by moxifloxacin;the original dialysis mode was changed to continuous veno-venous hemodiafiltration combined with hemoperfusion once every other day on the basis of conventional therapy of glucocorticoids combined with low-dose immunoglobulin;and skin care and supportive treatment were strengthened at the same time.After 3 weeks,the skin lesions of the patient basically recovered.