Stevens-Johnson综合征/中毒性表皮坏死松解症六例

Analysis of six cases of Stevens-Johnson syndrome/toxic epidermal necrolysis

目的探讨Stevens-Johnson综合征(SJS)/中毒性表皮坏死松解症(TEN)的临床特征、皮肤创面表现及治疗方式。方法回顾性病例研究。对2022年8月至2023年8月于北京大学首钢医院修复重建外科收治确诊为SJS/TEN 6例患者的临床特征、皮肤创面表现及治疗进行回顾性分析。结果6例SJS/TEN主要的临床特征为全身皮肤不同程度剥脱、黏膜受累、肝肾功能异常、电解质紊乱、低蛋白血症等。其中SCROETEN评分≥3分者为3例(50%)。所有患者入院后均系统性应用糖皮质激素1.5~2 mg/kg/d,连用(7~10)d,丙种球蛋白400 mg/kg/d,连用(3~5)d,局部皮肤和黏膜受损区域予以系统性清创换药治疗,并加强皮肤创面管理。6例患者全部康复出院。结论SJS/TEN均表现为不同程度的全身皮肤及黏膜损害,在全身和局部应用足量糖皮质激素控制疾病的基础上,选择合适的皮肤创面治疗方式,加强皮肤护理,可有效提高疾病治疗效果,改善疾病预后。

Objective To investigate the clinical characteristics,skin wound manifestations,and treatment methods of Stevens-Johnson syndrome(SJS)/toxic epidermal necrolysis(TEN).Methods A retrospective analysis was conducted on the clinical characteristics,skin wound manifestations,and treatment of six patients diagnosed with SJS/TEN at the Department of Reconstructive Surgery of the Peking University Shougang Hospital from August 2022 to August 2023.Results The main clinical features of the six cases of SJS/TEN were varying degrees of skin exfoliation,involvement of mucous membranes,abnormalities in liver and kidney function,electrolyte imbalance,and hypoproteinemia.Three cases(50%)had a SCROETEN score of≥3.All patients received systemic glucocorticoid therapy at a dose of 1.5~2 mg/kg/day for 7~10 days,and gamma-globulin therapy at a dose of 400 mg/kg/day for 3~5 days after admission.Systemic debridement and dressing changes were performed on the affected areas of the skin and mucosa,and skin wound management was strengthened.All six patients recovered and were discharged.Conclusion Both SJS/TEN present with varying degrees of systemic skin and mucosal damage.On the basis of controlling the disease with sufficient systemic and local glucocorticoids,selecting appropriate skin wound treatment methods and strengthening skin care can effectively improve the therapeutic effect and prognosis.