Stevens-Johnson综合征和中毒性表皮坏死松解症患者护理的回顾性分析

A retrospective analysis of nursing patients with Stevens-Johnson syndrome or toxic epidermal necrolysis

目的 总结分析Stevens-Johnson综合征(SJS)和中毒性表皮坏死松解症(TEN)患者的皮肤护理方法与疾病转归。方法 回顾性分析2016年1月—2023年2月于南方医科大学皮肤病医院住院的SJS/TEN患者资料,收集住院期间实施的护理方法、皮损受累占全身体表面积(BSA)变化、皮损控制时间、皮损愈合时间、住院天数、并发症等情况并进行分析。结果 共纳入SJS/TEN患者41例。其中14例采用粉床干性剥脱护理,16例采用新型敷料湿性愈合护理,11例采用粉床干性剥脱护理联合湿润烧伤膏凡士林油纱湿性混合护理。粉床干性剥脱护理法和新型敷料湿性愈合护理法患者的BSA在第5天明显低于入院时,差异具有统计学意义(t值分别为5.25、6.28,均P<0.001);混合护理法BSA第9天明显低于入院时,差异具有统计学意义(t=2.03,P=0.042)。粉床干性剥脱护理法的皮损控制时间、皮损完全愈合时间和住院天数分别为4.0 (3.0, 5.0)、8.5 (7.0, 11.0)、9.5 (8.0, 11.0) d,而新型敷料湿性愈合护理法和混合护理法的时间较长。3种不同护理模式的并发症发生率差异无统计学意义(P=0.827)。结论 在药物系统治疗基础上,SJS/TEN患者早期采用粉床干性剥脱护理,后期采用新型敷料湿性愈合护理可较快控制皮损。临床应根据不同时期皮损表现采用不同护理模式。

Objective To summarize and analyze the skin care methods for and outcomes of patients with Stevens-Johnson syndrome(SJS)or toxic epidermal necrolysis(TEN).Methods Inpatients with SJS or TEN at Dermatology Hospital of Southern Medical University from January 2016 to February 2023 were retrospectively analyzed.The changes in the total body surface area(BSA),control time,healing time,hospitalization days and complications of skin lesions during hospitalization were analyzed.Results Forty-one patients were included.Fourteen patients were treated with dry powder exfoliation,while 16 patients were treated with wet-dress healing care.The rest 11 cases were treated with the combination of dry powder exfoliation,moist burn ointment and vaseline gauze.On the 5th day,treatment with either dry powder exfoliation or wet-dress healing care significantly decreased the BSA(t=5.25,6.28,P<0.001).On the 9th day,the combination care also markedly decreased BSA from the baseline(t=2.03,P=0.042).There was no significant difference in the incidence of complications among the three nursing models(P=0.827).Conclusions In combination with systemic treatments,early dry powder exfoliation and later wet dressing care can quickly improve skin lesions and shorten hospitalization time.Clinically,different nursing models should be adopted according to the manifestations of skin lesions in different phases.