本文選題：兒童 + 藥疹��； 參考：《大連醫(yī)科大學(xué)》2013年碩士論文

【摘要】：背景：TEN（Toxic epidermal necrolysis，中毒性表皮壞死松解癥）又稱大皰性表皮松解萎縮型藥疹（drug-induced bullosa epidermolysis）是一種罕見的、爆發(fā)性出現(xiàn)廣泛的皮膚粘膜和內(nèi)臟損害的嚴(yán)重性皮膚病。TEN預(yù)后較差，統(tǒng)計(jì)表明死亡率高達(dá)25~35%。多由服藥或上呼吸道感染而誘發(fā)，而對于兒童除了藥物致敏誘發(fā)外，也常由感染因素誘發(fā)，如肺炎支原體或單純皰疹病毒，還有骨髓移植或器官移植。TEN為皮膚科的重癥之一，若發(fā)生于兒童風(fēng)險(xiǎn)更大。本病發(fā)病機(jī)制尚不清楚，治療上存在爭議。 病例報(bào)告：我科于2011年7月29日至9月15日間，應(yīng)用糖皮質(zhì)激素聯(lián)合免疫球蛋白成功治愈三名TEN男性患兒。TEN進(jìn)展快，三名患兒均在入院后的2天內(nèi)出現(xiàn)嚴(yán)重的表皮剝脫，累及面積超過體表面積的30%，并且均累及眼結(jié)膜、口腔黏膜及會陰部黏膜。在3例TEN患兒發(fā)病早期，給予甲基強(qiáng)的松龍2~3mg/(kg·d)靜脈滴注，同時予靜脈注射人免疫球蛋白(Intravenous immunoglobulin，IVIG)0.4g/(kg·d)連續(xù)治療5天。同時給予積極有效的支持治療和全面的護(hù)理。經(jīng)治療3例患者皮膚及黏膜損害得到有效控制。3名患兒于出院時，糖皮質(zhì)激素均減量至停藥。治療過程中未見明顯不良反應(yīng)。 結(jié)論：對于兒童TEN，糖皮質(zhì)激素聯(lián)合免疫球蛋白治療是該病目前比較理想的治療方案。免疫球蛋白對于治療TEN的作用是肯定的。與成人相比較，無論免疫球蛋白應(yīng)用劑量大小，，都能夠明顯改善兒童TEN的病情。聯(lián)合應(yīng)用能夠更及時的控制患者病情的進(jìn)展，縮短了住院時間，并且有助于糖皮質(zhì)激素的快速減量，減少了其帶來的副作用，降低了該病的死亡率。
[Abstract]:Background: Toxic epidermal necrosis (toxic epidermal necrolysis), also known as epidermolysis bullosa atrophy type (drug-induced bullosa epidermis molysis), is a rare disease with a poor prognosis of severe dermatosis with extensive skin, mucosal and visceral lesions. Statistics show that the death rate is as high as 25% 35%. Most of them are induced by medication or upper respiratory tract infection, and in addition to drug sensitization, children are also often induced by infection factors, such as Mycoplasma pneumoniae or herpes simplex virus, and bone marrow transplantation or organ transplantation. TEN is one of the severe cases in dermatology. Children are at greater risk if they occur. The pathogenesis of the disease is not clear, and treatment is controversial. Case report: from July 29 to September 15, 2011, our department successfully cured three male TEN patients with TEN by using glucocorticoid combined with immunoglobulin. All of them developed severe epidermal exfoliation within 2 days after admission. The area involved was more than 30% of the body surface area, and the conjunctiva, oral mucosa and perineum mucosa were all involved. At the early stage of onset of TEN, patients with TEN were given intravenously infusion of methylprednisolone (2~3mg/(kg d) and intravenous injection of human immunoglobulin (IVIG) 0.4 g / kg / d for 5 days. At the same time, to actively and effectively support treatment and comprehensive care. Skin and mucous membrane lesions were effectively controlled in 3 patients after treatment, glucocorticoids were reduced to withdrawal after discharge. There was no obvious adverse reaction during the treatment. Conclusion: glucocorticoid combined with immunoglobulin is an ideal treatment for TEN in children. The role of immunoglobulin in the treatment of TEN is positive. No matter the dose of immunoglobulin, it can improve the condition of TEN in children. Combined use can control the progress of patients more timely, shorten the hospitalization time, and help to reduce the rapid reduction of glucocorticoid, reduce its side effects, reduce the mortality of the disease.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R758.2

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