發(fā)布時(shí)間：2019-05-16 16:52

【摘要】： 前言 葡萄球菌性燙傷樣皮膚綜合征(staphylococcal scalded skin syndrome, SSSS),是一種重癥感染性皮膚病,起病急驟,以在全身泛發(fā)性紅斑基礎(chǔ)上發(fā)生松弛性燙傷樣大皰及大片表皮剝脫為特征,好發(fā)于兒童,成人罕見。兒童病死率為3-4%。本病起病急,進(jìn)展迅速廣泛,常因不能及早確診而延誤診治,嚴(yán)重時(shí)合并敗血癥、肺炎等并發(fā)癥而危及生命。總結(jié)本病在兒童中的發(fā)病誘因、臨床特點(diǎn)、誤診誤治原因及治療經(jīng)驗(yàn)均非常必要,可為今后的臨床工作提供有益的借鑒。 實(shí)驗(yàn)方法 回顧性分析臨床確診的135例SSSS患者的臨床資料,應(yīng)用SPSS17.0 forwindows軟件,數(shù)據(jù)用t檢驗(yàn)、x2檢驗(yàn)、Kruskal-Wallis H檢驗(yàn)及nemenyi法檢驗(yàn)等,以a=0.05為檢驗(yàn)水準(zhǔn)。 結(jié)果 入院前僅有49例患者門診診斷為SSSS,確診率36.30%。疾病初期以誤診為“過敏性疾病”并行脫敏對(duì)癥治療的患者居多。 30例(14.8%)患者伴有不同程度體重低下。有33.3%的患者存在總蛋白降低,1.5%的患者存在白蛋白降低,65.9%的患者存在前白蛋白降低。檢測了114例患者的血清免疫球蛋白水平,37.7%IGA水平和17.5%IGG水平降低,IgM水平降低不明顯。對(duì)所有患兒的血清肌酐(SCr)和血清尿素氮(BUN)數(shù)據(jù)統(tǒng)計(jì)分析發(fā)現(xiàn),有50例(37.0%)患者的尿素氮和103例(76.3%)患者的血清肌酐水平呈輕度降低。 比較不同治療組間住院天數(shù)的差異,結(jié)果顯示：頭孢組與大環(huán)內(nèi)酯類組的住院天數(shù)有顯著性差異,P0.005；頭孢組與頭孢+丙球組,頭孢+丙球組與大環(huán)內(nèi)酯類組之間,住院天數(shù)無明顯差異。 丙球+頭孢組與頭孢組比較結(jié)果：①丙球組患者體溫峰值較頭孢組更高,體溫恢復(fù)、疼痛緩解需時(shí)更長,病情相對(duì)較嚴(yán)重；②丙球組與頭孢組在病情好轉(zhuǎn)時(shí)間、住院天數(shù)、最終療效方面無差異。 結(jié)論 1、體液免疫低下、低體重、營養(yǎng)不良可能是兒童易患SSSS的原因； 2、在SSSS治療中頭孢組優(yōu)于大環(huán)內(nèi)酯類組,住院時(shí)間明顯縮短； 3、頭孢聯(lián)合丙球在SSSS重癥患者的治療中具有顯著療效,可以迅速控制癥狀、緩解病情。 4、SSSS主要發(fā)生于身體既往健康的1-6歲幼兒及學(xué)齡前兒童,農(nóng)村多于城市,秋冬季節(jié)高發(fā)； 5、膿皰瘡、上呼吸道感染、皮膚外傷、抓傷及皮膚局部感染是SSSS患病的主要誘因；
[Abstract]:(staphylococcal scalded skin syndrome, SSSS), is a severe infectious skin disease with acute onset. It is characterized by relaxation scalding bullae and large epidermis exfoliation on the basis of generalized erythema of the whole body, which is easy to occur in children and is rare in adults. The mortality rate of children was 3% or 4%. The disease is urgent and develops rapidly and extensively. It often delays the diagnosis and treatment because it can not be diagnosed early. In serious cases, it is complicated with septicemia, pneumonia and other complications, which is life-threatening. It is necessary to summarize the inducement, clinical characteristics, misdiagnosed and mistreated treatment and treatment experience of this disease in children, which can provide useful reference for clinical work in the future. Methods the clinical data of 135 patients with SSSS were analyzed retrospectively. the data were tested by t test, x2 test, Kruskal-Wallis H test and nemenyi test by SPSS17.0 forwindows software. Results before admission, only 49 patients were diagnosed as SSSS, 36. 30%. At the beginning of the disease, most of the patients were misdiagnosed as allergic diseases and desensitized. 30 patients (14.8%) were accompanied by different degrees of low weight. 33. 3% of the patients had a decrease in total protein, 1.5% had a decrease in albumin, and 65.9% had a decrease in prealbumin. The serum immunoglobulin level, 37.7%IGA level and 17.5%IGG level were decreased, but the IgM level was not significantly decreased in 114 patients. The data of serum creatinine (SCr) and serum urea nitrogen (BUN) in all children were statistically analyzed. It was found that the serum creatinine levels of 50 patients (37.0%) and 103 patients (76.3%) were slightly decreased. The difference of hospitalization days between different treatment groups was compared. the results showed that there was significant difference in hospitalization days between cephalosporin group and macrolide group (P0.005). There was no significant difference in hospitalization days between cephalosporin group and cephalosporin group, cephalosporin group and macrolides group. The results showed that: (1) the peak temperature of the patients in the group C was higher than that in the group of cephalosporins, the body temperature recovered, the pain relief took longer, and the condition was relatively serious. There was no difference in the improvement time, hospitalization days and final curative effect between the C-ball group and the cephalosporin group. Conclusion 1. Humoral immunity, low body weight and malnutrition may be the causes of SSSS in children. 2. In the treatment of SSSS, cephalosporin group is superior to macrolides group, and the hospitalization time is obviously shortened. 3. Cephalosporium combined with propene has a significant effect in the treatment of severe SSSS patients, which can quickly control the symptoms and alleviate the disease. 4, SSSS mainly occurred in 1 < 6 years old children and preschool children, which were more in rural areas than in urban areas, and the incidence was high in autumn and winter. 5. Pustulous, upper respiratory tract infection, skin trauma, scratch and local skin infection are the main causes of SSSS.
【學(xué)位授予單位】：中國醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R753.2

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