中毒性大疱表皮松解症的观察与护理

<正> 中毒性大疱表皮松解症,是皮肤科少见的一种重症药物过敏反应,该症以全身泛发性红斑或大疱以至皮肤迅速出现松解、剥脱、感染为特征,病情危重,并发症多属临床疑难病症,近年来我们在临床护理该症中,取得较好效果。现报道如下:     

1例重症多形红斑型药疹的护理体会

本研究报道1例重症多形红斑型药疹的护理体会.患者全身水肿性红斑、丘疹,痒,伴部分皮肤、口腔黏膜破溃、糜烂.治疗上采取激素冲击疗法,并以注射用人免疫球蛋白支持.通过用药护理、皮肤护理、饮食护理、心理护理及严格消毒隔离等措施,患者病情得到控制,预后良好.     

1例重症大疱性表皮松解坏死型药疹患者的观察和护理

总结1例重症大疱性表皮松解坏死型药疹患者的观察和护理。密切观察患者的病情变化,采取有效的护理措施,重视了患者的心理护理,注意全身用药的观察,加强皮肤、口腔的护理,给予合理的支持疗法。患者经过25天的治疗和护理,痊愈出院。     

21例大疱性表皮坏死松解型药疹护理体会

目的:总结大疱性表皮坏死松解型药疹的护理经验。方法:对21例大疱性表皮坏死松解型药疹患者给予精心的护理。将患者实行保护性隔离,预防感染发生,给予饮食、心理及皮肤黏膜的护理,并密切观察患者的病情变化。结果:20例患者痊愈出院,1例患者因感染性休克而死亡。结论:完善的护理可提高大疱性表皮坏死松解型药疹的治愈率,降低其死亡率,对患者的早日康复至关重要。     

复方新诺明致重症药疹1例护理体会

重症多形红斑是一种临床少见、侵犯全身皮肤的疾病,其发病急剧,高热,畏寒,皮疹呈水肿性鲜红色或紫红色斑,很快出现水疱或大疱,黏膜损坏广泛而严重[1].可并发中耳炎,支气管肺炎、心肌炎、肝、肾衰竭、脑水肿等,若抢救不及时可致死. 我院曾收治1例重症多形红斑患者,经20天的治疗和护理,痊愈出院,现将对该病的护理体会报道如下.     

重症多型红斑患者的护理

重症多型红斑又称Stevens-Johnson综合征,可发生于任何年龄,发病急骤,患者常有高烧、畏寒等全身症状,皮损迅速出现,常广泛分布于全身,为水肿性鲜红或紫红色斑,其上很快出现水疱、大疱、血疱或瘀斑等,水疱破溃后为鲜红色糜烂面[1]。黏膜损害广泛且严重,眼、口腔和外生殖器、呼吸     

37例大疱性表皮坏死松解型药疹的护理

大疱性表皮坏死松解型药疹是重型药疹的一种类型,本病起病急,全身中毒症状严重,皮损由弥漫性红斑迅速发展成松解型水疱或大面积表皮松解,具有症状重,并发症多,死亡率高的特点,现将我科近年来收治该病37例患者的护理总结如下.     

局限性Castleman病伴副肿瘤性天疱疮1例

<正>患者,女,41岁。主因口腔黏膜及口唇糜烂10个月,全身红斑、大疱、糜烂1个月就诊。患者于10个月前舌及口腔黏膜、口唇出现糜烂,伴疼痛。1个月前,患者全身出现红斑、水疱,疱壁薄易破,伴瘙痒。在当地医院拟诊为"寻常型性疱疮",给予甲泼尼龙80 mg/d、丙种球蛋白等治疗,症状无好转,大部分水疱融合破裂,并出现全身大片红斑、糜烂及结痂。既往体健,无药物过敏史,无家族遗传病史。查体:患者口腔黏膜、口唇糜烂严重;颜面部、四肢、躯干、会阴部等处约占90%体表面积皮肤     

1例重症大疱性表皮松解型药疹合并坏死性筋膜炎的护理

大疱性表皮松解型药疹,为药物通过各种途径进入人体内而引起的皮肤黏膜炎症反应,表现为全身性红斑松弛性水疱及表皮松解,呈烫伤样改变,全身中毒症状及皮疹严重,伴有高热,对肝肾心肺及造血系统等均有损害,并发症多,患者可因感染、败血症而死亡,病死率在药疹中最高［1］。该病起病急,全身中毒症状重,皮损由弥漫性红斑迅速发展成松弛性水疱或大面积表皮松解,轻微摩擦表皮即可脱落,形成糜烂,常伴有明显的眼、鼻、口腔、外阴黏膜的损害［2］。急性坏死性筋膜炎,是一种以进展迅速、范围广泛的皮下和筋膜坏死为特征的严重软组织感染,常由多种细菌感染所致,病变范围可波及腹壁、腹股沟、臀部、会阴、肛周等部位,其特点是起病急骤,发展讯速,局部组织可广泛坏死,导致全身脓血症,出现感染性休克,和严重多器官功能衰竭［3］。现就我院收治的1例重症大疱性表皮松解型药疹合并坏死性筋膜炎患者的护理体会报告如下。     

糖尿病合并艾滋病的护理策略

目的：探讨糖尿病合并艾滋病的护理工作重点和注意事项。方法：对27例糖尿病合并艾滋病患者护理中注意进行饮食护理、药物护理、健康教育、心理护理,特别是并发症及控制感染的护理。结果：25例患者病情得到控制,好转出院,2例因经济原因自动出院。结论：对糖尿病合并艾滋病患者加强饮食、药物、心理护理和并发症的护理,控制感染,可明显提高患者的生存质量。     

186例药疹致病药物及临床类型分析

目的:分析我院近6年药疹患者的致病药物及临床表现类型.方法:收集我院1997年1月～2002年12月间的药疹住院患者,对其致病药物及药疹类型进行分析.结果:共收集药疹病例186例,其中最常见的致病药物有抗生素类(57.5%)、解热镇痛类(18.8%)和中药类(5.9%).最常见的药疹类型为麻疹及猩红热样发疹型(63.4%)、荨麻疹型(14%)和多形性红斑型(8%).引起麻疹样及猩红热样药疹的主要致病药物为青霉素类(33.9%)、头孢菌素类(20.3%)和解热镇痛类(14.4%);引起荨麻疹型的主要为血清制品(23%)和青霉素类(19.2%);引起多形性红斑型的主要为解热镇痛类(33.3%)和青霉素类(20%).抗癫痫药、抗痛风药和解热镇痛药是重症药疹如重症多形性红斑、剥脱性皮炎和大疱性表皮松解症的主要致病药物.结论:本研究中引起药疹的致病药物主要为抗生素类和解热镇痛类药物.中药引起的药疹有增加的趋势,应引起足够重视.     

阿莫西林药疹32例临床分析

对３２例阿莫西林药疹进行临床观察，皮疹发疹潜伏期平均４．９天，皮疹发病率与用药剂量不相关，皮疹类型多为麻疹样或猩红热样疹型，也可见到紫癜型、荨麻疹型、多形红斑型、红皮病型及脓疱型皮损，病程中皮疹类型可以转变。皮疹经治疗后多在一周内消退，合并病毒感染者消退较慢且反复发作，对阿莫西林药疹临床上应注意鉴别诊断。     

儿童重症药疹30例临床分析

目的探讨儿童重症药疹的致敏药物、临床特点及预后相关因素。方法对2005年1月～2008年1月期间住院治疗的30例儿童重症药疹患者的临床资料进行分析。结果 30例患者中重症多形红斑型药疹16例,大疱性表皮松解型药疹9例,剥脱性皮炎型药疹5例。致敏药物以解热镇痛药为首位。结论临床上应高度重视儿童给药引起药疹的问题,糖皮质激素仍为首选药物。     

The differential diagnosis of erythema nodosum.

Erythema nodosum is an uncommonly seen skin eruption which may be a marker of underlying systemic or infectious disease. It may also occur as a reaction to a variety of medications. The diagnosis of erythema nodosum should prompt a thorough investigation of possible causes or associated conditions which may be treatable. This paper presents a case of erythema nodosum and reviews the differential diagnosis of its causes and of similar appearing skin lesions.     

202例住院药疹患者致病药物临床分析

目的：观察药疹与致病药物之间的关系。方法：通过对202例住院药疹的致病药物进行临床分析。结果：引起或可能引起药疹的药物有20余类,排在前5位的分别是：抗感染药、解热镇痛药、抗痛风药、抗癫痫药、生物制品等。多型性红斑药疹是最常见的,其次为荨麻疹型。生物制品和呋喃唑酮多引起荨麻疹型药疹;磺胺类药多引起固定型药疹。结论：不同致病药物与不同药疹类型之间存在某些内在联系。     

儿童重症多形性红斑19例

目的探讨儿童重症多形性红斑(EMM)的临床特征,提高临床诊治水平.方法回顾分析19例EMM的临床特征及治疗.结果 100%的病例均有发热、皮疹及黏膜损害,伴有不同程度的内脏器官受累和免疫学指标异常.94.7%的病例早期给予糖皮质激素治疗,57.9%的病例同时给予丙种球蛋白静滴(IVIG).临床症状迅速缓解,实验室指标大都在6周内完全恢复正常.伴有肺部受累的6例,随访期间,3例恢复正常,2例病情缓解,1例3个月后死于肺间质纤维化.结论 EMM是儿童急重症之一,肺部并发症严重威胁儿童健康甚至生命,早期糖皮质激素及IVIG治疗有助于降低死亡率及重要内脏器官并发症的发生.     

The relation between hospital experience and in-hospital mortality for patients with AIDS-related PCP

There is marked debate by physicians and policymakers regarding the creation of regionalized acquired immunodeficiency syndrome (AIDS) centers. A central issue is whether outcomes of care, particularly mortality, differ as a function of hospital experience with patients with AIDS. We evaluated the experience of 257 patients with AIDS and Pneumocystis carinii pneumonia treated at 15 California hospitals between October 1986 and October 1987. An overall 15.2% in-hospital mortality rate was observed. However, a markedly lower in-hospital mortality rate was observed in the group of patients treated at hospitals that had a high level of experience with patients with AIDS (greater than or equal to 30 human immunodeficiency virus-related discharges per 10,000 hospital discharges) relative to the group treated at hospitals with less experience (less than 30 human immunodeficiency virus-related discharges per 10,000 hospital discharges): 12% vs 33%. Other factors significantly associated with in-hospital mortality included intensive care unit use, admission from an emergency department or through an interhospital transfer, and a history of hospitalizations. A logistic regression model indicated that, after controlling for severity indicators, AIDS experience remained significantly related to mortality. Our findings suggest that policymakers should consider three options: creating regional AIDS centers, implementing policies that promote a rapid but carefully monitored increase in experience of low-volume hospitals with human immunodeficiency virus-infected individuals, or providing highly focused educational efforts at low-AIDS-experience facilities. Without such policy initiatives, differences in mortality rates like those we have found might persist as cases of AIDS begin to occur in every area of the country.     

青蒿琥酯治疗皮肤病90例临床分析

目的：实验曾证明青蒿琥醌具有免疫调节、抗光感等多方面作用，本文探讨它的临床实用价值。方法：选择湿疹、异位性皮炎、多形红斑、多形日光疹、夏令水疱病、建党型银屑病、皮肌炎共９０例，单独采用青蒿琥酯治疗，观察其疗效。结果：对湿疹、多形红斑、多形日光疹、夏令水疱病有效率１００％；对建党型银屑病，皮肌炎有效率分别为６０％、７５％。结论：通过临床应用进一步论证青蒿琥醌有抑制变应性皮炎与抗光感作用，具有临床使用     

110例药疹临床分析

目的 了解所应用药物和药疹发生的关系以及药疹的防治方法.方法 选取我科于2012年1月～2013年1月诊治的110例药疹患者作为临床研究对象,根据患者致敏药物、潜伏期、临床表现和实验室结果对患者的情况进行分析,根据药疹类型将患者分为重症组和非重症组两组,并观察两组患者机体状况和致敏药物类型.结果 重症组17例,非重症组93例.两组患者的发热情况、外周血、尿常规、肝功能和肾功能异常等方面的差异均有统计学意义(P＜0.05).110例患者中,共有27例患者有应用过两种或以上的药物,因此致敏药物不易确定,将他们所应用的药物列入可疑药物,而剩下的83例单一用药导致药疹的患者用药情况也各不相同.结论 特别注意使用抗生素、解热镇痛药和抗癫痫药物患者的病情,以防药疹发生,一旦出现药疹,应立即停药并进行积极治疗,促进患者早日康复.     

The relation between hospital experience and mortality for patients with AIDS.

OBJECTIVE--To determine whether there is an association between mortality and hospital acquired immune deficiency syndrome (AIDS) experience for all AIDS-related diagnoses, and to determine whether the association is explained by differences in severity of illness, earlier discharge of terminally ill patients, or differences in resource use. DESIGN AND SETTING--Population-based statewide cohort study. All hospitalizations identified for a cohort of AIDS patients diagnosed during 1987 in 40 Massachusetts hospitals were included. PATIENTS--All women and all male intravenous drug users (n = 151), and a random sample of all male non-intravenous drug users diagnosed with AIDS during 1987 in Massachusetts (n = 149). MAIN OUTCOME MEASURES--Primary end points studied were (1) inpatient mortality and (2) 30-day mortality. Length of stay, cost, and intensive care unit use were also examined. RESULTS--In 806 hospitalizations at 40 hospitals inpatient mortality was 13.2%. Relative risk of mortality at low AIDS experience hospitals was 2.16 (95% confidence interval, 1.43 to 3.26) compared with high AIDS experience hospitals. When logistic regression was used to control for age, sex, race, human immunodeficiency virus transmission mode, severity, payer, admission type, hospital ownership, and teaching status, low hospital experience with AIDS remained a significant predictor of inpatient mortality (relative risk, 2.92; 95% confidence interval, 1.37 to 6.22). Comparisons of 30-day mortality by hospital AIDS experience yielded similar results. Length of stay and intensive care unit use were also significantly higher at low-experience hospitals after controlling for severity of illness (P < .05). CONCLUSIONS--We conclude that mortality of AIDS patients is higher at hospitals with less AIDS experience. This finding is not because of greater severity of illness, differences in discharge patterns of the terminally ill, or less intensive use of resources.