史蒂文生氏症候群合毒性皮膚上皮壞死中西醫結合治療病例

一位多器官疾病之老年男性加護病房病人，因爲大腸菌感染引發敗血症，經重劑抗生素治療不幸發生嚴重皮膚黏膜反應及神識昏迷，全身幾乎70%左右的皮膚潰爛起疱，皮下出血成斑，背部有兩處的褥瘡，除了臉部外，手足胸部均包覆無菌紗布，每日需換2-3次的紗布。此外，病人肢體嚴重水腫。經西醫診斷爲史蒂文生氏症候群(Stevens-Johnsons syndrome; SJS)合毒性皮膚上皮壞死(toxic epidermal necrosis; TEN)。中醫診斷爲濕熱熾盛，熱入心營，治療原則給予大劑量涼血清熱解毒利濕藥，其中最主要是配合台灣民間草藥小本七層塔，在西醫和中醫合併治療約十天，病人嚴重的皮膚起疱潰爛徵兆及瀰漫性水腫明顯消除，此爲國內第一個以中西醫結合治療SJS/TEN得到明顯療效成功之案例。

關鍵字

史蒂文生氏症候群；毒性皮膚上皮壞死；涼血清熱利濕藥；小本七層塔

並列摘要

A chronic multiple organ diseases of old male patient admitted and received antibiotics treatment by E-coli sepsis in our intensive ward. Unfurturely he developed a severe mucocutaneous reaction and loss of consciousness. Intensive skin erosion distribution over 70% of whole body and widespread dusky erythema and two bedsores were found. Except face, he was wrapped with sterile gauze at chest and extremities and the dressing was need changed 2-3 times per day. On the other hand, his extremities suffered severely edema. The diagnosis confirmed as Stevens-Johnson syndrome (SJS) and toxic epidermal necrosis (TEN). The identify patterns diagnosis was exuberant damp-heat and the evil heat invaded cardiac-construction aspect. The principle treatment was administered a big dosage of blood-cooling heat-clearing and toxin-resolving dampness-disinhibiting medicinal. Among of above, Salvia plebeian as a Taiwan folk herb administered plays an important role. After Western and Chinese Medicine combined therapy around 10 days, the patient severe lesion of skin blister, erosion and diffused edema were obviously remission. This case was the first report for successfully treated SJS/TEN by Chinese medicine integrated Western medicine.

並列關鍵字

Stevens-Johnson syndrome ； toxic epidermal necrosis ； blood-cooling heat-clearing and toxin-resolving dampness-disinhibiting medicinal ； Salvia plebeian

國際替代計量

史蒂文生氏症候群合毒性皮膚上皮壞死中西醫結合治療病例

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