Toxic Epidermal Necrolysis (TEN) Chang Gung Memorial Hospital Burn Center Experience

毒性表皮溶解壞死症林口長庚醫院燙傷中心之經驗

李弘毅(Hung-Yi Lee) ； 楊瑞永(Hung-Chi Chen) ； 陳宏基(Shiow-Shuh Chuang) ； 莊秀樹(Fu-Chan Wei) ； 魏福全(Jui-Yung Yang)

《中華民國重建整形外科醫學會雜誌》 7卷4期 (1998/12) Pp. 303-311

https://doi.org/10.7096/JPRSA.199812.0303

摘要

從1992年至1998，共有17位毒性表皮溶解壞死症的病人在林口長庚紀念醫院燙傷中心接受治療，而其死亡率為54%。
其中可能的病因最主要者為藥物引起(15/17)而另外兩例可能為惡性淋巴瘤及病毒感染引起。這些病患表皮脫落壞死的程度平均達體表面積的82%。在傷口照顧上，使用人工皮敷料及灼膚星黃胺藥膏並沒有顯著性的差異。另外類固醇藥物的使用與否仍是未定之中。
由我們的經驗顯示，病患年齡小於45歲者，其死亡率(25%)遠低於大於45歲者(89%)，而沒有伴隨其他系統性疾病的患者（死亡率28%）亦有較佳之癒後。患者伴有如高血壓、糖尿病等系統性疾病，則死亡率大為提高(80%)。我們認為，這毒性表皮溶解壞死症很可能與患者的免疫能力息息相關。

並列摘要

From 1992 to 1998, 17 patients with Toxic Epidermal Necrolysis (TEN), a devastating illness, were treated at the burn center of the Chang sung Memorial Hospital (CGMH). A mortality rate of 54% was noted.
The majority of possible etiologies were medications (15/17) and other two etiologies included malignancy (non-Hodgkin's lymphoma) and infection (Epstein-Barr Virus). The average involvement of skin sloughing was 82% of the total body surface area. The wound care with biobrane coverage compared to the silver sulfadiazine (sulfasil) applying showed no statistically significant difference and the role of steroid still remained debatable. Two better prognostic factors might be concluded according to this study: a) the younger age (＜45 y/o) with a mortality rate of 25% vs the older age (＞45 y/o) with a mortality rate of 89%. b) no associated systemic disease caused a mortality rate of 28% compared to an 80% mortality rate of those with systemic disease. This possible conclusion revealed that TEN syndrome might have a strong relationship to the patient's immune capacity itself.

並列關鍵字

toxic epidermal necrolysis ； steroid ； prognostic factor