Gerdts B, Vloemans A F P M, Kreis R W
Rode Kruis Ziekenhuis, Burns Centre, Department of Surgery, Beverwijk, The Netherlands.
J Eur Acad Dermatol Venereol. 2007 Jul;21(6):781-8. doi: 10.1111/j.1468-3083.2006.02082.x.
Toxic epidermal necrolysis (TEN) is a severe and potentially fatal drug reaction characterized by an extensive skin rash with blisters and exfoliation, frequently accompanied by mucositis. The wounds caused by TEN are similar to second-degree burns and severe cases may involve large areas of skin loss.
Analysis of our results in patients with TEN and evaluation of the variety of therapeutic interventions that has been studied and suggested in TEN.
PATIENTS/METHODS: Retrospective analysis of 19 consecutive patients with TEN treated in our burns centre between 1989 and 2004.
Immediate withdrawal of any potentially fatal drug, maximum supportive care, and a restricted and tailored antibiotic, medical and surgical treatment regimen confined mortality to 21%, whereas prognosis scores like APACHE II and SCORTEN predicted mortality of 22 and 30%, respectively. A positive contribution of selective digestive decontamination is suggested but has yet to be established.
Because of a potentially fatal outcome, fast referral of a patient suspected of TEN to a specialized centre (mostly a burns unit or specialized dermatology centre) for expert wound management and tailored comprehensive care is strongly advised and contributes to survival.
中毒性表皮坏死松解症（TEN）是一种严重且可能致命的药物不良反应，其特征为广泛的皮疹伴水疱和剥脱，常伴有黏膜炎症。TEN所致伤口类似于二度烧伤，严重病例可能涉及大面积皮肤缺失。
分析我们治疗TEN患者的结果，并评估TEN中已研究和建议的各种治疗干预措施。
患者/方法：对1989年至2004年间在我们烧伤中心接受治疗的19例连续性TEN患者进行回顾性分析。
立即停用任何可能致命的药物，给予最大程度的支持治疗，以及采用受限且量身定制的抗生素、内科和外科治疗方案，可将死亡率控制在21%，而APACHE II和SCORTEN等预后评分预测的死亡率分别为22%和30%。选择性消化道去污显示出积极作用，但尚未得到证实。
鉴于可能出现致命后果，强烈建议将疑似TEN的患者迅速转诊至专业中心（主要是烧伤科或专业皮肤科中心），以便进行专业的伤口处理和量身定制的综合护理，这有助于提高生存率。
