Engelhardt S L, Schurr M J, Helgerson R B
Department of Surgery, University of Wisconsin Hospital, Madison 53792, USA.
J Burn Care Rehabil. 1997 Nov-Dec;18(6):520-4.
Toxic epidermal necrolysis (TEN) is an exfoliative disorder associated with epidermal slough and systemic toxicity. As of 1986, the literature has advocated early burn center transfer and has rejected the use of steroids. We questioned whether therapy for TEN has changed to reflect these concepts. All cases of TEN referred to our tertiary burn center since 1988 were reviewed. The history was evaluated for steroid usage and timing of burn center transfer. Drug exposures, septic complications, and deaths were noted. Statistics are expressed as mean +/- SD. Fourteen cases of TEN were identified. Transfer was delayed more than 2 days in 10 (72%) instances. Mean delay was 4.4 +/- 2.7 days. Half received steroids. There were three deaths (21%). Pneumonia developed in five patients (36%), urinary tract infections developed in three (21%) patients, seven (50%) patients required intubation, and three (21%) required hemodialysis. No differences in mortality rates or infectious complications were noted in patients who received steroids or who were transferred late. Septic complications occur frequently in TEN. Delay in transfer and initiation of steroids at referring institutions are common. Early burn center referral and avoidance of steroids needs to be reiterated at the level of the referring physician.
中毒性表皮坏死松解症（TEN）是一种与表皮脱落和全身毒性相关的剥脱性疾病。截至1986年，文献主张早期转至烧伤中心，并反对使用类固醇。我们质疑TEN的治疗方法是否已发生改变以反映这些观念。对自1988年以来转诊至我们三级烧伤中心的所有TEN病例进行了回顾。评估病史以了解类固醇的使用情况和转至烧伤中心的时间。记录药物暴露、脓毒症并发症和死亡情况。统计数据以平均值±标准差表示。共确定了14例TEN病例。10例（72%）转院延迟超过2天。平均延迟时间为4.4±2.7天。半数患者接受了类固醇治疗。有3例死亡（21%）。5例患者（36%）发生肺炎，3例（21%）患者发生尿路感染，7例（50%）患者需要插管，3例（21%）患者需要血液透析。接受类固醇治疗或转院较晚的患者在死亡率或感染并发症方面未发现差异。TEN患者经常发生脓毒症并发症。转诊机构转院延迟和开始使用类固醇的情况很常见。在转诊医生层面需要重申早期转诊至烧伤中心并避免使用类固醇。
