Kertai M, Dárdai E, Telkes M, Nébenführer L
FP6árosi Szent István Kórház és Intézményei, Központi Aneszteziológiai és Intenzív Terápiás Osztály, Budapest.
Orv Hetil. 1997 Oct 12;138(41):2609-11.
The authors report the case of a 30-year-old man treated with toxic epidermal necrolysis. Toxic epidermal necrolysis was due to anticonvulsive drug treatment. The patient was admitted with denudated skin surface similar to second-degree burn that covered 90 per cent of the patient's body surface. The patient was isolated and treated, receiving sterile wound care, broad spectrum antibiotic and corticosteroid. Total parenteral nutrition was instituted until the 5th day of care because the patient was unable to take normal food. The energy intake reached 146 kJ/kg bodyweight containing 4 g/kg bodyweight carbohydrates and 2 g/kg bodyweight fat emulsion supplemented with 10-15 g of nitrogen per day. The enteral nutrition was commenced gradually with decreasing parenteral nutrition. The nutritive solutions were supplemented with ions, vitamins and trace elements. The patient left the intensive care unit after 23 days of care. The toxic epidermal necrolysis is a life-threatening dermatological disease and should be treated at intensive care unit. The early recognition of the disease, the intensive care and nutritional therapy may improve the survival of patients with toxic epidermal necrolysis.
作者报告了一例接受中毒性表皮坏死松解症治疗的30岁男性病例。中毒性表皮坏死松解症是由抗惊厥药物治疗引起的。患者入院时皮肤表面剥脱，类似二度烧伤，覆盖了患者90%的体表。患者被隔离并接受治疗，接受无菌伤口护理、广谱抗生素和皮质类固醇治疗。由于患者无法正常进食，在护理的第5天开始实施全胃肠外营养。能量摄入量达到146千焦/千克体重，其中含有4克/千克体重的碳水化合物和2克/千克体重的脂肪乳剂，每天补充10 - 15克氮。随着胃肠外营养的减少，逐渐开始肠内营养。营养溶液补充了离子、维生素和微量元素。经过23天的护理，患者离开了重症监护病房。中毒性表皮坏死松解症是一种危及生命的皮肤病，应在重症监护病房进行治疗。对该疾病的早期识别、重症监护和营养治疗可能会提高中毒性表皮坏死松解症患者的生存率。
