CAJ | 학술논문

目的通过研究严重脓毒症合并药物超敏反应综合征患儿的临床表现和各项指标,探讨如何治疗和预防严重脓毒症患儿的药物超敏反应综合征.方法回顾性分析2009年1月至2014年4月收入首都儿科研究所重症监护病房(PICU)的16例严重脓毒症合并药物超敏反应综合征患儿的临床资料,其中男9例,女7例;年龄7个月～7岁.对患儿的临床表现、实验室检查、影像学资料、治疗及随访预后等方面进行总结.结果 16例患儿药物超敏反应综合征大多发生在患儿脓毒症治疗的恢复期,潜伏期14 ～21 d.16例患儿均出现发热、全身皮疹、浅表淋巴结肿大和内脏损害,其中有8例患儿表现为嗜酸粒细胞升高,4例患儿表现为人类疱疹病毒6型(HHV-6)再激活.致敏药物分别为头孢类10例、万古霉素6例.患儿均予停用可疑致敏药物后,静脉用丙种球蛋白及甲泼尼龙治疗,经积极治疗后16例患儿均治愈出院.结论严重脓毒症合并药物超敏反应综合征时病情危重,临床表现多样,极易造成误诊或重症病例的漏诊,延误治疗时机.临床医师应加强对药物超敏反应综合征的认识,动态监测、早期发现和干预是本病减少死亡、改善预后的关键.
목적 통과연구엄중농독증합병약물초민반응종합정환인적림상표현화각항지표,탐토여하치료화예방엄중농독증환인적약물초민반응종합정.방법 회고성분석2009년1월지2014년4월수입수도인과연구소중증감호병방(PICU)적16례엄중농독증합병약물초민반응종합정환인적림상자료,기중남9례,녀7례;년령7개월～7세.대환인적림상표현、실험실검사、영상학자료、치료급수방예후등방면진행총결.결과 16례환인약물초민반응종합정대다발생재환인농독증치료적회복기,잠복기14 ～21 d.16례환인균출현발열、전신피진、천표림파결종대화내장손해,기중유8례환인표현위기산립세포승고,4례환인표현위인류포진병독6형(HHV-6)재격활.치민약물분별위두포류10례、만고매소6례.환인균여정용가의치민약물후,정맥용병충구단백급갑발니룡치료,경적겁치료후16례환인균치유출원.결론 엄중농독증합병약물초민반응종합정시병정위중,림상표현다양,겁역조성오진혹중증병례적루진,연오치료시궤.림상의사응가강대약물초민반응종합정적인식,동태감측、조기발현화간예시본병감소사망、개선예후적관건.
Obgective To discuss how to treat and prevent severe sepsis which was combined with drug hypersensitivity syndrome (DHS) in children by studying the clinical features and laboratory results of severe sepsis with DHS in children.Methods The clinical data of sixteen patients (9 boys and 7 girls,aged from 7 months to 7 years) with severe sepsis combined with DHS in Capital Institute of Pediatrics Affiliated Children's Hospital from January 2009 to April 2014 were reviewed and analyzed.Clinical characteristics,laboratory examinations,radiographic findings and the treatment were analyzed.Results In this study,DHS happened in all patients with severe sepsis during the treatment and recovery periods.The incubation period was about 14-21 days.All 16 patients had fever,skin widespread rash,lymphadenopathy and internal organ involvement,among which 8 patients had elevated level of eosinophil and 4 patients had reactivated human herpes virus type 6 (HHV-6).Sensitization drugs were cephalosporins (10 cases),vancomycin(6 cases).After stopping the use of suspected drugs,static drops of Methyl prednisolone and intravenous immunoglobulin therapy (IVIG) were given to them,and 16 cases were cured after active treatment.Conclusions DHS is a severe adverse drug-induced reaction.It is challenging to diagnose DHS,which is due to the diversity of cutaneous eruption and multiple organs involved.DHS can be misdiagnosed due to its non-specific and variable presentations.But given its significant mortality,failure to make a right diagnosis can be disastrous.Early recognition,early diagnosis and early treatment are the keys to decrease the morbidity and mortality of severe sepsis combined DHS.Better understanding of DHS may contribute to the improvement of the diagnosis and management of this syndrome in the clinical practice.