中国实用儿科杂志

中国实用儿科杂志 ›› 2025, Vol. 40 ›› Issue (9): 779-783.DOI: 10.19538/j.ek2025090614

• 病例报告 • 上一篇    下一篇

血浆置换治疗儿童中毒性表皮坏死松解症3例报告

  

  1. 广州医科大学附属妇女儿童医疗中心PICU，广东  广州  510120
  • 出版日期:2025-09-06 发布日期:2025-10-21
  • 通讯作者: 梁宇峰，电子信箱：13710666550@126.com
  • 基金资助:
    广东省自然科学基金面上项目（No.2022A1515010556）；西藏自治区自然科学基金组团式援藏医学项目［No.XZ2022ZRZY44（Z）］

Plasmapheresis in the treatment of toxic epidermal necrolysis in children： report on 3 cases

  1. Department of PICU，Guangzhou Women and Children’s Medical Center Affiliated to Guangzhou Medical University，Guangzhou  510120，China
  • Online:2025-09-06 Published:2025-10-21

摘要： 2022年1月至2023年12月，广州医科大学附属妇女儿童医疗中心重症监护室（PICU）收治了3例中毒性表皮坏死松解症（toxic epidermal necrolysis， TEN）患儿，年龄分别为4岁、8岁、13岁，皮损面积分别为50%、70%、90%，累及部位分别为眼、鼻腔、口腔、外生殖器、尿道口、肛周黏膜。SCORTEN评分及住院死亡概率评估分别为2、2、3分及12%、12% 和32%。在糖皮质激素及静脉注射免疫球蛋白（intravenous immunoglobulin，IVIG）治疗无效后，分别给予2~5次（每次1.5~2.0倍血浆量）的血浆置换（plasma exchange，PE）治疗，每次间隔48 h。治疗后，3例皮损均明显好转，炎症因子明显下降，同时未出现视野缺损等眼部并发症。文章认为PE治疗儿童TEN可能是一种有效治疗方法。

关键词: 儿童, 中毒性表皮坏死松解症, 血浆置换, 炎症因子

Abstract: From January 2022 to December 2023，the Pediatric Intensive Care Unit（PICU） of the Women and Children's Medical Center Affiliated to Guangzhou Medical University admitted 3 children with toxic epidermal necrolysis（TEN），aged 4，8 and 13 respectively. The areas of skin lesion were 50%，70% and 90% respectively，and the involved sites were the eyes，nasal cavity，oral cavity，external genitalia，urethral orifice and perianal mucosa respectively. The SCORTEN score and the in-hospital mortality rate assessment were 2/12%，2/12%，and 3/32%，respectively. After ineffective treatment with glucocorticoids and intravenous immunoglobulin（IVIG），2 to 5 sessions（1.5 to 2.0 times the plasma volume each time） of plasma exchange（PE） treatment were given respectively，with an interval of 48 hours between each two sessions. After treatment，the skin lesions of all three cases improved significantly，and the inflammatory factors decreased significantly，while no ocular complications such as visual field defects occurred. The article holds that PE may be an effective treatment method for children with TEN.

Key words: child, toxic epidermal necrolysis, plasma exchange, inflammatory factor