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題名 | 毒性表皮壞死鬆解症營養支持--個案報告=Nutrition Support for a Patient with Toxic Epidermal Necrolysis--A Case Report |
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作者 | 林晏如; 陳玉如; 李靜怡; 戰臨茜; 王秀媛; | 書刊名 | 中華民國重症醫學雜誌 |
卷期 | 8:2 民95 |
頁次 | 頁85-89 |
分類號 | 416.351 |
關鍵詞 | 營養支持; 毒性表皮壞死鬆解症; 營養評估; Nutrition support; Toxic epidermal necrolysis; Nutritional assessment; |
語文 | 中文(Chinese) |
中文摘要 | 毒性表皮壞死鬆解症為少見嚴重藥物引起致死率高的疾病,特徵為皮膚表面由於壞死而大面積剝離的症狀,其外觀類似二度燒傷。本個案80歲男性診斷為吸入性肺炎併發呼吸衰竭收住院,分別因急性呼吸窘迫症候群、肺塌陷、敗血性休克三次轉入内科加護中心治療,服用Vancomycin後皮膚出現壞死剝離約60%總體表面積,經皮膚科醫師診斷為毒性表皮壞死鬆解症。適當的營養支持可能改善毒性表皮壞死鬆解症患者存活率。個案經營養評估以Harris-Benedict公式,在考量疾病、感染及影響皮膚總體表面積的百分比的壓力因子算出的熱量及蛋白質需求,並給予適當的營養支持。 |
英文摘要 | Toxic epidermal necrolysis (TEN) is a rare medicine associated severe skin problem, in which patient presents massive area of skin necrosis and is similar as second degree burns. Patients with TEN may have high mortality. This case report will describe an 80 years old male patient with diagnosis of ARDS secondary to pneumonia who has been admitted to ICU for three times in the hospitalization. Antibiotics (such as vancomycin) have been used to treat his pneumonia. Unfortunately, there is 60% of patient's skin appeared rush and blisters which is similar as the second degree burns after antibiotics treatment. Patient is diagnosed with TEN by a dermatologist. According to literature review, patient is treated with appropriated nutritional support that has been proven to increase patient's survival rate. This appropriated nutritional support is including enough caloric and protein that is based on Harris-Benedict principle and patient's disease condition to fit with patient's requirement. |
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