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題 名 | Acute Kidney Injury in Toxic Epidermal Necrolysis Syndrome=毒性表皮溶解壞死症候群的急性腎臟損傷 |
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作 者 | 胡瀞暄; 蘇鉉尊; 張乃仁; 鍾文宏; 田亞中; 莊秀樹; 楊瑞永; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷 期 | 22:1 2013.03[民102.03] |
頁 次 | 頁10-19 |
分類號 | 415.7 |
關鍵詞 | 毒性表皮溶解壞死症候群; 急性腎臟損傷; Acute kidney injury; RIFLE; Toxic epidermal necrolysis syndrome; SCORTEN; |
語 文 | 英文(English) |
中文摘要 | 背景:毒性表皮溶解壞死症候群toxic epidermal necrolysis syndrome(TEN),是一種罕見但卻又高度致命的皮膚反應。急性腎臟損傷在此種強烈的皮膚反應是常見的併發症。但對於腎臟受損的表現在此類病例上,卻很少被討論及研究。目的及目標:在此篇研究中,我們利用RIFLE(一種定義Acute kidney injury的工具)指標來定義腎臟受損的程度,藉以表現腎臟受損的程度是否和預後及存活率有相關性,並且討論在其發生率及相關致病因子在毒性表皮溶解壞死症候群案例中的表現。材料及方法:回溯性的病例研究。在1992~2009年間,我們蒐集101名被診斷為毒性表皮溶解壞死症候群而在本院燙傷加護病房接受治療的病患,我們藉由病歷記載做回溯性分析。結果:38(37.6%)TEN病患併發急性腎臟損傷,按照其嚴重度由輕而重區分: risk: 11(10.9%),injury : 8(7.9%)and failure : 19(18.8%)。病患若併發較嚴重的腎臟損傷,有較高的死亡率。且病患當初入院時,若年紀較大,皮膚病灶範圍較大,較高的SCORTEN分數,或是發生敗血症及多重器官衰竭的病患較易有併發急性腎臟損傷的可能。在38名併發腎臟損傷的病患其中31名屬於“早期腎臟損傷”,7名屬於“晚期腎臟損傷”。我們發現晚期才併發腎臟損傷的病患,多因感染及敗血症所導致。結論:在此篇文章,我們發現急性腎臟損傷(AKI)是TEN病患的常見併發症,利用RIFLE criteria對腎臟損傷的嚴重度分級,確實可以幫助我們預測整體的存活率及病患當時腎臟受損的程度,越嚴重的腎臟損傷也伴隨高的死亡率。在TEN病患後期的照護,尤以感染控制為最重要的課題以預防晚期腎臟損傷。 |
英文摘要 | Background:Toxic epidermal necrolysis syndrome (TEN) is a rare but life-threatening skin condition. Acute kidney injury (AKI) is a consequence of TEN. However, the cascade of events leading to renal manifestations secondary to TEN is not so clear.Aim and Objectives:This study, evaluates the severity of AKI using the RIFLE criteria (Risk, Injury, Failure, Loss of function and End stage) in patients with toxic epidermal necrolysis. We also present the overall incidence, risk factors and elements that influenced survival.Materials and Methods:A retrospective review of medical records was performed on 101 cases presenting with TEN all of which were admitted to the Linkou Chang Gung Intensive Care Burn Unit from 1992 to 2009.Results:Out of all the patients that presented TEN; AKI occurred in 38 (37.6%) the distribution of these patients using the RIFLE criteria was the following: Patients with Risk were 11 (10.9%), Injury 8 (7.9%) and Failure 19 (18.8%) patients. Mortality was higher among patients with AKI. Old age, larger skin detachment, and a higher SCORTEN score on admission, sepsis, multiple organ failure and comorbidity such as chronic kidney disease are risk factors for developing AKI. Among the thirty-eight patients, thirty-one patients were classified as early AKI and seven as late AKI. Infection and sepsis are the main reasons that contribute to late AKI.Conclusion:In our observation AKI is common in TEN patients. RIFLE criteria help to predict the degree of kidney injury and overall outcome. The highest class of AKI tends to have the lowest survival rate. Infection control are the upmost important in later period of TEN. |
本系統中英文摘要資訊取自各篇刊載內容。