ISSN 1674-3865  CN 21-1569/R
主管:国家卫生健康委员会
主办:中国医师协会
   辽宁省基础医学研究所
   辽宁中医药大学附属医院

中国中西医结合儿科学 ›› 2020, Vol. 12 ›› Issue (5): 413-417.doi: 10.3969/j.issn.1674-3865.2020.05.013

• 临床研究 • 上一篇    下一篇

重症渗出性多形红斑并发闭塞性细支气管炎5例临床分析及文献复习

张继燕,陈艳萍   

  1. 410007 长沙,湖南省儿童医院呼吸内科
  • 出版日期:2020-10-25 发布日期:2020-11-28
  • 通讯作者: 陈艳萍,E-mail:814415605@qq.com
  • 作者简介:张继燕(1989-),女,医学硕士,医师。研究方向:小儿呼吸系统疾病的诊治

Clinical analysis of 5 cases of StevensJohnson syndrome complicated with bronchiolitis obliterans and literature review

  • Online:2020-10-25 Published:2020-11-28

摘要: 对2016年来5例诊断重症渗出性多形红斑(StevensJohnson综合征,SJS)合并闭塞性细支气管炎(BO)后的临床表现、胸部CT、治疗、预后的分析。3例有明确的用药史;5例均有咳嗽、喘息症状,其中4例出院前均有干湿啰音,出院后一直门诊随诊。1例出院后1周出现咳嗽喘息症状,出院后3个月诊断BO。5例患者中均有斑片状影、2例充气不均合并气管壁增厚、2例肺透亮度增高,2例呈典型马赛克征。治疗转归:5例患儿在急性期均使用了激素和免疫球蛋白,2例予血浆置换。5例均行纤维支气管镜灌洗,1例黏膜糜烂明显,1例气管下欠通畅。诊断BO后5例使用口服激素,同时雾化激素及口服阿奇霉素、孟鲁司特,其中1例家属擅自停药间断1个月。对其中4例进行随访0.5~3年,1例喘息已完全改善,2例活动时有喘息(成功脱氧气),1例安静时稍喘息。1例CT明显改善。SJS患者合并BO影响远期预后,临床表现为咳嗽喘息,治疗后临床症状好转早于CT的改善。

关键词: 重症渗出性多形红斑, 闭塞性细支气管炎, 喘息, 儿童

Abstract: The clinical features of 5 cases of StevensJohnson syndrome complicated with bronchiolitis obliterans(BO), chest CT, treatment and prognosis were analyzed.Three cases had a clear history of medication; 5 cases had cough and wheezing symptoms,4 of which had wet and dry murmurs before discharge, and had been followed up in the clinic after discharge. One patient developed cough and wheezing symptoms one week after discharge,and was diagnosed with BO 3 months after discharge. All 5 patients had patchy shadows,2 patients had uneven inflation combined with thickened tracheal wall; 2 patients had increased pulmonary transparency,and 2 patients had typical mosaic signs. Treatment and prognosis: 5 patients were treated with hormones and immunoglobulins in the acute phase,and 2 patients received plasma exchange. All 5 cases underwent fiber bronchoscopic lavage,1 case had obvious mucosal erosion,and 1 case was a little blocked in the lower trachea. Oral hormones were used in 5 cases after the diagnosis of BO,while nebulized hormones was used and azithromycin and montelukast were taken orally. One of the family members stopped the drug for 1 month. Four patients were followed up for 0.5~3 years. One patient's wheezing had completely improved,two patients had wheezing (successful deoxygenation) while moving,and one patient had some wheezing when being quiet. CT was significantly improved in 1 case. Combining BO in SJS patients affected longterm prognosis,and the clinical manifestations were cough and wheezing,and the improvement in clinical symptoms was earlier than CT

Key words: Stevens-Johnson syndrome, Bronchiolitis obliterans, Wheeze, Children