中华皮肤科杂志 ›› 2021, Vol. 54 ›› Issue (9): 790-797.doi: 10.35541/cjd.20210549

• 论著 • 上一篇    下一篇

皮肤科病房危重症1 057例临床分析

龙海1    蒋丽1    邱月棨1    姚南1    刘力聪1    谢昱明1    熊峰1    谭思齐1    匡琪琪1    尤睿璇1    柴可1    罗鑫1    龙浩君1    忻悦1    郭子瑜1    王佳琪1    谭怡忻1    张庆1    张桂英1    李亚萍1    苏玉文1    肖嵘1    陆前进1，2   

  1. 1中南大学湘雅二医院皮肤科  中南大学皮肤性病研究所  皮肤重大疾病与皮肤健康湖南省临床医学研究中心，长沙  410011；2中国医学科学院、北京协和医学院皮肤病医院，南京  210042
  • 收稿日期:2021-08-02 修回日期:2021-08-23 发布日期:2021-09-02
  • 通讯作者: 陆前进 E-mail:qianlu5860@pumcderm.cams.cn
  • 基金资助:
    “湖湘青年英才”支持计划项目（2018RS3031）；皮肤重大疾病与皮肤健康湖南省临床医学研究中心建设项目（2016SK4001）；湖南省高层次卫生人才“225”工程项目（2019-196）；长沙市杰出创新青年培养计划项目（kq1802002）

Clinical analysis of 1 057 patients with critical illnesses in a dermatological ward

Long Hai1, Jiang Li1, Qiu Yueqi1, Yao Nan1, Liu Licong1, Xie Yuming1, Xiong Feng1, Tan Siqi1, Kuang Qiqi1, You Ruixuan1, Chai Ke1, Luo Xin1, Long Haojun1, Xin Yue1, Guo Ziyu1, Wang Jiaqi1, Tan Yixin1, Zhang Qing1, Zhang Guiying1, Li Yaping1, Su Yuwen1, Xiao Rong1, Lu Qianjin1,2   

  1. 1Department of Dermatology, The Second Xiangya Hospital of Central South University, Institute of Dermatology and Venereology of Central South University, Hunan Clinical Medicine Research Center for Major Skin Diseases and Skin Health, Changsha 410011, China; 2Hospital of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China
  • Received:2021-08-02 Revised:2021-08-23 Published:2021-09-02
  • Contact: Lu Qianjin E-mail:qianlu5860@pumcderm.cams.cn
  • Supported by:
    Hu-Xiang Talents Program of Science-Technology Department of Hunan Province （2018RS3031）; Construction Project of Hunan Clinical Medicine Research Center for Major Skin Diseases and Skin Health （2016SK4001）; “225 Project” of Hunan Health Commission （2019-196）; Outstanding Innovation Talents Program of Changsha Science-Technology Bureau （kq1802002）

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摘要： 【摘要】 目的 总结皮肤科病房危重症患者的临床特点及救治经验。方法 收集中南大学湘雅二医院皮肤科病房2011年7月9日至2020年12月31日期间收治的所有“病危”、“病重”患者，回顾其病历资料，总结疾病种类及构成比、主要并发症、病危/病重原因、重要救治措施及病情转归，对死亡病例进行死亡原因分析。结果 共收治危重症患者1 057例，男女比例1∶1.11，18 ~ 65岁者占64.81%，收治病种主要涉及药疹（332例）、结缔组织病（226例）、大疱性皮肤病（104例）、银屑病（57例）、红皮病（45例）、感染性皮肤病（67例）等。其中，银屑病（39例）和红皮病（32例）以男性居多，结缔组织病（168例）以女性为主。常见并发症主要涉及感染、重要脏器损害或器官功能不全、低白蛋白血症及水电解质酸碱失衡。病危患者94例，告病危的主要原因涉及皮肤原发疾病、血液系统异常、呼吸衰竭、神经系统异常、肾功能衰竭、脓毒症、水电解质酸碱失衡。在危重症的救治过程中，43例使用大剂量糖皮质激素冲击治疗，264例使用丙种球蛋白冲击治疗，355例输入其他血液制品，34例实施血液灌流/免疫吸附、血浆置换、透析或人工肝等特殊治疗；42例转入重症监护室救治，12例转入外科手术，12例转入妇产科分娩或引产。经救治，989例（93.57%）好转出院。14例（1.32%）死亡，其中，7例因继发脓毒症、2例因严重肺部感染、2例因呼吸黏膜脱落堵塞气道致窒息死亡，其他3例分别因消化道大出血、脑出血、神经精神性狼疮死亡。结论 皮肤科病房危重病例主要集中在重症药疹、结缔组织病和大疱性皮肤病等重症皮肤病以及合并重要基础疾病、出现重要器官功能障碍、脓毒症或严重的水电解质酸碱失衡等并发症的患者。治疗上，应尽早明确诊断并进行病情严重程度评估，监测及防范可能出现的并发症，及时请相关学科会诊协助。

关键词: 皮肤疾病, 危重病, 药疹, 结缔组织疾病, 皮肤疾病, 水疱大疱性, 感染, 死亡原因, 合并症, 并发症, 救治措施

Abstract: 【Abstract】 Objective To summarize clinical characteristics of and treatment experience with patients with critical illnesses in a dermatological ward. Methods All patients with serious or life-threatening conditions，who were hospitalized at the dermatological ward of the Second Xiangya Hospital of Central South University from July 9, 2011 to December 31, 2020, were collected, and their clinical data were retrospectively analyzed. Demographic characteristics, disease types and proportions, main complications, causes of serious or life-threatening conditions, important treatment measures and outcomes were summarized, and causes of death were also analyzed and discussed. Results A total of 1 057 patients with critical illnesses were collected, with a male-to-female ratio of 1∶1.11, and 64.81% of them aged 18 to 65 years. The types of diseases mainly included drug eruptions （332 cases）, connective tissue diseases （226 cases）, bullous skin diseases （104 cases）, psoriasis （57 cases）, erythroderma （45 cases）, infectious skin diseases （67 cases）, etc. Among them, psoriasis （39 cases） and erythroderma （32 cases） mostly occurred in males, and connective tissue diseases （168 cases） mostly occurred in females. Common complications mainly involved infections, important organ damage or dysfunction, hypoalbuminemia, and fluid, electrolyte and acid-base imbalances. A total of 94 patients were diagnosed with life-threatening conditions, which were found to be mainly caused by primary skin diseases, hematologic abnormalities, respiratory failure, nervous system abnormalities, renal failure, sepsis, fluid, electrolyte and acid-base imbalances, etc. During the management of critical illnesses, 43 patients were treated with high-dose glucocorticoid pulse therapy, 264 were treated with gamma-globulin pulse therapy, 355 were transfused with other blood products, and 34 received special therapies such as hemoperfusion/immunoadsorption therapy, plasma exchange, dialysis, artificial liver support therapy; 42 patients were transferred to the intensive care unit （ICU）, 12 were transferred to the department of surgery for operations, and 12 were transferred to the department of obstetrics and gynecology for delivery or induction of labor. After treatment, 989 patients （93.57%） achieved improvement and were discharged. A total of 14 patients （1.32%） died, of whom 7 died of secondary sepsis, 2 died of severe pulmonary infections, 2 died of asphyxia caused by respiratory mucosa shedding-induced airway obstruction, the other 3 died of gastrointestinal hemorrhage, cerebral hemorrhage and neuropsychiatric systemic lupus erythematosus, respectively. Conclusions Critical cases in the dermatological ward mainly suffered from serious skin diseases such as severe drug eruptions, connective tissue diseases and bullous skin diseases, as well as complications such as severe underlying diseases, severe organ dysfunction, sepsis or severe fluid, electrolyte and acid-base imbalances. In terms of treatment, it is of critical significance to make a clear diagnosis and assess the severity of disease as early as possible, monitor and prevent possible complications, and to consult with specialists in relevant disciplines in time.

Key words: Skin disease, Critical illness, Drug eruptions, Connective tissue diseases, Skin diseases, vesiculobullous, Infection, Cause of death, Coexisting diseases, Complications, Treatment measures