中华皮肤科杂志 ›› 2022, Vol. 55 ›› Issue (8): 669-675.doi: 10.35541/cjd.20220003

• 论著 • 上一篇    下一篇

副肿瘤性天疱疮患者原发肿瘤切除后皮肤黏膜感染及管理分析

曹淼1    崇杉2    胡新媛1    朱学骏1    王明悦1   

  1. 1北京大学第一医院皮肤性病科/护理部  国家皮肤与免疫疾病临床医学研究中心  北京市皮肤病分子诊断重点实验室  国家药品监督管理局化妆品质量控制与评价重点实验室，北京  100034；2北京大学医学部，北京  100191
    曹淼和崇杉对本文贡献相同

  • 收稿日期:2022-01-04 修回日期:2022-04-28 发布日期:2022-08-02
  • 通讯作者: 王明悦 E-mail:wangmy@pku.edu.cn
  • 基金资助:
    国家自然科学基金（81130030、81000694）；北京市自然科学基金（7172214）

Analysis of skin and mucosal infections and their management after primary tumor resection in patients with paraneoplastic pemphigus

Cao Miao1, Chong Shan2, Hu Xinyuan1, Zhu Xuejun1, Wang Mingyue1#br#   

  1. 1Department of Dermatology and Venereology/Nursing Department, Peking University First Hospital, National Clinical Research Center for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing 100034, China; 2Peking University Health Science Center, Beijing 100191, China
    Cao Miao and Chong Shan contributed equally to the article
  • Received:2022-01-04 Revised:2022-04-28 Published:2022-08-02
  • Contact: Wang Mingyue E-mail:wangmy@pku.edu.cn
  • Supported by:
    National Natural Science Foundation of China （81130030, 81000694）; Beijing Municipal Natural Science Foundation （7172214）

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摘要： 【摘要】 目的 分析副肿瘤性天疱疮患者原发肿瘤切除后皮肤黏膜发生感染的情况及危险因素，总结相关护理经验。方法 回顾性分析1999年1月至2021年1月于北京大学第一医院皮肤科确诊并接受原发肿瘤切除的副肿瘤性天疱疮患者的临床特征和术后皮肤黏膜感染情况，分析常见的感染病原体，并通过逻辑回归分析确定感染相关危险因素。结果 共44例副肿瘤性天疱疮患者纳入本研究，男25例（56.8%），女19例（43.2%），年龄（33.8 ± 15.4）岁。术后21例（47.73%）发生皮肤黏膜感染；感染患者术后住院时间M（Q1，Q3）为38（25，60） d，显著长于无皮肤黏膜感染的患者［21（12，23） d，Z = -4.08，P < 0.001］。最常见的病原体是耐甲氧西林金黄色葡萄球菌［15例（34.09%）］。患者单位体重糖皮质激素剂量（OR = 1.21，95% CI：1.00 ~ 1.46，P = 0.047）、接受辅助通气治疗（OR = 9.20，95% CI：2.01 ~ 42.13，P = 0.004）是术后感染的独立危险因素。经积极的治疗和护理，出院时37例（84.1%）恢复良好。结论 皮肤黏膜感染是副肿瘤性天疱疮患者术后常见的并发症，其病原体多为耐药菌，且可导致患者住院时间延长，需关注术后皮肤护理；术后糖皮质激素单位体重剂量高及接受呼吸机支持可能与患者术后的皮肤黏膜感染相关。

关键词: 天疱疮, 治疗, 外科手术, 感染, 围手术期护理, 危险因素, 副肿瘤性天疱疮, 皮肤黏膜感染

Abstract: 【Abstract】 Objective To analyze the occurrence of and risk factors for skin and mucosal infections after primary tumor resection in patients with paraneoplastic pemphigus, and to summarize relevant nursing experience. Methods Clinical characteristics and postoperative skin and mucosal infections were retrospectively analyzed in patients with confirmed paraneoplastic pemphigus, who underwent primary tumor resection in Department of Dermatology, Peking University First Hospital between January 1999 and January 2021. Common infectious agents were analyzed, and infection-related risk factors were identified by logistic regression analysis. Results A total of 44 patients with paraneoplastic pemphigus were included in this study, including 25 （56.8%） males and 19 （43.2%） females, and their age were 33.8 ± 15.4 years. Postoperatively, 21 （47.73%） patients developed skin and mucosal infections, and their postoperative hospital stay （median ［Q1, Q3］） was 38 （25, 60） days, which was significantly longer than that in patients without skin and mucosal infections （21 ［12, 23］ days, Z = -4.08, P < 0.001）. The most common pathogen was methicillin-resistant Staphylococcus aureus （15 cases, 34.09%）. High glucocorticoid dosage per kilogram of body weight （OR = 1.21, 95% CI: 1.00 - 1.46, P = 0.047） and receiving assisted ventilation therapy （OR = 9.20, 95% CI: 2.01 - 42.13, P = 0.004） were independent risk factors for postoperative skin and mucosal infections. After active treatment and care, 37 （84.1%） patients recovered well at discharge. Conclusion Skin and mucosal infections are a common postoperative complication in patients with paraneoplastic pemphigus, and the pathogens are mostly drug-resistant bacteria, which can lead to prolonged hospital stay, so attention should be paid to postoperative skin care; high postoperative glucocorticoid dosage per body weight and respiratory support may be associated with postoperative skin and mucosal infections.

Key words: Pemphigus, Therapy, Surgical procedures, operative, Infection, Perioperative nursing, Risk factors, Paraneoplastic pemphigus, Skin and mucosal infections