Xav txog koj kub taub hau, mob lub cev, thiab koj pib noj tshuaj uas kws kho mob sau. Yog tias, ob peb hnub, tej zaum ib lossis ob lub lis piam, koj mam li muaj cov pob liab ntawm koj lub cev, cov qhov txhab hauv koj lub qhov ncauj, hauv koj lub qhov muag, thiab hauv koj lub qhov chaw mos, thiab koj daim tawv nqaij pib ua pob thiab tev tawm zoo li raug hlawv? Qhov no yog ib qho mob txaus ntshai, txaus ntshai heev, thiab tsis tshua muaj. Hnub no peb yuav tham txog qhov mob no hu ua Stevens-Johnson Syndrome (SJS). Nws yog ib qho tseem ceeb heev rau txhua tus kom paub txog qhov no.
SJS thiab TEN yog dab tsi? Qhov txawv ntawm ob qho no yog dab tsi?
Kab mob Stevens-Johnson Syndrome (SJS) yog ib qho kev ua xua hnyav heev, feem ntau yog rau tshuaj. Nws cuam tshuam txog kev puas tsuaj rau peb daim tawv nqaij thiab cov ntaub so ntswg, ua rau cov hlwb tuag thiab daim tawv nqaij tev tawm. Cov ntaub so ntswg yog cov ntaub so ntswg mos mos, noo noo uas kab peb lub qhov ncauj, qhov ntswg, qhov muag, qhov chaw mos, thiab qhov quav.
Muaj lwm yam mob hnyav heev uas peb hu ua Toxic Epidermal Necrolysis (TEN) . Hais yooj yim xwb, SJS thiab TEN zoo li ob sab ntawm tib yam kab mob.
- SJS (Stevens-Johnson Syndrome): Hauv qhov no , tsawg dua 10% ntawm daim tawv nqaij ntawm lub cev raug tshem tawm.
- TEN (Toxic Epidermal Necrolysis): Qhov no yog ib qho mob hnyav heev thiab muaj peev xwm ua rau tuag taus uas ntau dua 30% ntawm lub cev daim tawv nqaij poob.
Vim tias ob qho mob no hnyav heev, tus neeg mob yuav tsum tau mus pw hauv tsev kho mob , qee zaum hauv chav saib xyuas mob hnyav (ICU) lossis chav kub hnyiab.
Leej twg yuav muaj feem kis tau tus kab mob no tshaj?
Txawm hais tias SJS tuaj yeem tshwm sim rau txhua lub hnub nyoog, nws feem ntau tshwm sim rau cov menyuam yaus thiab cov hluas hnub nyoog qis dua 30 xyoo. Nws kuj tuaj yeem tshwm sim rau cov neeg laus. SJS feem ntau tshwm sim rau cov poj niam dua li cov txiv neej.
Muaj qhov sib txawv me ntsis thaum saib qhov laj thawj:
- Tus kab mob SJS tseem ceeb ua rau menyuam yaus mob yog cov kab mob sib kis xws li mob ntsws .
- Qhov ua rau muaj SJS/TEN hauv cov neeg laus yog kev ua xua rau tshuaj .
Cov tsos mob ntawm SJS yog dab tsi tiag?
Nws yog ib qho tseem ceeb heev uas yuav tsum paub txog cov tsos mob no, vim tias thaum koj paub lawv sai npaum li cas, koj thiaj li nrhiav kev kho mob tau sai npaum li ntawd. Cov tsos mob feem ntau tshwm sim hauv ib lossis peb lub lis piam tom qab pib noj tshuaj.
Cov tsos mob thawj zaug yog cov tsos mob ntawm tus mob khaub thuas xws li kub taub hau, mob lub cev, mob taub hau, thiab hnoos. Qhov no ua rau nws nyuaj rau kuaj mob SJS thaum ntxov. Tsuas yog tom qab ntawd cov tsos mob hnyav ntawm daim tawv nqaij thiaj li tshwm sim.
Hauv qab no yog cov tsos mob tseem ceeb ntawm SJS.
| Cov tsos mob | Piav qhia yooj yim xwb |
|---|---|
| Mob tawv nqaij heev | Hnov mob kub hnyiab heev ua rau koj kov tsis tau koj daim tawv nqaij. |
| Kub taub hau thiab mob lub cev | Cov tsos mob muaj xws li kub taub hau heev, mob lub cev, thiab mob taub hau. |
| Cov pob liab thiab cov thaj ua rau thaj | Cov pob liab los yog cov qhov txhab uas pib ntawm lub ntsej muag thiab hauv siab thiab kis mus thoob plaws lub cev. |
| Cov pob khaus thiab cov qhov txhab | Cov hlwv thiab cov qhov txhab mob rau ntawm daim tawv nqaij, sab hauv lub qhov ncauj, caj pas, qhov muag, qhov chaw mos, thiab qhov quav. |
| Kev tev tawv nqaij | Cov hlwv tawg thiab txheej sab saud ntawm daim tawv nqaij tev tawm ua cov nplais loj. |
| Nchuav cov qaub ncaug tawm ntawm lub qhov ncauj | Qaug dej vim yog mob qhov ncauj, tsis muaj peev xwm kaw qhov ncauj. |
| Kev sib cuag qhov muag | Cov hlwv thiab o ntawm lub qhov muag, ua rau nws nyuaj rau qhib lub qhov muag. |
| Mob thaum tso zis | Mob hnyav thaum tso zis vim yog hlwv ntawm cov ntaub so ntswg. |
Cov ua rau mob SJS tseem ceeb thiab cov tshuaj uas ua rau mob SJS
Qhov ua rau mob SJS yog vim koj ua xua rau ib yam tshuaj. Txawm li cas los xij, qhov no tsis tshwm sim rau txhua yam tshuaj. Muaj ntau hom tshuaj uas yuav ua rau mob SJS ntau dua.
| Vim li cas | Kev piav qhia |
|---|---|
| Kev ua xua rau cov tshuaj | Qhov no yog qhov ua rau feem ntau ntawm cov rooj plaub SJS thiab TEN. |
| Kev kis kab mob | Tshwj xeeb tshaj yog rau cov menyuam yaus, nws tuaj yeem tshwm sim los ntawm kev kis kab mob xws li Mycoplasma pneumonia, Herpes, thiab Hepatitis A. |
| Lwm yam laj thawj | Kab mob Graft-versus-host, ib qho teeb meem uas tshwm sim tom qab hloov pob txha, tshuaj tiv thaiv kab mob (tsis tshua muaj), thiab qee zaum tsis pom muaj laj thawj dab tsi. |
Cov tshuaj uas muaj feem yuav ua rau muaj SJS ntau dua
- Cov tshuaj sulfa tua kab mob: Qee hom tshuaj tua kab mob.
- Cov tshuaj tiv thaiv kab mob qaug dab peg: Piv txwv li, cov tshuaj xws li `Phenytoin (Dilantin®)`, `Carbamazepine (Tegretol®)`, `Lamotrigine (Lamictal®)`, `Phenobarbital (Luminal®)`.
- Allopurinol: Ib yam tshuaj siv los kho mob gout thiab qee hom pob zeb hauv lub raum (`Aloprim®`, `Zyloprim®`).
- Cov Tshuaj Tua Kab Mob (NSAIDs): Cov tshuaj tua kab mob uas tsis yog steroidal xws li 'Piroxicam (Feldene®)', 'Diclofenac (Cambia®, Flector®)'. Lwm cov tshuaj xws li 'Nevirapine (Viramune®)'.
- Lwm Cov Tshuaj Tua Kab Mob: Qee lwm hom tshuaj tua kab mob kuj tuaj yeem ua rau qhov no.
Tseem Ceeb: Tsis yog txhua tus neeg yuav mob SJS los ntawm cov tshuaj uas teev nyob ntawm no. Muaj ntau lab tus tib neeg siv lawv. Txawm li cas los xij, cov tshuaj no tau raug txheeb xyuas tias muaj kev pheej hmoo siab dua ntawm kev mob SJS. Tsis txhob tsum noj cov tshuaj uas tus kws kho mob tau sau tseg raws li tsab xov xwm no.
Kev kuaj mob thiab kev kho mob ntawm tus kab mob
Yog tias koj lossis ib tus neeg koj paub muaj cov tsos mob saum toj no, tshwj xeeb tshaj yog tias koj nyuam qhuav pib noj tshuaj tshiab, nws yog ib qho tseem ceeb uas yuav tsum mus rau Chav Kho Mob Thaum Muaj Xwm Ceev (ETU) ntawm lub tsev kho mob ze tshaj plaws tam sim ntawd .
Cov kws kho mob kuaj mob no los ntawm:
- Los ntawm kev kuaj xyuas koj daim tawv nqaij thiab cov ntaub so ntswg (xws li qhov ncauj, qhov muag).
- Los ntawm kev nug txog qib mob uas koj hnov.
- Los ntawm kev saib seb cov tsos mob ntawm daim tawv nqaij kis mus rau qhov twg thiab lawv kis mus rau qhov twg.
- Yog tias tsim nyog, yuav muab ib daim tawv nqaij me me coj mus kuaj (biopsy) tau.
Kev kho mob rau SJS
Lub hom phiaj tseem ceeb ntawm kev kho mob SJS yog kom tsis txhob noj tshuaj uas ua rau muaj tus kab mob, tswj cov tsos mob, tiv thaiv kom tsis txhob muaj teeb meem ntxiv, thiab pab kom daim tawv nqaij rov zoo. Yuav tsum tau mus pw hauv tsev kho mob rau qhov no.
Qee txoj kev kho mob tau teev tseg hauv qab no:
| Txoj kev kho mob | Kev piav qhia |
|---|---|
| Kev tsum tsis txhob siv tshuaj uas ua rau muaj teeb meem | Qhov no yog thawj kauj ruam thiab tseem ceeb tshaj plaws. Cov tshuaj uas xav tias ua rau muaj SJS yuav tsum raug tso tseg tam sim ntawd. |
| Muab cov kua dej thiab ntsev rau lub cev | Qhov tawv nqaij tev tawm ua rau muaj ntau cov kua dej poob ntawm lub cev, yog li cov kua IV siv los muab cov kua dej thiab electrolytes tsim nyog. |
| Kev kho mob ntawm daim tawv nqaij | Daim tawv nqaij raug mob raug npog nrog cov ntaub qhwv tshwj xeeb uas tsis nplaum, ib yam li kho qhov kub hnyiab. |
| Muab kev noj haus zoo | Nws nyuaj rau noj mov vim yog qhov mob hauv qhov ncauj. Vim tias nws siv zog ntau los kho, cov khoom noj uas muaj calorie ntau yog muab los ntawm ib lub raj xa mus rau hauv plab los ntawm lub qhov ntswg (tube-feeding). |
| Kev tswj qhov mob | Qhov no yog ib qho mob heev, yog li ntawd, cov tshuaj tua kab mob muaj zog yuav muab rau. |
| Kev pab kho mob tshwj xeeb | Nrhiav kev pab los ntawm kws kho mob tawv nqaij thiab, yog tias qhov muag raug mob, nrhiav kev pab los ntawm kws kho qhov muag. |
Cov teeb meem ntawm SJS thiab cov teebmeem tom qab kho zoo
Kab mob SJS yog ib yam mob hnyav heev uas ua rau tuag tau. Kwv yees li 10% ntawm cov neeg mob uas muaj kab mob SJS thiab txog li 50% ntawm cov neeg mob uas muaj hom kab mob TEN hnyav dua, tuag. Cov ua rau tuag yog cov teeb meem loj xws li sepsis, mob ntsws, thiab ntau lub cev tsis ua haujlwm.
Txawm tias tus kab mob kho tau zoo lawm los xij, qee tus neeg yuav muaj teeb meem mus sij hawm ntev.
- Kev hloov pauv ntawm daim tawv nqaij: Daim tawv nqaij qhuav, khaus, daim tawv nqaij hloov xim.
- Teeb meem ntawm qhov muag: qhov muag qhuav, qhov muag tsis xis nyob ntau zaus, pom kev tsis meej, nyuaj rau saib lub teeb (photophobia).
- Lwm yam: Tawm hws ntau dhau, mob ntsws, rau tes poob lossis puas, plaub hau poob, saj tsis zoo.
Tseem ceeb heev: Yog tias koj rov raug tshuaj uas ua rau muaj SJS dua, zaum ob koj tus mob yuav hnyav dua li zaum thawj zaug. Yog li ntawd, nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov lub npe ntawm cov tshuaj uas ua rau muaj SJS thiab cov tshuaj zoo sib xws rau koj lub neej thiab qhia rau txhua tus kws kho mob uas koj mus ntsib.
Cov Lus Qhia Txog Kev Coj Mus Tsev
- Kab mob Stevens-Johnson Syndrome (SJS) yog ib qho kev ua xua hnyav heev, uas ua rau tuag taus, feem ntau yog los ntawm tshuaj.
- Cov tsos mob thaum xub thawj muaj xws li kub taub hau thiab mob lub cev, tab sis tom qab ntawd yuav mob mus rau cov pob liab liab ntawm daim tawv nqaij, cov hlwv, thiab daim tawv nqaij tawv.
- Yog tias koj muaj cov tsos mob no tom qab pib noj tshuaj tshiab, mus rau chav kho mob ceev (ETU) ntawm tsev kho mob tam sim ntawd yam tsis muaj kev ncua.
- Txoj kev kho mob tseem ceeb yog nrhiav thiab tsum tsis txhob siv tshuaj uas ua rau muaj tus kab mob, thiab muab kev pab txhawb nqa hauv tsev kho mob.
- Nco ntsoov lub npe ntawm cov tshuaj uas ua rau koj muaj SJS mus tas koj lub neej thiab qhia rau koj tus kws kho mob txog nws txhua zaus koj mus kho mob. Qhov no yuav cawm tau koj txoj sia.
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Tsis muaj lus teb tau muab tso tawm. Ntxiv koj cov lus tawm ntawm no thawj zaug.
Ntxiv koj cov lus