Xav txog tias koj nyuam qhuav pib noj tshuaj tshiab rau qee yam mob. Tom qab li ib lossis ob lub lis piam, koj xav tias tsis zoo, zoo li koj yuav mob khaub thuas. Koj lub cev mob, koj xav tias kub taub hau, koj tshee hnyo... Tom qab ntawd, koj lub cev pib tawg ua cov pob liab uas maj mam hloov mus ua cov pob dej, thiab koj daim tawv nqaij pib tev tawm zoo li koj raug kub hnyiab. Qhov no yog ib qho txaus ntshai heev, mob heev, thiab muaj peev xwm ua rau tuag taus. Hnub no peb tab tom tham txog qhov mob txaus ntshai no, uas yog Toxic Epidermal Necrolysis (TEN) .
Hais yooj yim xwb, Toxic Epidermal Necrolysis (TEN) yog dab tsi?
Toxic Epidermal Necrolysis, lossis luv luv TEN, yog ib qho mob ntawm daim tawv nqaij uas mob heev thiab muaj peev xwm ua rau tuag taus. Nws ua rau muaj pob khaus thiab tawv nqaij ntawm ntau qhov chaw ntawm koj lub cev, feem ntau tsawg kawg yog 30% ntawm koj lub cev. Qhov tawv nqaij tawv no kuj tseem tuaj yeem tshwm sim rau thaj chaw uas muaj cov kua qaub ncaug, xws li lub qhov ncauj, qhov muag, thiab qhov chaw mos.
Qhov mob txaus ntshai no feem ntau tshwm sim los ntawm kev tsis haum tshuaj hnyav rau qee yam tshuaj uas peb noj. Thaum daim tawv nqaij raug puas tsuaj loj heev li no, muaj kev pheej hmoo siab ntawm kev qhuav dej thiab kev kis kab mob loj.
Yog hais kom meej, TEN yog hom mob tawv nqaij hnyav tshaj plaws hu ua Stevens-Johnson syndrome (SJS). Hauv SJS, tsawg dua 10% ntawm lub cev daim tawv nqaij poob. Thaum 10% txog 30% ntawm lub cev raug cuam tshuam, peb hu nws ua SJS-TEN overlap mob. Yog tias ntau dua 30% ntawm daim tawv nqaij poob, nws suav tias yog TEN.
Leej twg muaj feem yuav mob no tshaj?
Cov neeg uas lub cev tiv thaiv kab mob tsis muaj zog yuav muaj feem mob Stevens-Johnson syndrome (SJS) lossis TEN ntau dua. Muaj ntau yam ua rau lub cev tiv thaiv kab mob tsis muaj zog.
- Cov neeg uas muaj tus kab mob HIV (human immunodeficiency virus).
- Cov neeg uas muaj qee yam mob qog noj ntshav, xws li lymphoma.
Ntxiv mus, tej yam caj ces kuj tseem ua lub luag haujlwm. Ib txhia neeg lub cev tsis tuaj yeem zom thiab ua kom cov tshuaj muaj zog li qub. Qhov no yog ib yam dab tsi los ntawm lawv cov noob caj ces. Hauv cov xwm txheej zoo li no, cov tshuaj ntawd tuaj yeem sib sau ua ke hauv lub cev thiab ua rau muaj kev tsis haum tshuaj loj xws li SJS lossis TEN. Tsis tas li ntawd, vim muaj kev hloov pauv (kev hloov pauv) hauv qee cov noob caj ces, qee tus neeg yuav muaj feem ntau dua rau qee cov tshuaj.
Txawm hais tias TEN tuaj yeem tshwm sim rau txhua lub hnub nyoog, nws feem ntau tshwm sim rau cov neeg laus. Txawm li cas los xij, nws yog ib qho mob tsis tshua muaj .Nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias thoob ntiaj teb, SJS thiab TEN ua ke tsuas cuam tshuam txog ib lossis ob lab tus tib neeg hauv ib xyoos.
Cov ua rau muaj TEN yog dab tsi?
Feem ntau, cov kws kho mob ntseeg tias qee cov tshuaj yog qhov ua rau muaj TEN. Cia peb saib seb cov tshuaj twg muaj kev pheej hmoo siab dua.
| Pawg tshuaj | Piav qhia yooj yim |
|---|---|
| Allopurinol | Ib yam tshuaj siv los kho cov kab mob xws li pob zeb hauv lub raum thiab gout. |
| Cov tshuaj tiv thaiv kev qaug dab peg | Ib pawg tshuaj uas muab rau kev tswj cov mob xws li qaug dab peg. |
| Cov tshuaj tiv thaiv kab mob retroviral | Tshwj xeeb tshaj yog cov tshuaj siv los kho tus kab mob HIV (piv txwv li nevirapine). |
| Cov tshuaj Oxicams | Cov no yog ib pawg ntawm cov tshuaj tua kab mob thiab tshuaj tiv thaiv kev o uas koom nrog pawg NSAIDs. |
| Cov tshuaj sulfonamides | Cov no yog ib hom tshuaj tua kab mob. |
Ntxiv rau cov tshuaj no, tsis tshua muaj, qee yam kab mob lossis tshuaj tiv thaiv kab mob kuj tuaj yeem ua rau muaj TEN. Tab sis qhov no tsis tshua muaj. Qee zaum, qhov ua rau muaj TEN tsis tuaj yeem nrhiav tau.
Cov tsos mob ntawm TEN yog dab tsi?
Feem ntau cov tsos mob ntawm TEN yuav pib tshwm sim li ntawm ob peb lub lis piam tom qab pib noj tshuaj tshiab. Nws pib nrog cov tsos mob zoo li mob khaub thuas.
- Mob lub cev
- Hnoos
- Kub taub hau thiab mob khaub thuas
- Mob taub hau
- Qhov muag liab thiab o
Tom qab cov tsos mob thawj zaug no, cov pob liab mob (mob pob khaus) pib tshwm sim ntawm daim tawv nqaij. Cov pob no maj mam loj hlob tuaj, hloov mus ua cov pob dej puv nkaus, thiab thaum kawg daim tawv nqaij pib tev tawm. Cov qhov txhab uas tshwm sim thaum daim tawv nqaij tev tawm hu ua erosions . Cov no yog cov qhov txhab mob heev, qhib uas zoo li kub hnyiab hnyav.
Cov qhov txhab no xub tshwm sim rau ntawm lub ntsej muag thiab hauv siab, thiab tom qab ntawd tuaj yeem kis mus rau lwm qhov ntawm lub cev.
- Qhov Muag: Sab hauv ntawm lub qhov muag (conjunctiva) thiab sab nraud ntawm lub qhov muag dub (cornea) tuaj yeem raug puas tsuaj.
- Cov ntaub so ntswg hauv lub qhov ncauj: Cov qhov txhab tuaj yeem tshwm sim hauv lub qhov ncauj, qhov ntswg, caj pas, thiab txoj hlab pa.
- Txoj hlab zis, qhov quav, thiab qhov chaw mos: Cov chaw no kuj tuaj yeem raug mob hnyav.
Cov kev raug mob no ua rau txawm tias cov haujlwm yooj yim xws li noj mov, nqos, ua pa, kaw koj ob lub qhov muag, thiab tso zis mob heev thiab nyuaj heev.
Cov teeb meem loj uas tuaj yeem tshwm sim vim yog TEN
TEN tsis yog ib qho mob uas yuav tsum tau saib yooj yim. Nws tuaj yeem ua rau muaj teeb meem loj heev thiab ua rau tuag taus.
- Kev kis kab mob: Thaum daim tawv nqaij tawg, muaj feem ntau dua uas cov kab mob yuav nkag mus rau hauv lub cev. Yog tias cov kab mob no nkag mus rau hauv cov ntshav, qhov mob txaus ntshai heev hu ua sepsis tuaj yeem tshwm sim.
- Kev ua tsis tiav ntawm ntau yam hauv lub cev: Kev o thiab kev kis kab mob hnyav hauv lub cev tuaj yeem ua rau cov hauv nruab nrog xws li lub raum, siab, thiab lub ntsws ua tsis tiav.
- Mob ntsws (Pneumonia): Muaj kev pheej hmoo ntxiv ntawm kev kis kab mob ntsws vim yog kev raug mob rau txoj hlab pa.
Vim muaj peev xwm ua rau muaj teeb meem loj heev, ib tus neeg uas muaj cov tsos mob TEN yuav tsum tau mus pw hauv tsev kho mob thiab kho tam sim ntawd .
Cov kws kho mob kuaj mob li cas?
Feem ntau tus kws kho mob uas tsim nyog tuaj yeem kuaj mob TEN los ntawm kev kuaj koj daim tawv nqaij thiab nug txog koj cov tsos mob. Qee zaum, yuav tsum tau kuaj daim tawv nqaij kom paub tseeb tias koj muaj mob.
Qhov no suav nrog kev rho ib daim tawv nqaij me me los ntawm qhov mob ntawm daim tawv nqaij thiab siv tshuaj loog los kuaj xyuas hauv qab lub tshuab microscope. Qhov kev kuaj no tuaj yeem pom tseeb tias puas muaj cov hlwb tawv nqaij tuag (cov hlwb necrotic) thiab seb txheej sab saud ntawm daim tawv nqaij (epidermis) puas tau sib cais los ntawm txheej sab hauv qab.
Cov kev kho mob rau qhov no yog dab tsi?
Qhov tseem ceeb tshaj plaws, TEN yog qhov xwm txheej ceev kho mob.Qhov no tsis yog ib yam kab mob uas kho tau hauv tsev. Koj yuav tsum mus rau chav kho mob ceev (ETU) ntawm tsev kho mob tam sim ntawd thaum cov tsos mob pib.
Hauv tsev kho mob, tus neeg mob feem ntau raug xa mus rau chav kho mob hnyav (ICU) lossis chaw kho mob kub hnyiab, vim tias cov neeg mob no xav tau kev saib xyuas tshwj xeeb zoo ib yam li cov neeg mob kub hnyiab.
Cov txheej txheem kho mob muaj peev xwm muab faib ua ob ntu tseem ceeb.
| Cov kev xaiv kho mob rau TEN | |
|---|---|
| Kev kho mob tam sim ntawd | |
| Kev tso tseg cov tshuaj ua rau muaj teeb meem | Txhua yam tshuaj uas xav tias ua rau muaj TEN raug tso tseg tam sim ntawd. |
| Kev tswj cov dej hauv lub cev | Qhov tawv nqaij tev tawm ua rau muaj cov kua dej ntau heev tawm ntawm lub cev. Yog li ntawd, cov kua saline (IV fluids) raug muab los ntawm cov hlab ntsha kom tswj tau cov kua dej hauv lub cev. |
| Kev tiv thaiv kab mob | Cov tshuaj pleev lossis tshuaj pleev tua kab mob yuav raug siv rau cov qhov txhab qhib. Cov tshuaj tua kab mob yuav raug muab rau thaum pom thawj cov cim qhia tias muaj kab mob. |
| Lwm yam kev kho mob tshwj xeeb | |
| Immune globulin (IVIG) | Qhov no yog ib yam kua uas muab los ntawm cov leeg ntshav. Nws muaj cov tshuaj tua kab mob uas tau los ntawm cov ntshav ntawm cov neeg noj qab nyob zoo. Cov no pab tswj lub cev txoj kev tiv thaiv kab mob tsis zoo. |
| Cov tshuaj tiv thaiv kab mob | Cov tshuaj raug muab los tiv thaiv lub cev tiv thaiv kab mob kom tsis txhob tawm tsam nws cov hlwb, ua rau nws txoj haujlwm tsis muaj zog. |
| Kev siv plasmapheresis | Qhov no suav nrog kev xa cov ntshav ntawm tus neeg mob mus rau lub tshuab tshwj xeeb, cais thiab tshem tawm cov tshuaj tua kab mob hauv cov ntshav plasma, thiab xa cov ntshav huv rov qab rau hauv lub cev. |
Cov teebmeem mus sij hawm ntev tom qab rov zoo
Cov neeg uas dim ntawm TEN tej zaum yuav muaj qee yam teeb meem mus sij hawm ntev. Txawm tias daim tawv nqaij kho tau zoo tag nrho los xij, tej zaum yuav muaj lwm yam teeb meem tshwm sim.
- Tawv nqaij, plaub hau thiab rau tes: cov rau tes loj hlob tsis zoo lossis poob tawm, tawv nqaij muaj pob (dub lossis dawb), plaub hau poob rau qee qhov chaw (alopecia areata), tawv nqaij qhuav thiab khaus, hws ntau dhau.
- Qhov Muag: Qhov muag o lossis liab mus sij hawm ntev, qhov muag qhuav, qhov muag tsis zoo li qub, rhiab rau lub teeb, pom kev tsis meej lossis, tsis tshua muaj, dig muag.
- Qhov Ncauj, qhov ntswg thiab lub cev ua pa: Mob ntsws (bronchitis), cov kab mob ntsws xws li COPD, qhov ncauj qhuav, kab mob pos hniav, tsis hnov qab thiab tsis hnov tsw, lub ntsws puas tsuaj.
- Cov kab mob tso zis thiab kev yug me nyuam: Kev raug mob ntev lossis o ntawm txoj hlab zis, qhov chaw mos, lossis qhov chaw mos, nyuaj tso zis, qhov chaw mos qhuav rau cov poj niam.
Nws yog ib qho tseem ceeb heev uas yuav tsum tau nrog koj tus kws kho mob tham txog cov teebmeem mus sij hawm ntev no thiab nrhiav kev kho mob uas tsim nyog.
Cov Lus Qhia Txog Kev Coj Mus Tsev
- Toxic Epidermal Necrolysis (TEN) yog ib qho kev tsis haum tshuaj loj heev, uas yuav ua rau tuag taus rau qee yam tshuaj.
- Nws pib nrog cov tsos mob xws li kub taub hau thiab mob lub cev, tab sis tom qab ntawd nce mus rau qhov mob hlwv thiab tawv nqaij tawv zoo li kub hnyiab.
- Qhov no yog xwm txheej ceev hauv kev kho mob. Yog tias koj muaj cov tsos mob no, koj yuav tsum mus rau chav kho mob ceev (ETU) ntawm tsev kho mob tam sim ntawd.
- Yog koj daim tawv nqaij tawm pob liab, ua pob liab, lossis lwm yam tsos mob txawv txawv tom qab pib noj tshuaj tshiab, tsis txhob tsis quav ntsej txog nws. Mus ntsib koj tus kws kho mob tam sim ntawd.
- Yog tias koj tau muaj kev tsis haum tshuaj rau ib yam tshuaj twg yav dhau los, nco ntsoov qhia rau koj tus kws kho mob txog qhov no thaum twg koj mus nrhiav tshuaj.
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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