Tamer KUZUCUOĞLU, Ayten SARAÇOĞLU, Sezer YAKUPOĞLU, Tuncay ERHAN, Burak ERSOY, Recep DEMİRHAN

BÖLGE YANIK MERKEZİ YOĞUN BAKIM ÜNİTESİ’NDE TOKSİK EPİDERMAL NEKROLİZİS’Lİ HASTALAR

Amaç: Toksik epidermal nekrolizis (TEN) sepsis ve ölümle sonuçlanan potansiyel hayatı tehdit edici, ender görülen bir hastalıktır. Bu çalışmanın amacı hastanemiz yanık ünitesine kabul edilen 12 TEN hastasına ait mortalite oranı, ilişkili komorbiditeler, klinik ve epidemiyolojik karakteristiklerini belirlemektir. Yöntem: Yanık yoğun bakım ünitesine kabul edilen TEN tanısı konulmuş 12 hasta çalışmaya dahil edildi. Hastaların yaş, cinsiyet, ilaç kullanımı, cilt yanık hasarının derinliği ve yüzdesi, APACHE II skorları, cerrahi girişimler, hastanede kalış süresi, mekanik ventilasyon süresi, komplikasyonlar, mortalite ve morbidite oranları retrospektif olarak dökümante edildi. Hastaların mortalite oranlarının belirlenmesinde Scorten Skalası kullanıldı. Bulgular: Ortalama yaş 35±5,7 yıldı. Erkek hastaların kadınlara oranı 5:7 idi ve ortalama APACHE II skoru 15,4±3,2 idi. Epidermal ayrılma vücut yüzey alanının %75’inden fazla, median hasta yatış süresi 17±1,2 gündü. Bir hastada parasetamol ve etodolak, 3 hastada fenitoin alım öyküsü bulunmaktaydı. TEN semptomları bir başka hastada antitüberküloz tedavisi sonucunda, 4 hastada da sultamisilin tedavisini takiben ortaya çıktı. Diğer hastaların etyolojisi bilinmiyordu. Median mekanik ventilasyon destek süresi 3,2±0,7 gündü. Mortalite oranı %16,6 (2/12) idi. Sonuç: TEN hastaları yüksek mortalite riskinden dolayı değişik yaklaşımlar ve tedavi stratejileri gerektirirler. Sorumlu ilacın erken dönemde belirlenerek kesilmesinin ve bir yanık merkezinde özel destekleyici tedavi ortamının oluşturulmasının toksik epidermal nekroliziste mortalite oranını düşüreceği kanısına varılmıştır.

PATIENTS WITH TOXIC EPIDERMAL NECROLYSIS IN INTENSIVE CARE UNIT OF REGIONAL BURN CENTER

Objective: Toxic epidermal necrolysis (TEN) is a potentially life-threatening rare disorder, resulting in possible sepsis and death. The aim of this study is to determine the mortality rate, associated comorbidities, the clinical and epidemiological characteristics of 12 TEN patients hospitalized in our burn unit. Method: Twelve patients diagnosed with TEN and admitted to the burn intensive care unit were included in the study. Age, gender, medication, percentage and depth of skin burn damage, APACHE II scores, surgical interventions, hospitalization time, the duration of mechanical ventilation, complications, mortality and morbidity rates of patients were documented in a retrospective manner. The Scorten Scale was utilized to determine the mortality rate of the patients. Results: Mean age was 35±5.7 years. The ratio of males to females was 5:7 and the average APACHE II score was 15.4±3.2. Epidermal detachment was greater than 75% of the body surface area with a mean hospitalization time of 17±1.2 days. One patient had a history of paracetamol and etodolac, 3 had phenytoin medication. TEN symptoms were seen as a result of anti-tuberculosis treatment in another patient and appeared in four patients after treatment with sultamicilin. Other patients had an unknown etiology. Mean duration of mechanical ventilation support was 3.2±0.7 days. The mortality rate was 16.6% (2/12). Conclusion: Due to the high risk of mortality, patients with TEN may require different approaches and management strategies. We concluded that early identification and interception of the responsible drug and the provision of a specialized supportive care in a burn unit may reduce the mortality rate for toxic epidermal necrolysis.

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