非新生儿破伤风诊疗规范

中国已于2012年消除了新生儿破伤风,但非新生儿破伤风仍是一个严重的公共卫生问题。非新生儿破伤风重症患者在无医疗干预的情况下,病死率接近100%,即使经过积极的综合治疗,全球范围病死率仍为30%-50%,是一种极为严重的潜在致命性疾病。为规范中国非新生儿破伤风诊疗行为,提高医疗质量,保障医疗安全,特制定本规范。本规范包括非新生儿破伤风的病原学、流行病学、发病机制、临床表现、实验室检查、诊断、鉴别诊断、分级、治疗等内容。     

预防破伤风 你做对了吗

正说起破伤风,很多人都不陌生。这是一种极为严重的潜在致命性疾病,在没有医疗干预的情况下,尤其是老年人和婴幼儿,病死率接近100%,即便治疗,全球病死率仍高达30%～50%。所以,预防破伤风极为重要。但是,在我国,如何正确预防破伤风至今存在着很多的认知盲区和误区。本刊特地邀请了北京大学人民医院急诊外科主任王传林,详细解读如何正确预防破伤风。     

哪种情况该打破伤风针

正破伤风,一个几乎快要被人忘记的古老的疾病。由于现在病人已很少,大多数人对破伤风就不以为然了。不知道这是一种极为严重的潜在致命性疾病。破伤风在没有医疗干预的情况下,尤其是老年人和婴幼儿,病死率接近100%,即便治疗,病死率仍高达30%～50%。可喜的是,破伤风的预防效果很好。开放性外伤(特别是伤口深、污染严重者)有感染破伤风的危险时,     

新生儿破伤风治疗近况

解放后,在预防为主方针的指导下,普遍开展新法接生,新生儿破伤风已明显减少。但在部分农村地区仍有较高的发病率,病死率可占新生儿感染性疾病死亡的首位。因此,新生儿破伤风仍是危害农村新生儿生命的严重疾病。本文就近年来新生儿破伤风治疗的近况和进展综述如下,供临床参考。新生儿破伤风是一严重疾病,很多病儿由于严重痉挛导致窒息,全身衰竭或继发感染而死亡,因此在治疗上除尽早用抗     

珠海市2006～2010年新生儿破伤风流行病学特征及影响因素分析

目的:了解珠海市新生儿破伤风流行病学特征,为制定干预措施提供依据。方法:利用新生儿破伤风监测系统获得新生儿破伤风资料并进行统计分析。结果:2006～2010年珠海市新生儿破伤风发病率呈逐年下降趋势,年均发病率为0.46‰,年均病死率为7.69%,年均死亡率为0.035‰,病例全部为外来流动人群,分娩方式均为非住院分娩。结论:外来流动人群是新生儿破伤风发病的高危人群,非住院分娩是新生儿破伤风发病的主要原因。应采取综合干预措施提倡和推广住院分娩,消除新生儿破伤风。     

信宜县113例新生儿破伤风病例分析

信宜县１１３例新生儿破伤风病例分析邱文振新生儿破伤风是发展中国家严重的卫生问题，我国新生儿破伤风的发病率仍较高，为了解我县的新生儿破伤风发病情况，对１９９３年新生儿破伤风进行了分析，现报告如下：１资料来源与方法资料来源收集信宜县人民医院１９９３年１月...     

1999～2005年贵港市新生儿破伤风流行病学分析

目的了解新生儿破伤风(NT)发病原因,以便制定消除NT的策略。方法对贵港市1999～2005年新生儿破伤风进行流行病学分析。结果新生儿破伤风发病率在0.24～0.84‰,2003年前有1～2个县发病率≥1‰,病死率为3.45%～19.05%。全年均有病例发生,男女性别为4.211。新生儿破伤风病例96.62%在家分娩,其中87.84%是由非医务人员接生,所有的母亲几乎未接种过破伤风类毒素。结论经济落后、文化程度低、医疗保健水平薄弱和交通不便等是造成NT发病的主要原因,提高住院分娩率是控制NT的关健。     

新生儿破伤风40例综合治疗效果观察

目的了解新生儿破伤风的临床特征,观察新生儿破伤风临床治疗疗效,以提高新生儿破伤风抢救水平。方法对40例新生儿破伤风患者抗感染、应用破伤风抗毒素、控制痉挛、加强护理等治疗。结果本组40例患儿中有38例并发肺炎(95.0%),5例并发败血症(12.2%),10例合并皮肤感染(25.0%)如尿布疹、褥疮等。40例中治愈35例(87.5%),疗程30～90d;3例因家庭困难放弃治疗出院,2例因合并严重败血症死亡。结论新生儿破伤风临床症状典型,易诊断。新生儿破伤风关键在于预防,治疗较复杂,需注意控制惊厥,抗感染,营养支持,加强护理等综合治疗,方能取得较满意的临床疗效。     

新生儿破伤风预后的危险因素非条件Logistic回归分析

【目的】分析各项危险因素对新生儿破伤风患儿的综合作用。【方法】对297例新生儿破伤风患儿进行单因素分析，将单因素分析得出的显著性变量，进入非条件Logistic回归模式进行危险因素多元回归分析，计算OR值及其95％可信限等。筛选出相互独立的危险因素与新生儿破伤风病死率的关系。【结果】潜伏期、痉挛前期、痉挛发作持续时间、开始治疗的时间及并发症均为影响新生儿破伤风预后的主要危险因素。【结论】积极控制新生儿破伤风预后的各项危险因素，可降低新生儿破伤风病死率，改善预后。     

国内外破伤风防控现状

破伤风感染是大部分发展中国家危害人群健康的重要公共卫生问题之一。与国外相比,我国新生儿破伤风发病率高于欧洲地区国家及美国,没有建立成人破伤风监测,缺乏成人及孕产妇破伤风免疫策略,存在破伤风抗毒素或破伤风免疫球蛋白滥用现状,使医疗风险加大。同时,仍有较高的成人破伤风发病率。因此,应完善破伤风免疫策略,提高公众及医务人员对破伤风正确预防的认知,加强成人破伤风疫苗研发,促进我国破伤风防控工作开展。本文综述了国内外破伤风在诊断、监测、流行情况、控制策略及使用疫苗等方面的现状。     

Tetanus disease and deaths in men reveal need for vaccination

With efforts focused on the elimination of maternal and neonatal tetanus, less attention has been given to tetanus incidence and mortality among men. Since 2007 voluntary medical male circumcision has been scaled-up in 14 sub-Saharan African countries as an effective intervention to reduce the risk of human immunodeficiency virus (HIV) acquisition among men. As part of a review of adverse events from these programmes, we identified 13 cases of tetanus from five countries reported to the World Health Organization (WHO) up to March 2016. Eight patients died and only one patient had a known history of tetanus vaccination. Tetanus after voluntary medical male circumcision was rare among more than 11 million procedures conducted. Nevertheless, the cases prompted a review of the evidence on tetanus vaccination coverage and case notifications in sub-Saharan Africa, supplemented by a literature review of non-neonatal tetanus in Africa over the years 2003–2014. The WHO African Region reported the highest number of non-neonatal tetanus cases per million population and lowest historic coverage of tetanus-toxoid-containing vaccine. Coverage of the third dose of diphtheria–tetanus–polio vaccine ranged from 65% to 98% across the 14 countries in 2013. In hospital-based studies, non-neonatal tetanus comprised 0.3–10.7% of admissions, and a median of 71% of patients were men. The identification of tetanus cases following voluntary medical male circumcision highlights a gender gap in tetanus morbidity disproportionately affecting men. Incorporating tetanus vaccination for boys and men into national programmes should be a priority to align with the goal of universal health coverage.     

外伤后破伤风疫苗和被动免疫制剂使用指南

外伤后破伤风是非新生儿破伤风的主要类型。为指导基层医疗机构做好外伤后破伤风的预防控制工作,尤其是外伤后的预防处置,降低破伤风发病率及病死率,中国疾病预防控制中心国家免疫规划技术工作组参考《2017年世界卫生组织破伤风立场文件》,以及国内外最新研究进展,制定了本指南。本指南主要介绍了外伤后破伤风预防处置的基本流程,破伤风疫苗和被动免疫制剂的使用方法及潜在外伤高危人群的暴露前免疫。     

2005-2011年温州市新生儿破伤风疫情监测分析

目的 为监测新生儿破伤风发病及其趋势,为当地防控新生儿破伤风提供科学依据.方法 对2005-2011年全市县级以上医疗机构病案室登记的新生儿破伤风病例进行调查,并与国家疾病监测信息报告系统报告的新生儿破伤风病例进行核对;对病案室登记的新生儿破伤风病例的出生场所、户籍所在地也进行调查.结果 全市总的新生儿破伤风漏报率为19.90％;年均发病率为0.35/10万,呈逐年下降趋势;在家里分娩的占90.91％;发病者中以贵州籍为最多,占全部外省户籍的72.31％.结论 当地新生儿破伤风病例仍存在一定的漏报,故在评估新生儿破伤风疫情及其流行程度时需对此加以考虑.贵州等省籍的外来流动人群的孕妇选择在家里分娩是目前发生新生儿破伤风的主要高危因素,急需采取有效的干预措施,以减少和杜绝新生儿破伤风病例的发生.     

Mortality from neonatal tetanus in rural C?te d'Ivoire

A 30-cluster survey was carried out in order to estimate the incidence of neonatal tetanus in rural Côte d''Ivoire. Births in the 19 months preceding the survey were enumerated by interviewers in house-to-house visits. If a child born in that period had died, the interviewer asked a series of questions to establish a presumptive diagnosis of neonatal tetanus. A total of 41 deaths from neonatal tetanus was found in the study area among 2324 live births that occurred from 1 January 1981 to 31 July 1982. This gives a neonatal tetanus mortality rate of about 2%. Most deliveries and almost all deaths occurred at home, and only about 2% of neonatal tetanus cases were reported through the routine health information system. Birth in a clinic and antiseptic care of the umbilical cord protected infants from neonatal tetanus. Tetanus immunization of all women of child-bearing age is recommended as a preventive measure.     

江西省农村地区儿童保健指标状况及影响因素分析

目的:了解江西省农村地区儿童保健指标的变化情况,探讨围产儿死亡率及新生儿死亡率的影响因素。方法:利用江西省1999年与2005年的妇幼卫生保健年报表,并对随机抽取的妇幼保健人员进行定性访谈。结果:新生儿死亡率、婴儿后期死亡率、婴儿死亡率、5岁以下儿童死亡率、新生儿破伤风发病率、低出生体重儿发生率、5岁以下儿童中重度低体重患病率均有所下降且有显著性差异(P<0.001):围产儿死亡率、新生儿破伤风病死率变化无统计学意义;0～3岁儿童系统管理率下降且有显著性差异(P<0.001)。1999年与2005年围产儿死亡率和新生儿死亡率的影响因素发生变化。结论:提高医疗质量,改善农村地区孕妇与围生儿在围产期医疗保健的可及性。     

Cluster survey for poliomyelitis and neonatal tetanus in Ilorin, Nigeria

The incidence of poliomyelitis and neonatal tetanus in Ilorin Local Government Area was estimated using a 40-cluster, retrospective survey of neonatal tetanus deaths and lameness from poliomyelitis in March and April 1988. The survey identified 19 neonatal tetanus deaths among 1601 livebirths, giving an incidence rate of 14.9/1000 livebirths. Some 31 residual paralytic polio cases were identified among 4576 children aged five to nine years, giving a prevalence rate of 6.8/1000 children in this age group and an annual incidence rate of 38.3/100,000 general population. Immunization of pregnant women with tetanus toxoid, had a greater impact on mortality from neonatal tetanus than delivery in hospital or birth at home attended by a traditional birth attendant. Antenatal coverage with two doses of tetanus toxoid was 62.6%. Poliomyelitis and neonatal tetanus still constitute important causes of childhood morbidity and mortality in Ilorin and antenatal tetanus immunization coverage is not yet sufficient to control neonatal tetanus in this population. The target age for immunization with tetanus toxoid should be extended to include all women of childbearing age. Further retrospective surveys from other Nigerian states are needed to determine the magnitude of the neonatal tetanus problem throughout the country.     

深圳市龙岗区三年来“降消”项目实施情况分析

目的 评价深圳市龙岗区"降低孕产妇死亡率、消除新生儿破伤风"项目的 实施效果.方法 收集深圳市龙岗区2005～2008年孕产妇死亡及新生儿破伤风资料,比较项目实施初期与后期孕产妇死亡率及新生儿破伤风发病率,评价"降消"项目实施效果.结果 2005～2008年孕产妇死亡率分别为78.59/10万、38.14/10万、38.21/10万、12.19/10万,新生儿破伤风发病率分别为0.74‰、0.84‰、0.29‰、0.22‰. "降消"项目实施后,该区孕产妇死亡率(趋势χ2=14.743,P=0.0001)及新生儿破伤风发病率(趋势χ2=14.666,P=0.0001)呈逐年下降趋势,差异有统计学意义.结论 深圳市龙岗区"降消"项目的 实施,有效降低了孕产妇死亡率和新生儿破伤风发病率.     

Poliomyelitis, measles and neonatal tetanus: a hospital based epidemiological study

Vaccine-preventable diseases constitute a major health problem contributing to the morbidity and mortality in many developing countries including Egypt. WHO adopted resolutions to eradicate poliomyelitis by the year 2000, eliminate neonatal tetanus by the year 1995, and reduce measles mortality by 95% and morbidity by 90%, compared to the pre-immunization levels by 1995. Evaluation of preventive programs for these diseases necessitates availability of up to date information on their occurrence. The present study was undertaken to determine the current epidemiological features of poliomyelitis, neonatal tetanus and measles, to identify the trends of these diseases as well as to determine their outcomes and hospital loads. Data about the admitted cases of poliomyelitis, neonatal tetanus and measles were collected from the hospital register of Alexandria fever hospital for five successive years (1992-96). Available information on age, sex, residence, diagnosis, outcome of treatment, dates of admission and discharge were collected. The total number of cases of the three diseases admitted to the hospital during the period 1992-96 were 1406, measles represented 85.4%, neonatal tetanus 13.9% and poliomyelitis 0.7%. The results revealed that in the year 1994 only one case of poliomyelitis was admitted and since then no other cases were reported. The number of measles cases increased gradually in the latter years and about 78% of them were older than five years of age. A significant increase in the age of measles occurrence was observed. A gradual decline in the number of neonatal tetanus cases was observed. These cases were more apt to occur among early neonates but still clustered in certain geographical areas. The results of the study pinpoint the long term impact of the well run program aiming at eradicating poliomyelitis in Alexandria. However, for elimination of neonatal tetanus and controlling measles morbidity, further activities are required including strengthening the surveillance activities for detection of the high risk geographical areas and the high risk factors.     

Mortality from neonatal tetanus in Indonesia: results of two surveys

Two, 30-cluster, retrospective surveys of deaths from neonatal tetanus in Indonesia were conducted during 1982. The first survey, in the city of Jakarta, identified 16 deaths from neonatal tetanus among 2310 live births, giving a mortality rate of 6.9 per 1000 live births. The second survey covered 19 of Indonesia''s 27 provinces. Fifty-three neonatal tetanus deaths occurred among 4971 live births, giving a mortality rate of 10.7 per 1000 live births. Overall, 68.8% of mothers interviewed in the second survey received antenatal care on at least two occasions when tetanus toxoid was, in principle, available.