老年重症破伤风患者的临床特点及救治经验

目的分析12例老年重症破伤风患者的临床表现、治疗及转归,总结老年重症破伤风患者的患病特点及救治经验。方法回顾性分析我科2013年6月24日—2017年5月6日救治的12例老年重症破伤风患者资料。结果总体救治成功9例(75.00%),死亡3例(25.00%)。气管切开者11例,气管切开后存活率81.82%;11例发生院内感染者,以呼吸道及泌尿道感染最多见,主要病原体为鲍曼不动杆菌及嗜麦芽窄食单胞菌,最常见的真菌感染是酵母菌。抗生素治疗时间平均为(11.29±7.50)d,抗感染治疗有效率100%。12例患者平均住院时间(27.50±15.21)d。结论老年重症破伤风患者潜伏期长,病初症状不典型。及早识别重症患者,尽早气管切开、合理抗感染及营养支持是老年重症破伤风救治成功的关键。

Clinical characteristics and treatment experience of elderly patients with severe tetanus

Objective To analyze the clinical manifestation,treatment and outcome of 12 elderly patients with severe tetanus,and summarize the feature and therapeutic experience in treatment of severe tetanus for elderly patients.Methods The data of 12 elderly patients with severe tetanus treated in our department from June 24,2013 to May 6,2017 were retrospectively analyzed.Results Overall,9 cases(75.00%)were successfully treated and 3 cases(25.00%)died.Eleven cases received a tracheotomy and their survival rate was 81.82%.Eleven cases suffered nosocomial infection,among them,respiratory tract infection and urinary tract infection were the most prevalent,and Acinetobacter baumannii and Stenotrophomonas maltophilia were the main pathogens.The most common fungal infection was yeast.The mean duration of antibiotic treatment was(11.29±7.50)d,the effective rate of anti-infection treatment was 100%.The mean hospitalization time of 12 patients was(27.50±15.21)d.Conclusions The elderly patients have a long incubation period and atypical initial symptoms.Early identification of severe patients,early tracheotomy,reasonable anti-infection and nutritional support are the key measures in successful treatment of severe tetanus in the elderly.