成人重症破伤风45例治疗方法的探讨

目的探讨成人重症破伤风的治疗方法。方法搜集2000年以来成人重症破伤风病资料45例,分析治疗方法及疗效。结果45例病人均予以清创,注射破伤风抗毒素、抗感染、营养支持、镇静解痉等综合治疗。29例行气管切开,其中5例行呼吸机辅助呼吸,16例未行气管切开,45例病人中12例并发肺部感染,其中气管切开组4例,未切开组8例,1例并发下肢静脉血栓。结论成人重症破伤风,注重规范化的综合治疗,病程中加强心肺器官的保护,早期行气管切开和应用呼吸机辅助呼吸,可明显提高治愈率,改善病人预后。     

综合治疗方案在成人重症破伤风治疗中的疗效观察

目的:探讨综合治疗方案在成人重症破伤风治疗中的临床效果。方法:回顾广西柳州市工人医院重症医学科二病区38例成人重症破伤风患者临床资料,对所有患者实施包含创口处理、应用抗毒血清、控制并解除痉挛、抗生素治疗、预防性气管切开、心理治疗、营养支持在内的综合治疗。结果:经综合治疗后,38例患者治愈37例,死亡1率,治愈率为97.4%。结论:针对重症破伤风患者,给予规范综合治疗,并早期行气管切开并运用呼吸机辅助呼吸,临床疗效显著。     

5例重症破伤风患者的护理观察

目的总结重症破伤风患者的临床护理经验.方法：回顾性总结分析5 例海洛因成瘾者患重症破伤风合并戒断症状的救治和护理方法.结果：5 例重症破伤风患者1 例死亡,4 例痊愈出院.结论：有效的治疗措施和精心的护理可减少并发症,提高重症破伤风患者的治愈.     

成人重症破伤风12例治疗体会

目的 探讨成人重症破伤风的治疗方法.方法 对患者予静脉滴注大剂量破伤风抗毒素(TAT),以3～6万U配葡萄糖液维持静滴至抽搐停止.根据痰培养及药敏结果,选用头孢类抗生素或喹诺酮类抗生素药物治疗肺部感染.结果 12例患者全部治愈,无一例死亡,平均住院42 d,出院时均未遗留有明显的神经系统等症状.结论 成人重症破伤风应注重规范化的综合治疗,病程中加强心肺器官的保护,早期行气管切开和应用呼吸机辅助呼吸可明显提高治愈率,改善患者预后.     

13例重症成人破伤风的救治与护理

目的:探讨重症破伤风患者的治疗与护理。方法:回顾分析2006年6月至2010年2月我科监护室收治的13例重症成人破伤风的救治及护理。结果:13例患者12例治愈出院,1例死亡。结论:良好的重症监护条件、及早的气管切开及机械通气、积极控制痉挛与抽搐、及早的肠内外营养支持、精心细致的做好各项基础护理工作是减少并发症,改善患者预后及患者康复的重要保证。     

肌松剂联合麻醉镇静辅以有创机械通气救治极重症破伤风12例体会

目的 总结探讨极重症破伤风的临床特点及有效的救治措施.方法 对2005年以来笔者所在科室采用肌松剂联合麻醉镇静辅以气管切开有创机械通气救治的12例极重症破伤风患者进行回顾分析.结果 2例放弃治疗,1例后遗脑缺氧痴呆,余9例均完全治愈,无并发症,无院内死亡病例.结论 肌松剂联合麻醉镇静辅以气管切开有创机械通气救治极重症破伤风疗效满意,是临床救治极重症破伤风的有效方法.     

重症破伤风感染的救治

目的研究重症破伤风的救治经验,探索降低破伤风患者死亡率的有效方法。方法回顾分析2004—2010年收治的9例破伤风患者的临床特点及救治经过,总结破伤风救治的经验和教训。结果 2008年5月急诊ICU成立之前收治的4位患者,均未接受重症监护,3例死亡,死者均未行气管切开;2008年5月之后收治的5位患者,均接受重症监护和气管切开,1例死亡。结论伤后正规创面处理,常规预防注射（tetanus antitoxin,TAT）破伤风抗毒素TAT,及时转入ICU,采取积极的综合措施防治并发症（快速气管切开与有效镇静是关键）,是破伤风有效防治措施。     

安定,冬眠Ⅰ号联合治疗重症破伤风14例临床分析

安定、冬眠Ⅰ号联合治疗重症破伤风１４例临床分析李成秋，王敬余，高树华，马淑玲（沂南县人民医院）关键词破伤风；安定；冬眠Ⅰ；药物疗法我院自１９８９年３月～１９９４年共收治成人重症破伤风１４例。在病原综合治疗基础上采用安定、冬眠１号联合治疗，效果满意，报...     

爆竹炸伤致重症破伤风5例抢救与护理

目的 探讨在使用镇静剂的基础上,尽早气管切开、精心的护理与重症破伤风患者成功救治的关系.方法 回顾性分析我科2011年1月-2012年6月,由爆竹炸伤致重症破伤风患者5例的临床资料及其救治效果.结果 5例患者3例采取镇静剂、气管切开、机械通气,2例采取镇静剂、气管切开,均获得治愈.结论 重症破伤风患者在使用镇静剂的基础上,尽早的气管切开、精心的护理是保证成功救治、预防并发症发生的关键.     

大剂量安定治疗36例破伤风的疗效观察

目的 对36例成人破伤风的临床表现及治疗进行总结,提高成人破伤风的治愈率,降低病死率.方法 回顾性分析36例成人破伤风患者的临床资料,比较他们的临床治疗情况.结果 36例治愈31例,好转后出院3例,2例死亡.结论 对破伤风的治疗,除常规治疗外,采用大剂量安定持续静脉注射来控制痉挛,保持呼吸道通畅,是抢救成功的关键.     

Tetanus in adults--a continuing problem: an analysis of 217 patients over 3 years from Delhi, India, with special emphasis on predictors of mortality

Tetanus is still widely prevalent in many parts of the world especially in the developing countries. This study was conducted to assess the demographic and clinical features, treatment and outcome of tetanus in adults with a special emphasis on identification of predictors of mortality. This was a retrospective study of all adult patients admitted with tetanus over a three-year period from 1998 to 2000 at Lok Nayak Hospital, New Delhi, India. The demography, clinical features, treatment and complications of the patients were assessed and were evaluated against two possible outcomes- survival or death, to identify the predictors of mortality. There were 217 adults (148 males, 69 females) admitted with generalized tetanus during the study period. The mean age of the patients was 36.08 +/- 18.84 years. In most instances (63.5%), wounds / injuries served as the source of infection. Overall 31.8% had mild, 21.7% had moderate and 46.5% had severe disease at presentation. Respiratory failure and dysautonomia were the frequently observed complications. Of the 217 patients, 82 died - a mortality rate of 37.78%. Parameters that were significantly associated with increased mortality were: age (especially > 60 years); shorter duration of symptoms - trismus, rigidity and dysphagia; severe disease at presentation and shorter period of onset. Tetanus is a preventable disease associated with a high fatality rate. Universal coverage of immunization programme and appropriate wound prophylaxis is the corner stone of tetanus eradication. The treatment of tetanus is difficult and requires specialized and intensive care. The presence of parameters indicating an adverse outcome at the beginning in the patients will help identify the subset of patients that need more intensive management especially in resource poor nations.     

Immunisation of adults during an outbreak of diphtheria

In an outbreak of infection due to Corynebacterium diphtheriae in a hospital for mentally subnormal adults sera from 211 members of staff were screened for diphtheria antitoxin titres. Of these, 79 (37%) required immunisation, and a low dose preparation (1 LfU of diphtheria and 10 LfU tetanus toxoids) was offered. Of the 64 subjects who accepted a single immunisation and were subsequently retested, seroconversion to diphtheria toxoid occurred in 45 (70%), the rate being highest in younger adults. Seroconversion to tetanus toxoid occurred in 59% of subjects. Local reactions to the single dose were reported by 29 (43%) subjects, and nine (13%) experienced moderately severe local reactions and systemic symptoms. We conclude that adults should not be vaccinated without previous screening for susceptibility to diphtheria; that neither previous immunisation nor age is reliable in predicting the need for vaccination; and that though a single booster dose of diphtheria toxoid is probably effective in adults under 45, two doses should be given to those in the older age group.     

Severe Tetanus: Its Complications and Management

When phenothiazines and barbiturates fail to control the spasms of tetanus, total paralysis induced by muscle relaxants may be the only way of keeping the patient alive. The hazards of this technique are illustrated in this report of a patient with severe tetanus who was totally paralyzed for 26 days. Cardiac arrest, ileus, atelectasis, anemia, and limb contractures were among the problems dealt with. Devoted nursing care, an experienced medical team, respirators, minute ventilation meters, an airway pressure alarm, a hypothermia unit, a cardiac monitor pacemaker and facilities for determining blood-gas tensions were all necessary in the successful treatment of this patient. It is suggested that patients with severe tetanus should be transferred, under anesthesia and artificially ventilated, to hospitals possessing all these facilities.     

人破伤风免疫球蛋白在重症破伤风救治中的应用

目的 探讨人破伤风免疫球蛋白(TIG)在重症破伤风中的治疗作用.方法 将本院收治的39例重症破伤风患者分为两组,TIG组在常规治疗基础上应用人破伤风免疫球蛋白肌注并鞘内注射,与对照组进行临床疗效比较的回顾性分析.结果 TIG组较对照组患者痉挛缓解时间明显缩短,并发症减少,住院时间缩短,病死率明显减低(P＜0.01).结论 破伤风免疫球蛋白免疫时效长,无过敏性,易到达靶细胞中和游离毒素,能有效解除肌肉痉挛和减低破伤风的病死率.     

Combined diphtheria-tetanus immunization of adults.

The administration of a combined adult-type diphtheria-tetanus vaccine to a group of 35 adults seeking booster tetanus immunization produced a secondary immune response to the diphtheria antigen in 26. A satisfactory response to the tetanus antigen was noted in all those who gave a reliable history of active tetanus immunization, including eight individuals who had not received a dose of toxoid for 25 to 28 years. No systemic reactions were observed, but significant correlation was found between local reactivity and a high post-booster titre of tetanus antitoxin. Selective use of the combined vaccine instead of tetanus toxoid alone offers a means of raising the diphtheria immunity in the adult population.     

Tetanus: an analysis of the prognosticating factors of cases admitted into the medical wards of a tertiary hospital in a developing African country between 1990 and 2000

This is an analysis of the effects of prognosticating factors on the outcome of patients with tetanus who were seen in our hospital between 1990 and 2000. Tetanus remains a major public health hazard associated with high mortality. A total of 66 cases were analysed with a slight female preponderance. The mortality rate was 26.2% with an age-adjusted fatality rate of 16.2% for those under 40 years of age. This increased to 75% for those patients above 70 years of age. The most common portal of entry was lower limb, specifically the foot, and this was the case in 56%. The socio-economic status of the patients, the immunisation status, the incubation period, the age of the patient, the severity of the spasms, the duration of hospital stay, the type of treatment received and the onset time were found to affect the outcome of the patients. We recommend that health care providers should take every opportunity to review the vaccination status of their parents and provide tetanus vaccine when indicated, and recall when treating injured patients that many middle-aged and older adults are not adequately immunised against tetanus.     

Comparative clinical trial of diazepam with other conventional drugs in tetanus

Results of therapeutic trial of diazepam in tetanus are presented. The trial included 200 cases of tetanus—167 non-neonates and thirty-three neonates. The patients were divided into two groups and were matched as regards age, sex and severity of the disease. The cases of group I received standard treatment while the cases of group II received diazepam in addition. Over-all mortality in group I was 54% and in group II, 26%. The results were statistically significant in non-neonates and in severe degree of tetanus. The drug was well tolerated and side effects were not observed.     

Neuroparalysis and ventilatory support in severe tetanus

In severe form of tetanus, even with maximum dose of muscle relaxants, spasms and apnoeic spells may persist and that may be life-threatening. The aim of this study was to assess the effect of neuroparalysing the patients and then providing ventilatory support in bringing about their recovery. Forty-nine adult patients of severe tetanus (Ablett's grade IIIA--6 patients and Ablett's grade IIIB--43 patients) were studied during the period from April, 1993 to February, 1996. Mean period of onset ie, period from trismus to first spasm, in these patients was 24 hours. Patients were neuroparalysed with a bolus dose of 2-4 mg of pancuronium followed by a continuous infusion of 1-2 mg/hour and simultaneously supported with mechanical ventilation until spasms subsided. Fourteen patients (28.6%) survived and rest died. Mean duration of ventilatory support on survived patients was 14.4 days. The commonest complication encountered during ventilatory support was respiratory tract infection observed in 36 patients (73.5%). Commonest cause of death was autonomic imbalance encountered in 15 patients (30.6%). Treatment of choice in severe tetanus should be neuroparalytic ventilatory support. With use of new generation ventilators and better intensive care facility, death in severe tetanus is likely to be very less.     

静脉吸毒致破伤风临床特点分析

目的比较分析静脉吸毒所致破伤风与常见的外伤引起的破伤风在临床表现、诊断、治疗上的不同点.方法 15例静脉吸毒所致破伤风与24例外伤引起的破伤风的临床特点和治疗方案进行比较分析.结果静脉吸毒所致破伤风与常见的外伤引起的破伤风相比,没有明确的外伤史,临床症状复杂,常合并其他血源性传染病.结论静脉吸毒所致破伤风有特殊的症状,在诊断和治疗上应分别对待.