早期成人破伤风首诊误诊原因分析

目的分析成人破伤风的早期临床表现,总结破伤风误诊原因,以提高首诊准确率。方法回顾性分析我院12例首诊误诊的成人破伤风的临床资料。结果 12例均有不同程度张口困难及面肌痉挛表现,首诊时均未提供明确外伤史和慢性感染窦道史,分别于我院普外科、感染科、急诊科、神经内科、骨科及口腔科首诊,诊断抽搐原因待查4例,误诊为颈椎病2例,腰椎病、多颅神经炎、药物锥体外系反应、面神经炎、脑梗死及颞下颌关节炎各1例。12例均结合病史及临床表现确诊为破伤风,予相应治疗皆痊愈。随访1年无明显后遗症。结论首诊时无明确外伤史及典型破伤风表现的早期成人破伤风患者容易漏误诊。临床遇到面肌痉挛及张口困难表现者,尤其是1978年前出生未接种过百白破疫苗者,应高度警惕破伤风。

Primal Misdiagnosis Causes of 12 Adult Patients with Tetanus in Early Period

Objective To analyze clinical manifestations of adult tetanus in early period,and summarize the misdiag-nosis causes in order to improve accuracy of the primal diagnosis. Methods Clinical data of 12 adult patients with tetanus misdiagnosed in the primal diagnosis in our hospital was retrospectively analyzed. Results All the 12 patients had difficulties opening mouths and facial spasms in different degrees,while clear histories of trauma and chronic sinus infection were not of-fered in the first diagnosis. The patients were misdiagnosed as having convulsions of unknown origin（4 cases）,cervical spon-dylosis（2 cases）,lumbar spondylosis（1 case）,brain neuritis（1 case）,drug-induced extrapyramidal reactions（1 case）, facial neuritis（1 case）,cerebral infarction（1 case）and temporomandibular arthritis（1 case）in departments of general sur-gery,infectious diseases,emergency,neurology,orthopedics and dentistry respectively in the primal diagnosis. All the 12 pa-tients were confirmed of the diagnosis of tetanus after being combined with history and clinical manifestations,and were cured after corresponding treatment. All the patients had no obvious sequelae after follow-up for one year. Conclusion Adult pa-tients with tetanus without typical clinical manifestations of tetanus or definite trauma history in early period may be easily mis-diagnosed in the primal diagnosis. Patients with facial spasm and difficulties in opening mouths,especially those who were born before 1978 without DPT vaccine（ whooping cough,diphtheritis and tetanus）,should be more vigilant about tetanus.