评估破伤风病人预后的探讨

AN INQUIRE INTO THE EVALNATION OF PROGNOSIS OF THE PATIENTS WITH TETANUS

评估破伤风病人的预后，其目的是有利于治疗上寻找出新的措施，减少死亡率，对488例被伤风病人的临床资料进行分析表明，破伤风病人预后的不利主要：（1）年龄：新生儿以及老年病人病死率高达48．6％，而其他年龄组仅为19％，P＜0．001；（2）潜伏期：潜伏期越短，病死率越高，潜伏期＜9天的病人病死率为54．1％，而＞9天者仅为5．5％，P＜0．001；（3）起病期（即首次抽搐到全身性痉挛所经历的时间）越短，病死率越高，起病期＜48小时者病死率高达79．8％，而起病期＞48小时者病死率仅为17．7％，P＜0．001；（4）痉挛的程度，如反射性痉挛的致发绀甚至呼吸停止者预后差，病死率为61．4％，而其他为15．9％；（5）持续高热者（40℃以上者）病死率高，高热＞7天老病死率达59．1％，而＜7天老死亡率仅达37．3％，P＜0．001。其他并发感染，自主性神经的功能失调以及治疗不当等。

The aim of evaluating the prognosis of patients with tetanus is favourably finding new therzpy and clecreasing the mortality. To analyze the clinical data of 488 cases with tetanns showed that the unfavourable factors of prognosis were (a )Age: the mortality of newborn and aged was 48. 6%which was higher than 19.0%of the otherage groups (p < 0. 001 ) (b ) latency: The shorter the latency, the higher the mortality. The mortality was 54. 1% of the patients whose latency was < 9day and that was 5. 5% of the patients whose latency was≥ 9day (p < 0.001 ) (c ) The onset periad: (from the initial spasmto systemic tonicspasm ) the mortality was 79. 80% of the patients whose onset period was≤48 hours and that was only17. 7% of the patients whose onset period was>48hours,(p<0. 001 ) (d ) the level of spasm: patients with cyanosis and even respiratory arrest owing to reflex spasm had a poor prognosis. The mootality of them was 61. 4%while that of the patients, with of ther symptoms was 13. 9% (e ) a high mortaliry was seen in the patients with continual high fever (≥40℃ ) the mortality was 59. 1 % of the patients with high fever lasting≥7days while that was 37. 3% of the patients with high fever lasting<7days (p<0.001)Besides, Complicating infection, clisturbance of functions of autonomic nervous system and improper freatment were unfarorable factors of the prognosis.