成人破伤风患者的临床救治分析

Clinical treatment analysis of adult tetanus patients

目的:破伤风是可预防的疾病,在许多低收入和中等收入国家仍然常见,若不进行规范的救治,病死率高。成人破伤风的病程为4~6周,在救治的持久战中,如何把控治疗的关键环节是救治成功的基础。本文对29例破伤风患者的临床诊治关键环节进行分析探讨。方法:我院2017-01-2019-09期间收治成人破伤风患者共29例,其中男18例,女11例;年龄41~85岁,平均63岁。Ⅰ/Ⅱ级6例,Ⅲ级13例,Ⅳ级10例。予以环境控制、伤口处置、TAT和HTIG的应用、抗菌药物的治疗、控制肌肉痉挛、气道管理、营养支持综合治疗、并发症的防治等综合救治。结果:3例患者放弃治疗回家,26例患者均治愈出院,症状缓解期10~32 d,电话随访均无任何后遗症。结论:成人破伤风救治持久战中需要把控以下关键环节:阻止毒素产生是基本,中和游离毒素是必须,早期气管切开是关键,控制肌肉痉挛是要点,营养支持治疗是保证,主动免疫防止再发病。

Objective: Tetanus is a vaccine-preventable disease that is still common in many low-and middle-income countries. Without standardized treatment, the mortality rate is high, and the clinical course of adult tetanus is about 4-6 weeks. In the protracted treatment, how to control the key link of treatment is the basis of successful treatment. Method: There were 29 adult tetanus patients, including 18 males and 11 females, aged 41-85 years old, with an average age of 63 years old. There were 6 cases of Ⅰ/Ⅱ and 13 cases of grade Ⅲ, 10 cases of grade Ⅳ.We treat all the patients with environmental control, wound management, TAT and HTIG application, antimicrobial therapy, muscle spasm control, airway management, nutritional support and comprehensive treatment of complications. Result: Three patients gave up treatment and went home. All 26 patients were cured and discharged from the hospital. The symptom remission period was 10-32 days. Conclusion: Prevention of toxin production is essential, neutralization of free toxin is necessary, early tracheotomy is the essential point, control of muscle spasm is the key, nutritional support treatment is the guarantee, and active immunity is necessary to prevent recurrence.