我国烧伤后并发破伤风临床文献分析

Clinical literatures regarding burn wounds complicated with tetanus in China

目的分析我国有关烧伤并发破伤风的临床文献,了解其临床特点。方法以"烧伤"和"破伤风"为关键词,检索国内常用数据库相关文献,详细记录文献中烧伤后并发破伤风患者的临床资料并进行总结分析。结果符合纳入标准的文献共22篇,乔安娜·布里格斯研究所(JBI)文献质量评价的平均分数为6.59分。27例烧伤后并发破伤风感染患者中大多数为成年男性;多为火焰烧伤,热液烫伤较少,偶有电击伤和石灰灼伤。并发破伤风轻、中度烧伤患者较重度以上烧伤患者多。烧伤后未注射破伤风抗毒素(TAT)并发破伤风的患者数量和伤后注射TAT仍并发破伤风的患者数量相当。破伤风平均发病时间为烧伤后(13.80±11.49)d,其中男性、儿童、轻中度烧伤及未注射TAT患者发病较早。烧伤并发破伤风患者的病死率为22.22%,其中儿童、火焰烧伤及未注射TAT的患者并发破伤风后病死率较高。结论烧伤后并发破伤风发病率低。成年烧伤患者易并发破伤风,但儿童患者发病早、病死率高。不可忽视轻、中度烧伤患者的破伤风感染。烧伤后早期注射TAT可推迟破伤风发病时间,降低病死率,但预防作用有限。

OBJECTIVE To investigate the clinical literatures regarding burn wounds complicated with tetanus in China and observe the clinical characteristics.METHODS The related literatures were searched from common databases of China by setting‘burn wound’and‘tetanus’as key words,and the clinical data of the burn wound patients complicated with tetanus were recorded in detail.RESULTS Totally 22 literatures conformed to the inclusion criteria,and the average score of Joanna.Briggs Institute(JBI)Literature Quality Evaluation was 6.59 points.Among 27 burn wound patients complicated with tetanus,the male adults were dominant;most of the patients suffered from flame burns,less had hydrothermal scald,and the patients occasionally had electric shock injuries and lime burns.The mild and moderate burn wound patients complicated with tetanus were more than the severe burn wound patients.The number of the patients who were complicated with tetanus without injection of tetanus antitoxin(TAT)after burn wound was fairly the same as the number of the patients who were complicated with tetanus with injection of TAT after burn wound.The average onset time of tetanus was(13.80±11.49)days after burn wound,the onset of tetanus was earlier in the male patients,children,patients with mild and moderate burn wound and patients without injection of TAT.The mortality rate of the burn wound patients complicated with tetanus was 22.22%,and it was even higher among the children,patients with flame burns and the patients without injection of TAT.CONCLUSION The incidence of tetanus is low after burn wound.The adult burn wound patients are more likely to be complicated with tetanus,and the children may have a earlier onset,with the mortality rate high.The complication with tetanus in the mild and moderate burn wound patients can not be neglected.The early injection of TAT may postpone the onset of tetanus and reduce the mortality rate,but the preventive effect is limited.