破伤风的临床特点及预后影响因素分析  

Analysis of clinical features and prognostic factors of tetanus

作　　者：蔡妙甜[1] 梁连春[1] 李侗曾[1] 段忠辉[1] 牟丹蕾[1] Cai Miaotian;Liang Lianchun;Li Tongzeng;Duan Zhonghui;Mou Danlei(Integrate Department of Infectious Diseases, Beijing You＇ an Hospital, Capital Medical University, Beijing 100069, China)

机构地区：[1]首都医科大学附属北京佑安医院感染综合科,100069

出　　处：《北京医学》2018年第4期318-322,共5页Beijing Medical Journal

摘　　要：目的分析破伤风患者的临床特点及预后影响因素。方法回顾性分析2012年1月至2017年12月首都医科大学附属北京佑安医院收治的27例破伤风患者的病例资料,总结其临床特点、分析死亡相关危险因素。结果27例患者,男女比为20∶7,平均年龄(47.11±2.34)岁,有明确外伤史者占92.6%。全身性及局限性破伤风占比分别为85.2%及14.8%。主要症状包括牙关紧闭(100%)、吞咽困难(92.6%)、阵发性局部或广泛性肌肉痉挛、抽搐(92.6%)等。机械通气比例为48.1%,其中15.4%行气管切开。并发症发生率为74.1%,病死率为33.3%。Logistic回归分析提示Ablett分级是患者死亡风险的独立相关因素。结论中年男性是破伤风发病及死亡的主要人群,对于外伤后出现牙关紧闭、肌肉痉挛、抽搐等表现的患者应高度警惕该病,Ablett分级可用于预测患者死亡风险。Objective To explore the clinical features and prognostic factors of tetanus. Methods The clinical data of 27 patients with tetanus hospitalized between January 2012 and December 2017 were retrospectively summarized and analyzed to reveal the clinical features and prognostic factors. Results There were 20 males and 7 females with an average age of （47.11±2.34） years. Generalized and localized tetanus accounted for 85.2% and 14.8% of the patients, re- spectively. Trismus （100%）, dysphagia （92.6%） and paroxysmal muscle spasm or convulsion （92.6%） were the most common clinical manifestations. The mechanical ventilation rate was 48.1%, in which 15.4% were conducted with tracheotomy. Complications occurred in 74.1% of the patients. The case-fatality rate was 33.3%. Logistic regression analysis revealed that the Ablett classification was the independent risk factor of death in tetanus patients. Conclusion Middle-aged males are the main population of morbidity and mortality of tetanus. Patients exhibiting symptoms such as trismus, muscle spasm or convulsion after trauma should be highly concerned with tetanus. The Ablett classification could be used as prog- nostic markers of tetanus patients.

关 键 词：破伤风 临床特点 病死率 预后 危险因素 

分 类 号：R517.3[医药卫生—内科学]