2008—2018年某三级医院重症破伤风流行病学特征和死亡风险分析  

Epidemiological characteristics and death risk analysis of severe tetanus in a tertiary hospital, 2008-2018

作　　者：魏金刚 王素星[2] 秦浩[1] WEI Jin-gang;WANG Su-xing;QIN Hao(The Fifth Hospital of Shijiazhuang City,Shijiazhuang,Hebei 050021,China;Hebei Provincial People’s Hospital,Shijiazhuang,Hebei 050051,China)

机构地区：[1]石家庄市第五医院,河北石家庄050021 [2]河北省人民医院,河北石家庄050051

出　　处：《实用预防医学》2020年第1期50-53,共4页Practical Preventive Medicine

基　　金：2017年石家庄市科学技术研究与发展指导计划(项目编号:171461703)

摘　　要：目的分析重症破伤风的流行病学特征和死亡相关危险因素,为防治破伤风提供依据。方法回顾性分析2008年6月-2018年6月石家庄第五医院收治78例重症破伤风患者的病例资料,分析流行病学特征、死亡原因和死亡相关危险因素。结果78例患者男67例,女11例,平均年龄(48.1±16.1)岁。农村41例(52.6%),城镇37例(47.4%)。7-9月发病33例(42.3%)。外伤史患者73例(93.6%),多为铁钉、玻璃、刀具等刺伤。潜伏期5~33 d,平均(17.0±6.9)d;发病至住院间隔1~20 d,平均(6.5±2.0)d。并发症有肺炎(76.9%)、自主神经功能紊乱(66.7%)、休克(60.3%)、肺不张(7.7%)、急性肾衰(6.4%)、气胸(5.1%)、出血(5.1%)。死亡34例,死亡率43.6%。logistic回归分析提示自主神经功能紊乱、持续神经肌肉阻断、疫苗接种、APACHE II评分、年龄等是死亡风险相关因素。结论有外伤史的中年男性是破伤风发病和死亡的主要人群,夏季是高发季节,早期完整接种疫苗可降低发病和死亡风险。自主神经功能紊乱、持续神经肌肉阻断、疫苗接种、APACHE II评分、年龄等可用于预测患者死亡风险。Objective To analyze the epidemiological characteristics of severe tetanus and its death-related risk factors so as to provide a basis for prevention and treatment of tetanus.Methods The data regarding 78 patients with severe tetanus hospitalized in the Fifth Hospital of Shijiazhuang City from June 2008 to June 2018 were retrospectively analyzed,and their epidemiological characteristics,causes of death,and death-related risk factors were also analyzed.Results Among the 78 patients,there were67 male patients and 11 female ones,with an average age of(48.1±16.1)years.41(52.6%)cases came from rural areas and 37(47.4%)cases from urban areas.33(42.3%)cases occurred during July-September.73(93.6%)cases had traumatic history,and most of them were stabbing injuries caused by nails,glass and knives.The latent period was 5-33 days,with an average of(17.0±6.9)days.The median interval from symptom onset to hospitalization was 1-20 days,with an average of(6.5±2.0)days.Complications included pneumonia(76.9%),autonomic nervous system dysfunction(66.7%),shock(60.3%),atelectasis(7.7%),acute renal failure(6.4%),pneumothorax(5.1%)and hemorrhage(5.1%).There were 34 deaths,and the mortality rate was 43.6%.Logistic regression analysis indicated that autonomic nervous system dysfunction,continuous neuromuscular blockade,vaccination,Acute Physiology and Chronic Health Evaluation(APACHE)II score and age were death-related risk factors.Conclusions Middle-aged men with a history of trauma are the main population leading to morbidity and mortality of tetanus.Summer is a high-occurrence season for tetanus.Early complete vaccination can reduce the risk of morbidity and mortality.Autonomic nervous system dysfunction,persistent neuromuscular blockade,vaccination,APACHE II score and age can be used to predict the risk of death in patients.

关 键 词：破伤风 流行病学 疫苗 危险因素 

分 类 号：R517.3[医药卫生—内科学]