基于Ablett分级法破伤风患者的临床特点和预后分析  

Analysis of the clinical characteristics and prognosis of adult tetanus patients according to the Ablett classification

作　　者：李幼霞 邓西龙[1] 黄煌[1] 蔡水江 刘莹 刘勇进 梁桐 杜淑华 LI You-xia(Department of critical care medicine,Guangzhou No.8 people's hospital,Guangzhou,Guangdong,510060,China)

机构地区：[1]广州市第八人民医院重症医学科,510060

出　　处：《齐齐哈尔医学院学报》2020年第4期414-417,共4页Journal of Qiqihar Medical University

基　　金：2014年至2017年广州市健康医疗协同创新重大专项之“呼吸道新发突发及重大传染病综合防诊治(201400000002)”。

摘　　要：目的探讨不同严重程度成人破伤风患者的临床特点、预后及影响因素。方法回顾性分析2012年1月-2018年12月本院收治的100例成人破伤风患者的病例资料。根据Ablett分级法将其分为轻症组和重症组两组,比较两组患者的临床特点、相关危险因素及临床转归指标等。结果100例成人破伤风患者,轻症组70例(70%),重症组30例(30%);其中有23例(23%)需入住ICU监护治疗,Ablett分级均为Ⅲ级,其中气管插管20例(20%),气管切开8例(8%)。轻症组与重症组性别、年龄、潜伏期均无统计学意义(P均>0.05)。轻症组发病至就医时间、住院时间、发病至注射破伤风抗毒素或免疫球蛋白时间、症状消失时间、血白细胞、APACHEⅡ评分、Nutric评分明显低于重症组,差异有统计学意义(P均<0.05)。轻症组CD4细胞计数、白蛋白、RASS评分明显高于重症组,差异有统计学意义(P均<0.05)。100例患者中死亡1例,院内存活率99%,存活患者均未出现后遗症。结论破伤风重在预防,加强健康宣教、按时接种相关疫苗、伤后及时彻底处理伤口,尽早应用破伤风抗毒素或破伤风免疫球蛋白,是首要治疗;控制抽搐和保持呼吸道通畅是关键治疗;Ablett分级为Ⅲ级及以上的患者应尽早转入ICU,接受规范的ICU综合救治措施,可明显提高重症患者的救治成功率。Objective To investigate the clinical characteristics,prognosis and influencing factors of adult tetanus patients of different severity.Methods Retrospectively analyzedthe clinical data of adult tetanus patients admitted to the Guangzhou No.8 People’s Hospital from January 2012 to December 2018.According to the Ablett classification method,the patients were divided into mild case group and severe case group,indicators including clinical characteristics,prognosis and influencing factors of the two groups were compared.Results Among 100 adult tetanus patients,70(70%)were in mild group and 30(30%)were in severe group.23(23%)of them needed ICU monitoring and treatment.Ablett classification of the 23 cases was grade III.Among them,20(20%)had tracheal intubation and 8(8%)had tracheotomy.There was no significant difference in gender,age and latentperiod between mild group and severe group(P>0.05).The time from onset to hospitalization,from onset to injection of tetanus antitoxin or immunoglobulin,the time of disappearance of symptoms,leukocytes,APACHE II score and Nutric score in mild group were significantly lower than those in severe group,and the difference was statistically significant(P<0.05).CD4 cell count,albumin and RASS scores in mild group were significantly higher than those in severe group,and the difference was statistically significant(P<0.05).One of the 100 patients died,and the hospital survival rate was 99%.There were no sequelae in the survivors.Conclusions The most important treatment for tetanus is prevention,health education,timely vaccination,timely and thorough treatment of wounds after injury.Early application of tetanus antitoxin or tetanus immunoglobulin is chief treatment,control of convulsions and maintenance of airway unobstructedis the key treatment.Patients of Ablett grade III and above should be transferred to ICU as soon as possible and receive standardized comprehensive treatment measures,which couldimprove the success rate of treatment for severe patients.

关 键 词：破伤风 治疗 死亡率 并发症 免疫接种 预后 

分 类 号：R633.1[医药卫生—外科学]