加强和改进重症破伤风的中西医结合治疗——成功和失败案例分析  

Strengthening and improving the integration of traditional Chinese and Western medicine in severe tetanus therapy:retrospective study and analysis of survive and decease cases

作　　者：陈浩辉[1] 李赛[2] 伊敏[1] 李强[1] 朱曦[1] 么改琦[1] 葛庆岗[1] Chen Haohui;Li Sai;Yi Min;Li Qiang;Zhu Xi;Yao Gaiqi;Ge Qinggang(Department of Critical Care Medicine,Peking University Third Hospital,Beijing 100191,China;Department of Traditional Chinese Medicine,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院危重医学科,北京100191 [2]北京大学第三医院中医科,北京100191

出　　处：《中华危重病急救医学》2021年第2期233-236,共4页Chinese Critical Care Medicine

摘　　要：目的探讨进一步完善和改进重症破伤风治疗中实施中西医结合的方法,以达到成功控制严重抽搐、自主神经功能障碍和避免长时间应用大剂量镇静、肌松剂的致命并发症,降低重症破伤风病死率。方法回顾北京大学第三医院1965至2020年收治的破伤风患者的病情、治疗方法和结局。根据Ablett破伤风严重程度分级将患者分为Ⅰ~Ⅳ级,其中Ⅲ级、Ⅳ级为重症破伤风;根据是否应用中药治疗将患者分为两组;服用中药组再根据服用的中药是否为针对破伤风病症、符合传统破伤风基本处方,分为破伤风中药组和非破伤风中药组,分别计算各组的病死率。此外,选取严重抽搐、自主神经功能障碍、AblettⅣ级的1例治愈和1例死亡案例,结合各组的治疗方法和疗效,对中西药药物种类、使用方法及结局进行分析。结果共纳入46例破伤风患者,均接受西医治疗,其中服用中药治疗的22例患者中15例服用的中药符合破伤风基本处方。46例患者中死亡10例,总体病死率为21.7%。未服用中药组24例患者中死亡5例(病死率为20.8%),其中1例为AblettⅡ级,1例为AblettⅢ级,3例为AblettⅣ级。服用中药组22例患者中死亡5例(病死率为22.7%),均为重症患者,其中2例为AblettⅢ级,3例为AblettⅣ级,这5例死亡患者均服用非破伤风中药;而服用破伤风中药的15例患者(6例为重症)均未死亡。案例分析:1例严重抽搐行气管插管患者,第8天出现持续自主神经功能障碍,艾司洛尔注射液以及加大镇静、肌松剂剂量治疗改善不明显,2 d后开始服用中药存命汤,次日症状明显控制,服用4周后治愈出院。另一例患者也因重度抽搐行气管插管,插管后3 d发生持续自主神经功能障碍,艾司洛尔注射液以及大剂量镇静、肌松剂治疗改善不明显,自主神经功能障碍8 d后开始服用中药存命汤,次日自主神经功能障碍控制,继续使用大剂量肌松剂;服用�Objective To investigate the perfection and improvement of the execution of integrative medicine therapy in severe tetanus therapy,to successfully control tetanus severe spasms,autonomic dysfunction and prevent lethal side-effect of prolong and high-dosage sedative-muscle-relaxant therapy,resulted in significant reduction of mortality of tetanus.Methods Symptoms,treatments and outcome of tetanus patients admitted to Peking University Third Hospital from 1965 to 2020 were reviewed.Patients were classified with Ablett classification.The cases of Ablett gradeⅢandⅣwere severe tetanus.The patients were divided into two groups according to whether they were treated together with traditional Chinese medicine(TCM)simultaneously during the standard tetanus treatment;the patients in the TCM group were divided into the tetanus TCM medication group and the non tetanus TCM medication group according to the medicine provided whether was in accord with the conventional tetanus TCM prescriptions.The mortality of each group was calculated.In addition,one survived and one deceased case with severe convulsion,autonomic nerve dysfunction(Ablett gradeⅣ)were selected,combined with the treatment methods and curative effects,the types,use methods and outcomes of Chinese and Western medicine were analyzed.Results The 46 tetanus cases were treated with Western medicine.Twenty-two of them,TCM were applied.Fifteen of the 22 cases took the TCM prescription which was accord with the conventional tetanus prescription.The mortality of the 46 cases was 21.7%(10/46).The number of non-TCM group was 24 cases,with mortality of 20.8%(5/24);1 case was AblettⅡ,1 was AblettⅢand 3 were AblettⅣ.The number of the TCM group was 22 cases,with mortality of 22.7%(5/22),2 cases were AblettⅢ,3 were AblettⅣ.The TCM prescription of these 5 deceased cases was not directed towards tetanus.The tetanus TCM medication group was 15 cases,with no mortality.Case analyses:case 1 was intubated because of severe spasms.Autonomic dysfunction occurred on the 8t

关 键 词：破伤风 中药 中西医结合 肌松剂 病死率 

分 类 号：R517.3[医药卫生—内科学]