成人重症破伤风五例临床分析  

Five adult patients with severe tetanus:cases report and literature review

作　　者：严凤娣[1] 吴晓燕[1] 殷静静[1] Yan Fengdi;Wu Xiaoyan;Yin Jingjing(Department of Critical Care Medicine,Jiangsu Provincial Subei People′s Hospital,Yangzhou 225001,China)

机构地区：[1]江苏省苏北人民医院重症医学科,扬州225001

出　　处：《中华全科医师杂志》2021年第10期1080-1083,共4页Chinese Journal of General Practitioners

摘　　要：回顾性分析2019年10月至2021年1月江苏省苏北人民医院重症监护病房治疗的5例成人重型破伤风患者临床资料。5例中男性2例,女性3例,年龄19~65岁。发病前5~30 d有外伤史,发病后1~11 d就诊,主要表现为颈痛伴活动受限、张口困难就诊,住院期间出现颈部、双上肢阵发性抽搐、全身阵发性痉挛发作或腹肌紧张、腹痛等;就诊时2例外伤已愈合。入院后均予局部清创,甲硝唑联合青霉素/头孢菌素抗感染治疗,人破伤风免疫球蛋白(HTIG)3000 U于臀大肌及三角肌深部肌内注射中和体内游离毒素,咪达唑仑联合硫酸镁持续静脉泵入控制和解除骨骼肌痉挛。3例患者因呼吸衰竭行气管切开、呼吸机辅助通气;1例因严重骨骼肌痉挛导致横纹肌溶解综合征、急性肾损伤,行床旁持续肾脏替代治疗。治疗后5例均痊愈出院。The clinical date of 5 adult patients with severe tetanus admitted in the ICU of Jiangsu Provincial Subei People′s Hospital between October 2019 and January 2021 were analyzed retrospectively.There were 2 males and 3 females,aged 19-65 years.Patients had a history of trauma 5 to 30 days before the onset of the disease,and were admitted 1 to 11 days after the onset of the disease.The main manifestations were neck pain with limited movement,difficulty in opening the mouth,paroxysomal convulsions of the neck and both upper limbs,generalized paroxysomal convulsions or abdominal muscle tension,and abdominal pain.At the time of admission,the wounds of 2 patients had healed.After admission,all patients were treated with local debridement,metronidazole combined with penicillin/cephalosporin for anti-infection,and human tetanus immunoglobulin(HTIG)3000 U was injected into the gluteus and deltoid muscles to neutralize the free toxin in the body.Midazolam combined with magnesium sulfate was intravenously infused to control and relieve skeletal muscle spasm.Among them,3 patients received tracheotomy and ventilation due to respiratory failure.One patient underwent bedside continuous renal replacement therapy(CRRT)for severe skeletal muscle spasm resulting in rhabdomyolysis syndrome and acute kidney injury.All five patients with severe tetanus were cured and discharged.

关 键 词：破伤风 重症监护 硫酸镁 治疗结果 

分 类 号：R517.3[医药卫生—内科学]