外科ICU诊治的6例成人重症破伤风患者临床特点和治疗经验

Objective: To analyze the clinical characteristics and management of adult patients with severe tetanus in surgical ICU. Methods: We retrospectively analyzed 6 adult patients with severe tetanus treated in the surgical ICU of The First Affiliated Hospital of Xi'an Jiaotong University from January 2013 to June 2019. Results: We collected 6 cases of severe tetanus with left untreated wound and uncertain vaccination over the studied period. The patients' average age was (49.5±7.25), and incubation period varied from 4 to 12 d. There were 2 cases of Ablett grade Ⅲ and 4 cases of grade Ⅳ. The diagnosis was mainly based on clinical manifestations, trismus was an early and the most characteristic symptom. Pulmonary infection (5/5, 100%) occurred after mechanical ventilation (average 9.67±4.13 days) with tracheostomy in 5 cases. Four patients suffered from autonomic dysfunction, 2 developed rhabdomyolysis and 1 underwent continuous renal replacement therapy (CRRT). Among the 6 patients, 2 of grade Ⅳ gave up treatment and died, 4 patients were cured and discharged from hospital. The average length of ICU stay was (25.33±13.92) days, and mortality rate was 33.3%. Results: Treatment of severe tetanus is lengthy, costly and complex, requiring close monitor and ICU care. Control of muscle spasm and autonomic dysfunction are the key, early tracheotomy and effective sedation are critical to successful treatment, and support therapy is the guarantee. Vaccination is the only way to prevent this potentially fatal disease.