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近年来,破伤风已普遍成为特护病房以麻醉科医生为主集中治疗的疾病。全身痉挛发作伴呼吸停止15分钟后窒息死亡的病例非常多。诊断:不少患者就诊牙科及耳鼻喉科;有因伴呼吸困难、胸痛、痉挛、昏倒以心绞痛,也有因腹痛、腹肌强直以阑尾炎,或以脑肿瘤,脑血管障碍送来就诊;约25%患者因外伤史不明、外伤程度很轻而漏诊;也有送诊时注射苯巴比妥,到院时药效出现体征消失,认为非破伤风病而令回家结果死亡的病例。本病并无特殊检查方法,需除外类似疾患,观察病情变化作出确切诊断。其肌酐磷酸酶几乎全部病例恒定上升,且多为M 型;GOT、GPT、乳酸脱氢酶也有上升。抗毒素:外科处理前,是否应该注射抗毒素,目前见解认为并非那么重要。抗毒素(马),现在不太用24,000～36,000单位,也不像以前那样用10万单位;抗毒素(人),即TIG—破伤风人体免疫γ球蛋白,使用时静脉点滴2,000～3,000单位;前者血中量减少速度迅速,注射后20天为0.01单位/毫升以下,后者减少速度缓慢,88天为0.01单位/毫升;TIG 尽管静脉点滴之总量为肌肉注射的1/3以下,血清中抗体最高水平仍几乎相等,故认为TIG 应给予静脉点滴。
In recent years, tetanus has generally become a intensive care unit intensive care unit intensive care treatment of diseases. Severe seizures with respiratory arrest 15 minutes after suffocation deaths are many. Diagnosis: Many patients visit dentistry and otolaryngology; due to difficulty with breathing, chest pain, cramps, fainting angina, but also because of abdominal pain, abdominal stiffness with appendicitis, or brain tumor, cerebrovascular disease sent to treatment; about 25 % Of patients due to trauma history is unknown, trauma is very light and missed diagnosis; also when the injection of phenobarbital, when the hospital signs of disappearance of pharmacodynamics, that non-tetanus and home deaths. The disease is no special inspection methods, except for similar diseases need to observe the changes in the condition to make a definite diagnosis. The creatinine phosphatase in almost all cases of constant increase, and mostly M type; GOT, GPT, lactate dehydrogenase also increased. Antitoxin: Before surgical treatment, whether anti-toxins should be injected, the current view that is not so important. Antitoxin (horse), now less than 24,000 ~ 36,000 units, nor as 100,000 units; anti-toxin (human), that TIG-tetanus human immunoglobulin, intravenous drip when used 2,000 to 3,000 units; the former Blood volume decreased rapidly, 20 days after injection of 0.01 units / ml or less, the latter slow rate of decline, 88 days to 0.01 units / ml; TIG although intravenous infusion of the total amount of intramuscular injection of 1/3 or less in serum The highest level of antibodies is still almost equal, so that TIG should be given intravenous drip.