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严重破伤风病人长时间用机械呼吸支持,有时血压过高过低可持续约两周。心血管不稳的早期可能导致心脏骤停,晚期则并发肾衰或呼吸系感染致命。为了解这段交感亢进期的代谢变化,作者选择6例重症破伤风病人从角弓反张观察到病情好转。这6例病人(男5,女1),32～75岁,潜伏期7～10天,发病10小时至14天出现痉挛惊厥,于2～19天发生不稳定高血压,应用机械呼吸24～42天。入院后全部病人注破伤风免疫球蛋白,每天注大剂量青霉素7～10天并用安定和本可松保持镇静、肌松。因为用神经节阻滞剂和β阻滞药不能控制高血压,5例伍用硬膜外阻滞和静滴去甲肾上腺素或肾上腺素,另一例只静滴硫戊巴比妥钠。所有病人于入院5天后即持续静脉高营养。
Severe tetanus patients with mechanical breathing support for a long time, and sometimes high and low blood pressure can last about two weeks. Cardiovascular instability in the early may lead to cardiac arrest, late renal failure or fatal respiratory infection. In order to understand the metabolic changes in this period of hypersensitivity, the author chose 6 patients with severe tetanus to observe the improvement of the condition from the angle arch anti-Zhang. The 6 patients (male 5, female 1), 32 to 75 years old, the incubation period of 7 to 10 days, the onset of convulsive convulsions 10 to 14 days, unstable hypertension occurred in 2 to 19 days, the application of mechanical breathing 24 to 42 day. All patients after admission injection of tetanus immunoglobulin, daily injection of large doses of penicillin 7 to 10 days and with stability and the pine may be to maintain calm, muscle relaxation. Because ganglion blockers and beta blockers were unable to control hypertension, epidural block and intravenous norepinephrine or epinephrine were administered in 5 patients and intravenous thiobarbitone sodium alone in 5 patients. All patients continued intravenous nutrition 5 days after admission.