ABSTRACT
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 . 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 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.
ABSTRACT
Objective To study the efficacy and safety magnesium sulfate for the treatment of adult severe tetanus.MethodsTwenty-seven inpatients with adult severe tetanus during April 2005 - October 2010 were retrospectively analysed.ResultsThe total serum magnesium more than 4 mmol/L was found in 2 patients ( 2/27,7.40％ ).The tracheotomy was performed in 25 Patients (25/27,92.6％),22 of which (22/25,88.0％) run mechanical ventilation with the mean mechanical ventilation time (7.5 ± 3.7 ) days,(4 to 16 days).Pulmonary infection occurred in 25 cases (25/27,92.6％).Twenty-three of 27 (23/27,85.2％ ) cases were cured except 4 cases died,and the mean hospital stay was (32.22 ± 18.78) days,(25to 48) days.Conclusions20％ magnesium sulfate is safe for treatment of the patients of adult severe tetanus.It can control not only muscle rigidity and spasms but also autonomic instability efficaciously,and lower the dosage of sedative such as diazepam and chlorpromazine.This method is worth popularizing in clinical practice for its easy operation and low cost.
ABSTRACT
Tetanus is a potentially fatal but largely preventable disease through immunisation.Despite efforts by the World Health Organization to eradicate the disease,tetanus(particularly severe tetanus)remains a worldwide cause of morbidity and mortality.Timely diagnosis and appropriate intensive care management are essential to ensure survival.Recently,with progress in the treatment of severe tetanus,the mortality has been decreased significantly.