新生兒破傷風的臨床觀察

Clinical Observation of Neonatal Tetanus

梁垠森(In-Sun Liang)

《Acta Paediatrica Sinica》 22卷3期 (1981/09) Pp. 155-163

摘要

在過去10年間，本院經驗了82個新生兒破傷風病例。有44例痊癒，23例死亡，15例自動出院，自動出院例病人住院時情況與痊癒例相似，有很高的治癒希望但家屬放棄治療。自動出院例略去不算死亡率爲34.3%。潛伏期愈長，發病至住院時間愈久，年齡愈大者其死亡率愈低。住院時臨床上有痙孿，弓形反張，發熱與發紺等症狀則死亡率愈高。著者試提一種「新生兒破傷風預後評分法」認爲可應用於預後之判定。

並列摘要

During the past 10 years from October 1970 to September 1980, 82 cases of neonatal tetanus were admitted to the pediatric department of Changhua Christian Hospital. Out of these, 44 survived, 23 died and 15 were discharged against our advice. The sex ratio was 2 males to 1 female. Most of the patients were from the rural areas of middle Taiwan. The majority of them were delivered under unsterile conditions. The average age on admission was 7 days and the mean incubation period was about 6 days. Excluding the 15 patients who were discharged against our advice and eventually were given up by their families, the mortality rate among the remaining 67 cases was 34.3%. All 23 expired cases died within one week after their admission. The average hospital stay for those 44 survivors was 19 days.
The common signs and symptoms on admission were trismus, refusal for feedings, risus sardonicus, spasticity of extremities, neck rigidity, convulsions, irritability and restlessness, opisthotonus, fever and cyanosis. Antitetanus serum (horse) 48,000 units, 1/3 by intramuscular injection, 2/3 by intravenous injection was used in most cases. Tetanus immunoglobulin (human) 1,000-2,000 units intramuscular injection combined with antitetanus serum (horse) 20,000-32,000 units intravenous injection was used in 4 cases, and all survived. But the significant effect of this combination still needs further clinical study. Valium, luminal and paraldehyde were used in most cases as sedatives to control spasm or convulsion.
The prognosis of neonatal tetanus seemed to be closely correlated with the length of incubation and the interval from onset to admission, and the pressence of fever, cyanosis, convulsions and sucking inability on admission. Using these criteria, a “prognostic scoring system for neonatal tetanus” was proposed in this report. If the patient on admission has a temperature of 39°C or above, he gets one point; if the age is under 6 days gets two points, if 6-9 days one point; if any sign and symptom of cyanosis, convulsions and/ or inability to suck is present he gets one point for each.
Using our scoring system we found that those patients with a score of two or less all survived and those with score above five all died. The mean score of those who expired was 4.61±0.89 and of those who survived was 2.64±1.08. This difference is highly significant (P＜0.0001). The mean score of those discharged against medical advice was 2.08±1.01 and was not significantly different from those known to be survived.
The treatment of neonatal tetanus and especially its prevention requires a concerted co-operative effort of public health, social work and medical departments.

並列關鍵字

tetanus ； newborn