An experience in treating generalized tetanus: A case report

全身性破傷風：病例報告

陳仁澤(Jen-Tse Chen) ； 廖品雯(Pin-Wen Liao) ； 李美靜(Mei-Ching Lee)

《輔仁醫學期刊》 16卷2期 (2018/06) Pp. 97-103

https://doi.org/10.3966/181020932018061602006

摘要

Tetanus is a rare but lethal disease in developed countries. We report a case involving a 68-year-old man who presented to our hospital with trismus, opithotonus with neck pain, and episodic apnea. He had an open wound in his right index finger that had not received appropriate treatment. Tetanus immunoglobulin G was administered. Endotracheal intubation and subsequent tracheotomy with a ventilator were performed with total sedation with midazolam and diazepam. To relieve the persistent muscle spasm, magnesium sulfate and baclofen were added. He completely recovered after 40 days of hospitalization. Although tetanus-related mortality is rare in Taiwan, prompt diagnosis and empirical treatment are necessary.

關鍵字

tetanus ； trismus ； opithotonus ； magnesium sulfate

並列摘要

破傷風之病原為破傷風梭狀芽胞桿菌，通常是由沾有細菌的物品造成皮膚損傷而進入體內。破傷風桿菌會產生破傷風痙攣毒素造成中樞神經和自主神經受損，干擾肌肉正常收縮的能力，使肌肉異常痙攣。常見之症狀為顎部、腹部僵硬及肌肉痙攣，典型的破傷風痙攣現象為「角弓反張」及牙關緊閉，伴隨強烈的肌肉收縮疼痛。由於台灣公共衛生之普及與疫苗注射之完善，每年破傷風感染之病例數均為個位數，死亡個案更為稀少。我們報告一位68歲男性因一周前右食指傷口形成壞死，因吞嚥困難、背部肌肉疼痛住院。其後因持續間歇性呼吸停止接受氣管內插管，其後氣管切開術合併呼吸器使用以維持心肺功能。診斷為破傷風後，使用鎮靜劑及硫酸鎂以緩解其肌肉痙攣，同時施行傷口清創合併抗生素注射和破傷風免疫球蛋白及支持性療法，個案於住院40天之後完全復原出院。因破傷風病例稀少容易被忽略，因此迅速正確的診斷才能給予病人完備的治療。

並列關鍵字

破傷風 ； 牙關緊閉 ； 角弓反張 ； 硫酸鎂