破傷風桿菌感染導致呼吸衰竭病人之呼吸照護經驗

目前於臨床上破傷風的病例已趨於罕見，這一切均歸功於疫苗的盛行。在台灣，針對嬰幼兒施打的三合一混合疫苗（白喉、百日咳、破傷風類毒素）中就包含破傷風疫苗，而破傷風病例通常會發生在農業區或低度開發地區，因為該等地區較易出現與動物排泄物接觸或疫苗接種較不完善的情形。此個案即是因從事農耕作業時不慎受感染且發病。於發病後出現嚴重全身肌肉痙攣須合併神經肌肉鬆弛劑與呼吸器使用，神經肌肉的病變以及鬆弛劑的使用都讓個案成為感染肺炎的高危險群，但礙於個案對聲光、肢體接觸等刺激均會引發嚴重痙攣而遲遲未介入傳統胸腔物理治療使得肺炎持續惡化甚至肺塌陷而影響呼吸器的脫離。該如何照護才能避免肺炎的產生更防止其惡化？本文將藉此個案探討破傷風對肺部帶來的影響並提出適當的痰液清除治療方法與執行時機，希望藉本個案臨床照護經驗之分享，作為提供將來面對此罕見疾病時之借鏡。

關鍵字

破傷風；肺炎；呼吸器脫離困難；肺部復原

並列摘要

Because the prevailing use of three-in-one vaccine (diphtheria, pertussis, tetanus, DPT), patient who are suffered from tetanus had been decrease in numbers. But we could still had some patients coming from agriculture areas or underdeveloped countries as a result of contact with animal waste or lack of vaccination. The case is an example that patient was infected while working in the field. As the infection progressed, muscle spasms affected whole body. The use of neuromuscular blockade and mechanical ventilation were needed for neuromuscular sequels. But recurrent pneumonia would be complicated by the sequels of neuromuscular disorder and the use neuromuscular blockade especial during the acute period which might lasted for 4 to 6 weeks. However, conventional chest physiotherapy could not be performing because any stimulation with light, voice or physical contact will result in severe spasms. That would lead to neuromuscular dysfunction and even rhabdomyolysis. Recurrent pneumonia and even prolong mechanical ventilator might be caused by these evens. How to prevent the pneumonia? Based on the experience of this patient, we recommend management to prevent and improve pneumonia in such rare disease.

並列關鍵字

tetanus ； pneumonia ； difficult weaning ； pulmonary rehabilitation

被引用紀錄

張方玫、黃怡真（2020）。一位破傷風病人合併肺炎於加護病房之護理經驗。高雄護理雜誌，37(2)，71-81。https://doi.org/10.6692/KJN.202008_37(2).0007

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破傷風桿菌感染導致呼吸衰竭病人之呼吸照護經驗

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