| ObjectiveTo investigate the clinical data of tetanus patients in Fujian province,to understand the current treatment and prognosis of tetanus patients and to analyze the influencing factors in diagnosis and treatment of severe tetanus patients.MethodThis was a retrospective multicenter observational study of patients who presented with a clinical diagnosis of tetanus at 5 general hospitals in Fujian from January 2008to December 2018.The diagnosis of tetanus was maninly clinical and based on the presence of one or more of the following:1.trismus;2.rigidity of the neck and or abdomen;3.reflex spasms.Through the electronic medical record system of each hospital,enter"tetanus"in the"main diagnosis"and search out all the information of the patients,including all the course of disease,doctor’s orders and laboratory orders.Then retrieve the relevant information through the data collection table,input it into Excel documents,and then import it into SPSS 25.0 statistical software for data analysis.Finally,the above information is integrated.to explain the current situation of diagnosis as well as treatment of tetanus,and to explore the factors that may affect the prognosis.ResultsA total of 95 patients from five hospitals were recruited,including 6 newborns.The average age of the adult tetanus patients was 55.5±15.4 years old.The tetanus severity was classified as grade III and IV in more than half of the patients accroding to Ablett scoring system.None of the patients knew their previous history of tetanus immunization.The most common first symptoms were limited opening of mouth,lockjaw and risus sardonicus of which involving the cephalofacial muscle.Body stiffness(72.63%),body spasm(74.74%),fever(43.16%)were the most common clinical manifestations.More than half(53.68%)of the patients had autonomic nervous dysfunction,and more than half(63.16%)of patients had complications.The rate of having received human tetanus immunoglobulin(HTIG)was 9.47%.There was no uniform standard for the dosage and duration of tetanus antitoxin(TAT).A total of 73(76.84%)patients were cured,17(17.89%)patients had an unknown prognosis,and 5(5.26%)patients died(3 were drug addicts).All neonatal tetanus infection injury routes were unclean deliveries,and all of them were discharged automatically without standard treatment,with an unknown prognosis.Among the 78 adult tetanus patients with a total length of hospitalization of more than 3 days,the average age was significantly higher in those with complications(58.5±14.1 years),and than in those without complications(51.6±14.8 years,p=0.047).There was a linear correlation between age and total length of hospital stay(y=3.611+0.359x,p=0.002,R~2=0.122).In 60 adult patients admitted to the ICU for more than 3 days,there was a linear correlation between age and length of stay in the ICU(y=3.274+0.296x,p=0.008,R~2=0.115).The severity of the disease at gradeⅢandⅣ,the presence of complications and the use of more than 3 types of antibiotics were all associated with an increase in the total length of hospital stay(mean total length of hospital stay was29.64±16.86 days,27.79±16.01 days and 30.54±16.23 days,respectively).Dysphagia as the first symptoms(χ2=7.489,p=0.013),autonomic dysfunction(χ2=7.785,p=0.008),and complications(χ2=25.648,p<0.001)including pulmonary infection(χ2=21.810,p<0.001),sedative drug therapy(χ2=46.915,p<0.001)and antibiotic therapy(χ2=16.863,p<0.001),were all significantly correlated with mechanical ventilation(p<0.005).According to the occurrence of dyspnea,the severity of the disease was divided into mild(grade I)and severe(grade II,III,IV).After chi-square test,it was found that they were significantly correlated with the implementation of mechanical ventilation((χ2=17.339,p<0.001).Compared with endotracheal intubation,tracheotomy increased the length of stay in the ICU(17.5±10.6 days vs.29.5±12.0 days,p=0.003),but did not affect the total length of hospitalization(25.3±15.2 day vs.34.5±16.8 days,p=0.092)and the length of mechanical ventilation(18(4,22)day vs.15(11,23)days,p=0.480).Conclusion1.Neonatal tetanus still occurs from time to time,and most of them did not receive standard treatment,which shoud be paid more attention by society.2.Drug-induced tetanus cases also occur occasionally and should be on the alert of medical staff.3.Both the total length of stay in the elderly patients and the length of stay in the ICU increased,which may be related to the higher incidence of complications in this part of the population.Patients with dysphagia as the first symptoms,dyspnea and autonomic nerve dysfunction are associated with mechanical ventilation,and this group should be more vigilant.4.There is still some disagreement about the management of tetanus and a more standardized treatment regimen needs to be established.5.We should raise our awareness to further promote the tetanus immunization programme,including the immune-strengthening programme,to better prevent tetanus. |
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