破伤风的科学防治(1)
摘 要 尽管破伤风已不再是一种多发病,但因破伤风杆菌广泛存在于环境中且引起其感染的外伤性因素依然很多、病死率又高,故破伤风仍是威胁人类健康的主要疾病之一。破伤风的诊断主要依赖外伤史和临床表现,早期识别并给予科学的治疗是改善预后的关键,而关键的治疗措施包括对伤口的彻底处理以及控制肌肉痉挛和肺部感染等。破伤风抗毒素是防治破伤风的重要药物,但其明显的不良反应限制了临床应用。新型抗毒素免疫制剂如人破伤风免疫球蛋白和马破伤风免疫球蛋白F(ab′)2将在今后破伤风的防治中发挥重要作用。预防接种是预防破伤风的主要措施。推广新法接生、外伤后正确处理伤口等也有助于预防破伤风。外伤后应首先清洁伤口,而后根据伤口情况及患者受伤前的免疫接种史来决定如何进行抗毒素预防接种。
关键词 破伤风 破伤风抗毒素 破伤风免疫球蛋白
中图分类号:R517.3 文献标识码:C 文章编号:1006-1533(2012)19-0009-04
, 百拇医药
Scientific treatment and prevention of tetanus
SHEN Yin-zhong1*, ZHANG Yong-xin2**
(1. Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China;
2. Huashan Hospital, Fudan University, Shanghai 200040, China)
Abstract Tetanus is no longer a common disease nowadays, however, it is still a serious disease threatening the human health and has a high mortality because Clostridium tetani is distributed widely in the environment, and there exist many traumatic factors which can cause tetanus. The diagnosis of tetanus is entirely dependent on the history of trauma and clinical manifestations. Early identification and scientific treatment is the key to improve the prognosis. The key measure of treatment includes the wound thoroughly cleaned and controls of muscle cramps and pulmonary infection. Tetanus antitoxin is an important drug to prevent and treat tetanus but its side effect restricts the clinical usage. A new type antitoxin immune agent such as tetanus immunoglobulin will play an important role in prevention and treatment of tetanus in the future. Immunization is a main measure to prevent tetanus. Popularizing hospital delivery and correct treating wounds post-traumatic are also benefit for preventing tetanus. After trauma, the wound should be cleaned first and then what antitoxin vaccination is decided according to the condition of the patient’s wound and immunization history.
, http://www.100md.com
Key words tetanus; tetanus antitoxin; tetanus immunoglobulin
破伤风(tetanus)是一种由破伤风杆菌(Clostridium tetani)侵入伤口内繁殖、分泌毒素引起急性中毒的人畜共患疾病,以骨骼肌持续性痉挛和神经反射兴奋性增高为特征,临床表现包括牙关紧闭以及强直性和阵挛性痉挛,累及的肌群主要有咬肌、背棘肌、腹肌和四肢肌等。破伤风见于世界各国或地区,发生呈散在性。破伤风的临床表现有时很不典型,加上临床医生、尤其是综合医院的医生和急症科医生常对此病缺乏认识,致使对破伤风的防治尚存许多误区,临床上的误诊亦不少见[1]。为了提高临床医生对破伤风的认识程度,本文对其诊治作一介绍。
1 破伤风仍是影响人类健康的主要疾病之一
破伤风杆菌属梭状芽孢杆菌属,广泛存在于自然界。菌体呈细长杆状,培养24 h后几乎所有菌体都会产生芽孢。芽孢的抵抗力强,能耐沸煮15~90 min;如不受日光直接照射,在土壤中可生存数年之久。细菌培养早期表现为革兰染色阳性,但24 h后往往变成阴性。芽孢不着色、无荚膜,大部分有鞭毛,能运动。破伤风杆菌为极厌氧菌,可在普通琼脂平板上成长、在血琼脂上产生溶血环,最适宜的生长温度为35~37 ℃、最适pH为7.0~7.5。
破伤风杆菌的分布极广,家畜粪便中含菌较多,人粪中也常带菌。土壤、污泥和尘埃中均可含破伤风杆菌。各年龄段人均易感。温暖季节因户外活动多,受伤患病也较多见。发展中国家由于新法接生和破伤风主动免疫接种不普及,破伤风成为新生儿的主要死因之一。患者患破伤风后无持久免疫力,可再次感染。, http://www.100md.com(沈银忠 张永信)
关键词 破伤风 破伤风抗毒素 破伤风免疫球蛋白
中图分类号:R517.3 文献标识码:C 文章编号:1006-1533(2012)19-0009-04
, 百拇医药
Scientific treatment and prevention of tetanus
SHEN Yin-zhong1*, ZHANG Yong-xin2**
(1. Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China;
2. Huashan Hospital, Fudan University, Shanghai 200040, China)
Abstract Tetanus is no longer a common disease nowadays, however, it is still a serious disease threatening the human health and has a high mortality because Clostridium tetani is distributed widely in the environment, and there exist many traumatic factors which can cause tetanus. The diagnosis of tetanus is entirely dependent on the history of trauma and clinical manifestations. Early identification and scientific treatment is the key to improve the prognosis. The key measure of treatment includes the wound thoroughly cleaned and controls of muscle cramps and pulmonary infection. Tetanus antitoxin is an important drug to prevent and treat tetanus but its side effect restricts the clinical usage. A new type antitoxin immune agent such as tetanus immunoglobulin will play an important role in prevention and treatment of tetanus in the future. Immunization is a main measure to prevent tetanus. Popularizing hospital delivery and correct treating wounds post-traumatic are also benefit for preventing tetanus. After trauma, the wound should be cleaned first and then what antitoxin vaccination is decided according to the condition of the patient’s wound and immunization history.
, http://www.100md.com
Key words tetanus; tetanus antitoxin; tetanus immunoglobulin
破伤风(tetanus)是一种由破伤风杆菌(Clostridium tetani)侵入伤口内繁殖、分泌毒素引起急性中毒的人畜共患疾病,以骨骼肌持续性痉挛和神经反射兴奋性增高为特征,临床表现包括牙关紧闭以及强直性和阵挛性痉挛,累及的肌群主要有咬肌、背棘肌、腹肌和四肢肌等。破伤风见于世界各国或地区,发生呈散在性。破伤风的临床表现有时很不典型,加上临床医生、尤其是综合医院的医生和急症科医生常对此病缺乏认识,致使对破伤风的防治尚存许多误区,临床上的误诊亦不少见[1]。为了提高临床医生对破伤风的认识程度,本文对其诊治作一介绍。
1 破伤风仍是影响人类健康的主要疾病之一
破伤风杆菌属梭状芽孢杆菌属,广泛存在于自然界。菌体呈细长杆状,培养24 h后几乎所有菌体都会产生芽孢。芽孢的抵抗力强,能耐沸煮15~90 min;如不受日光直接照射,在土壤中可生存数年之久。细菌培养早期表现为革兰染色阳性,但24 h后往往变成阴性。芽孢不着色、无荚膜,大部分有鞭毛,能运动。破伤风杆菌为极厌氧菌,可在普通琼脂平板上成长、在血琼脂上产生溶血环,最适宜的生长温度为35~37 ℃、最适pH为7.0~7.5。
破伤风杆菌的分布极广,家畜粪便中含菌较多,人粪中也常带菌。土壤、污泥和尘埃中均可含破伤风杆菌。各年龄段人均易感。温暖季节因户外活动多,受伤患病也较多见。发展中国家由于新法接生和破伤风主动免疫接种不普及,破伤风成为新生儿的主要死因之一。患者患破伤风后无持久免疫力,可再次感染。, http://www.100md.com(沈银忠 张永信)