Analysis of risk factors of nine deaths cansed by tetanus
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摘要: 目的 分析破伤风患者的临床特点及死亡危险因素。 方法 收集2009年9月—2020年7月江苏省人民医院30例破伤风住院患者的临床资料,按照预后分为死亡组9例和存活组21例,比较2组患者的临床资料,分析破伤风患者死亡的危险因素。 结果 30例破伤风患者中,男21例,女9例,平均年龄为(56.20±14.50)岁。单因素分析结果提示,死亡组与存活组患者年龄、Ablett分级为重症比率、机械通气比率、潜伏期、急性生理与慢性健康评分Ⅱ(APACHE Ⅱ)及并发症发生率的差异有统计学意义(P<0.05)。Logistic回归分析显示,年龄、Ablett分级及潜伏期是患者死亡的独立危险因素。年龄与潜伏期联合预测破伤风患者死亡的曲线下面积(AUC)为0.979(95%CI=0.840~1.000, P<0.001), 敏感性为88.9%, 特异性为100.0%。 结论 尽管破伤风的发病率有所下降,但病死率仍然很高,临床上要加强对老年患者的重点关注,而联合年龄及潜伏期2个变量可以较好地预测破伤风患者的预后。
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关键词:
- 破伤风 /
- 临床特点 /
- 死亡危险因素 /
- Logistic回归分析
Abstract: Objective To analyze the clinical characteristics and risk factors of death caused by tetanus. Methods Clinical materials of 30 tetanus patients treated in Jiangsu Provincial People's Hospital from September 2009 to July 2020 were collected, and they were divided into death group(n=9)and survival group(n=21)according to prognosis. The clinical materials of the two groups were compared, and the risk factors of death in patients with tetanus were analyzed. Results Among the 30 patients with tetanus, there were 21 males and 9 females with an average age of(56.20±14.50)years old. Univariate analysis showed that there were significant differences in age, ratio of severe Ablett classification, ratio of mechanical ventilation, incubation period, score of Acute Physiology and Chronic Health Scale Ⅱ(APACHE Ⅱ)and incidence rate of complications between the death group and the survival group(P<0.05). Logistic regression analysis showed that age, Ablett classification and incubation period were independent risk factors of death. The area under curve(AUC)of age combined with incubation period in predicting death of tetanus patients was 0.979(95% CI was 0.840 to 1.000, P<0.001), and the sensitivity and specificity were 88.9% and 100.0% respectively. Conclusion Although the incidence rate of tetanus has decreased, the mortality is still high, and we should pay more attention to the elderly patients in clinic. Combination of age and incubation period can effectively predict the prognosis of patients with tetanus.-
Keywords:
- tetanus /
- clinical features /
- risk factors of death /
- Logistic regression analysis
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Centers for Disease Control and Prevention(CDC). Tetanus surveillance: United States, 2001-2008[J]. MMWR Morb Mortal Wkly Rep, 2011, 60(12): 365-369.
AFSHAR M, RAJU M, ANSELL D, et al. Narrative review: tetanus-a health threat after natural disasters in developing countries[J]. Ann Intern Med, 2011, 154(5): 329-335.
蔡妙甜, 梁连春, 李侗曾, 等. 破伤风的临床特点及预后影响因素分析[J]. 北京医学, 2018, 40(4): 318-322. COOK T M, PROTHEROE R T, HANDEL J M. Tetanus: a review of the literature[J]. Br J Anaesth, 2001, 87(3): 477-487.
MARULAPPA V G, MANJUNATH R, MAHESH BABU N, et al. A ten year retrospective study on adult tetanus at the epidemic disease(ED)hospital, Mysore in southern India: a review of 512 cases[J]. J Clin Diagn Res, 2012, 6(8): 1377-1380.
AMARE A, MELKAMU Y, MEKONNEN D. Tetanus in adults: clinical presentation, treatment and predictors of mortality in a tertiary hospital in Ethiopia[J]. J Neurol Sci, 2012, 317(1/2): 62-65.
FARRAR J J, YEN L M, COOK T, et al. Tetanus[J]. J Neurol Neurosurg Psychiatry, 2000, 69(3): 292-301.
LALLI G, GSCHMEISSNER S, SCHIAVO G. Myosin Va and microtubule-based motors are required for fast axonal retrograde transport of tetanus toxin in motor neurons[J]. J Cell Sci, 2003, 116(pt 22): 4639-4650.
RUMMEL A, BADE S, ALVES J, et al. Two carbohydrate binding sites in the H(CC)-domain of tetanus neurotoxin are required for toxicity[J]. J Mol Biol, 2003, 326(3): 835-847.
KYU H H, MUMFORD J E, STANAWAY J D, et al. Mortality from tetanus between 1990 and 2015: findings from the global burden of disease study 2015[J]. BMC Public Health, 2017, 17(1): 179-183.
Infectious Agent Surveillance Report(IASR). Tetanus in Japan as of December 2008[J]. IASR, 2009, 30: 65-66.
PASCUAL F B, MCGINLEY E L, ZANARDI L R, et al. Tetanus surveillance—United States, 1998–2000[J]. MMWR Surveill Summ, 2003, 52(3): 1-8.
HSU S S, GROLEAU G. Tetanus in the emergency department: a current review[J]. J Emerg Med, 2001, 20(4): 357-365.
ADEKANLE O, AYODEJI O, OLATUNDE L. Tetanus in a rural setting of South-Western Nigeria: a ten-year retrospective study[J]. Libyan J Med, 2009, 4(2): 78-80.
SIDHARTHA S S, PETER J V, SUBHASH H S, et al. A proposed new scoring system for tetanus[J]. Indian J Crit Care Med, 2004, 8: 168-172.
GRECO J B, TAVARES-NETO J, GRECO J B JR. Accidental tetanus: prognosis evaluation in a historical series at a hospital in Salvador, Bahia, Brazil[J]. Rev Inst Med Trop S Paulo, 2003, 45(1): 35-40.
WOLDEAMANUEL Y W, ANDEMESKEL A T, KYEI K, et al. Case fatality of adult tetanus in Africa: Systematic review and meta-analysis[J]. J Neurol Sci, 2016, 368: 292-299.
NAKAJIMA M, ASO S, MATSUI H, et al. Clinical features and outcomes of tetanus: Analysis using a National Inpatient Database in Japan[J]. J Crit Care, 2018, 44: 388-391.
MCQUILLAN G M, KRUSZON-MORAN D, DEFOREST A, et al. Serologic immunity to diphtheria and tetanus in the United States[J]. Ann Intern Med, 2002, 136(9): 660-667.
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