Al-Kaabi J M, Scrimgeour E M, Louon A, Al-Riyami B M
Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman.
Saudi Med J. 2001 Jul;22(7):606-9.
Although tetanus is now uncommon in Oman (The Expanded Program on Immunization was introduced in 1981), patients continue to present from time to time at an average rate of 6 cases per year. Worldwide, the mortality rate for tetanus remains high (ranging from 15-20% in developed countries). At the Sultan Qaboos University Hospital, Muscat, Oman, prolonged Intensive Care Unit treatment and multi-disciplinary management is invariably required for tetanus patients. This study was carried out to evaluate our results over the past decade.
All tetanus patients admitted to the Sultan Qaboos University Hospital from 1991 up to the end of 1999 were retrospectively reviewed. Patients were diagnosed early, and aggressive treatment in the Intensive Care Unit was instituted, with a coordinated multidisciplinary management.
Ten cases were identified and included in the review, comprising 9 adults and one infant aged 2 weeks. Adult patients were aged 36-75 years (mean 59 years), and the average Intensive Care Unit stay of the 9 surviving patients was 5.5 weeks (range 3-7 weeks). All patients presented with severe generalized tetanus. Two patients with traditional cautery marks developed tetanus. A focus of infection could not be found in 2 patients. All patients had early tracheostomy and assisted ventilation with appropriate sedation. One patient required almost 45 gm of diazepam throughout his Intensive Care Unit stay. One adult patient died on the 6th day of admission following myocardial infarction. The neonatal case survived after 35 days care in the Intensive Care Unit. The mortality rate for our patients was therefore 10%.
Tetanus in Oman remains an infrequent but important disease requiring costly and prolonged Intensive Care Unit treatment. We attribute the comparatively low mortality rate (10%) in this study, to early diagnosis, institution of aggressive treatment, good nursing as well as a well-coordinated multi-disciplinary management.
尽管破伤风在阿曼如今已不常见（1981年引入了扩大免疫规划），但患者仍不时出现，平均每年有6例。在全球范围内，破伤风的死亡率依然很高（在发达国家为15%至20%）。在阿曼马斯喀特的苏丹卡布斯大学医院，破伤风患者 invariably 需要长时间的重症监护病房治疗和多学科管理。本研究旨在评估我们在过去十年的结果。
对1991年至1999年底入住苏丹卡布斯大学医院的所有破伤风患者进行回顾性研究。患者得到早期诊断，并在重症监护病房进行积极治疗，同时进行协调的多学科管理。
共确定10例并纳入本研究，其中包括9名成年人和1名2周大的婴儿。成年患者年龄在36至75岁之间（平均59岁），9名存活患者在重症监护病房的平均住院时间为5.5周（3至7周）。所有患者均表现为严重的全身性破伤风。2名有传统烧灼痕迹的患者发生了破伤风。2名患者未发现感染源。所有患者均早期行气管切开术，并在适当镇静下进行辅助通气。1名患者在重症监护病房住院期间需要近45克地西泮。1名成年患者在入院第6天因心肌梗死死亡。新生儿病例在重症监护病房接受35天治疗后存活。因此，我们患者的死亡率为10%。
破伤风在阿曼仍然是一种罕见但重要的疾病，需要昂贵且长时间的重症监护病房治疗。我们将本研究中相对较低的死亡率（10%）归因于早期诊断、积极治疗的实施、良好的护理以及协调良好的多学科管理。
