Wateba Mi, Diop Sa, Nichols S, Patassi A, Adjo S, Gbadamassi G, Tidjani O
Service des maladies infectieuses et de pneumologie Centre hospitalier universitaire de Tokoin BP 57 Lomé Togo.
Sante. 2008 Jul-Sep;18(3):125-9. doi: 10.1684/san.2008.0115.
To determine the effect on clinical progression and mortality during tetanus of intrathecal therapy with 1 500 IU of heterologous antitetanus serum administered with 1.5 g of intravenous metronidazole.
This prospective study took place from August 1, 2006, to June 30, 2007, and included two groups of patients randomly allocated to treatment by two different techniques. The test group of 17 patients received 1 500 IU of antitetanus heterologous immunoglobulin by the intrathecal route as well as 1.5 g of intravenous metronidazole daily. The control group of 25 patients received the standard treatment of 9 000 IU of heterologous antitetanic serum administered half (4 500 IU) cutaneously and half intramuscularly. Clinical manifestations and mortality were assessed. Mollaret's classification and the Dakar prognosis score were used to classify patients according to severity.
Forty-two patients were treated. Their mean age was 29.44 years (standard deviation: 18.3 years) and the M/F sex ratio was 5. Skin wounds accounted for 57.1% of the portals of entry, deep wounds for 26.2%; the rest were unknown. Twenty patients (47.6%) had fever when admitted. Tetanus was generalized in all cases and 76.2% of patients were stage III. Four patients were HIV-positive. Clinical improvement, defined as a decrease in dysphagia, trismus, and paroxysm, was observed more quickly in the test group: 48 hours after treatment began, improvement was seen in more than 76% of the test group compared with 28% in the control group. In the test group, the mean hospitalization period was 7.4 days and mortality was 11.7%, compared with 19 days and a mortality rate of 52% in the control group.
Prevention through vaccination appears to be the long-term solution for the eradication of tetanus. In the meantime, we can hope for a better clinical response with intrathecal therapy of 1 500 IU of heterologous antitetanus serum and 1.5 g of intravenous metronidazole daily.
确定鞘内注射1500国际单位异源抗破伤风血清并静脉注射1.5克甲硝唑对破伤风临床进展和死亡率的影响。
这项前瞻性研究于2006年8月1日至2007年6月30日进行，包括两组通过两种不同技术随机分配接受治疗的患者。17名患者的试验组通过鞘内途径接受1500国际单位抗破伤风异源免疫球蛋白，并每天静脉注射1.5克甲硝唑。25名患者的对照组接受标准治疗，即9000国际单位异源抗破伤风血清，一半（4500国际单位）皮下注射，一半肌肉注射。评估临床表现和死亡率。使用莫拉雷分类法和达喀尔预后评分根据严重程度对患者进行分类。
42名患者接受了治疗。他们的平均年龄为29.44岁（标准差：18.3岁），男女比例为5。皮肤伤口占入口部位的57.1%，深部伤口占26.2%；其余情况不明。20名患者（47.6%）入院时发热。所有病例均为全身性破伤风，76.2%的患者为III期。4名患者艾滋病毒呈阳性。试验组吞咽困难、牙关紧闭和抽搐发作减少，即临床改善，出现得更快：治疗开始48小时后，试验组超过76%的患者出现改善，而对照组为28%。试验组的平均住院时间为7.4天，死亡率为11.7%，而对照组分别为19天和52%的死亡率。
通过疫苗接种进行预防似乎是根除破伤风的长期解决方案。与此同时，我们有望通过每天鞘内注射1500国际单位异源抗破伤风血清和静脉注射1.5克甲硝唑获得更好的临床反应。
