Sikendar Rana Imran, us Samad Bader, Ali Safdar, Memon Mohammad Iqbal
Department of Anaesthesia and Intensive Care Unit, Pakistan Institute of Medical Sciences, Islamabad, Pakistan.
J Ayub Med Coll Abbottabad. 2009 Apr-Jun;21(2):132-5.
Tetanus is a life threatening disease. Reported mortality for tetanus is 15-39%. Conventional treatment includes heavy sedation and artificial ventilation. Complications resulting from long term heavy sedation and artificial ventilation contribute to 60% of the total mortality caused by tetanus. In this study magnesium sulphate was used to reduce the need for sedation and artificial ventilation. Objectives of this prospective study were to determine the role of magnesium sulphate in post traumatic tetanus.
The study was carried out in surgical Intensive Care at Pakistan Institute of Medical Sciences (PIMS), Islamabad from Jan 2004 to Dec 2007. Forty-four patients presented during this period and 33 patients were included in the study. All patients had tracheostomy done within 48 hours. Every patient was started Magnesium Sulphate therapy for control of spasms after sending baseline investigations. Patients were given ventilatory support when needed. All data was entered in well structured proforma. SPSS-10 was used to analyse data.
Thirty-three patients were included in the study and all patients were given magnesium sulphate. Out of these, 45.5% cases were grade 4 tetanus, 73.6% and 63.3% cases did not require artificial ventilation and additional sedation respectively, 51.1% patients remained free of complications of tetanus. Overall mortality was 30.3%.
Use of Magnesium Sulphate is safe and reduces the need for sedation and artificial ventilation in high grade tetanus thus contributing to survival benefit in adult post-traumatic tetanus cases.
破伤风是一种危及生命的疾病。据报道，破伤风的死亡率为15%至39%。传统治疗包括深度镇静和人工通气。长期深度镇静和人工通气引起的并发症占破伤风所致总死亡率的60%。在本研究中，使用硫酸镁来减少镇静和人工通气的需求。这项前瞻性研究的目的是确定硫酸镁在创伤后破伤风治疗中的作用。
该研究于2004年1月至2007年12月在伊斯兰堡巴基斯坦医学科学研究所（PIMS）的外科重症监护室进行。在此期间有44例患者就诊，33例患者纳入研究。所有患者均在48小时内进行了气管切开术。在进行基线检查后，每位患者均开始接受硫酸镁治疗以控制痉挛。根据需要给予患者通气支持。所有数据均录入结构完善的表格。使用SPSS - 10软件进行数据分析。
33例患者纳入研究，所有患者均接受了硫酸镁治疗。其中，45.5%的病例为4级破伤风，分别有73.6%和63.3%的病例不需要人工通气和额外的镇静，51.1%的患者未出现破伤风并发症。总体死亡率为30.3%。
硫酸镁的使用是安全的，可减少重度破伤风患者对镇静和人工通气的需求，从而对成人创伤后破伤风病例的生存有益。
