Trung Truong N, Duoc Nguyen V T, Nhat Le T H, Yen Lam M, Hao Nguyen V, Truong Nguyen T, Duong Ha T H, Thuy Duong B, Phong Nguyen T, Tan Le V, Puthucheary Zudin A, Thwaites C Louise
Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Viet Nam.
Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Viet Nam.
Trans R Soc Trop Med Hyg. 2019 Nov 1;113(11):706-713. doi: 10.1093/trstmh/trz055.
In many countries, in-hospital survival from tetanus is increasing, but long-term outcome is unknown. In high-income settings, critical illness is associated with muscle wasting and poor functional outcome, but there are few data from resource-limited settings. In this study we aimed to assess muscle wasting and long-term functional outcome in adults with tetanus.
In a prospective observational study involving 80 adults with tetanus, sequential rectus femoris ultrasound measurements were made at admission, 7 days, 14 days and hospital discharge. Functional outcome was assessed at hospital discharge using the Timed Up and Go test, Clinical Frailty Score, Barthel Index and RAND 36-item Short Form Health Survey (SF-36) and 3 and 6 months after discharge using the SF-36 and Barthel Index.
Significant muscle wasting occurred between hospital admission and discharge (p<0.01), particularly in severe disease, where a median 23.49% (interquartile range 10.01-26.07) reduction in rectus femoris cross-sectional area occurred in those with severe (Ablett grades 3 and 4) disease. Muscle mass at discharge was related to objective and subjective measures of physical and emotional function at discharge and 3 and 6 months after discharge. In patients >70 y of age, functional recovery at 6 months was reduced compared with younger patients. Hospital-acquired infection and age were risk factors for muscle wasting.
Significant muscle wasting during hospitalization occurred in patients with tetanus, the extent of which correlates with functional outcome.
在许多国家，破伤风患者的院内生存率正在提高，但长期预后尚不清楚。在高收入环境中，危重病与肌肉萎缩和功能预后不良有关，但资源有限环境中的数据很少。在本研究中，我们旨在评估破伤风成年患者的肌肉萎缩和长期功能预后。
在一项涉及80例破伤风成年患者的前瞻性观察性研究中，在入院时、7天、14天和出院时对股直肌进行连续超声测量。在出院时使用计时起立行走测试、临床衰弱评分、巴氏指数和兰德36项简短健康调查（SF-36）评估功能预后，并在出院后3个月和6个月使用SF-36和巴氏指数进行评估。
入院和出院之间出现了明显的肌肉萎缩（p<0.01），特别是在严重疾病患者中，重度（阿布莱特3级和4级）疾病患者的股直肌横截面积中位数减少了23.49%（四分位间距10.01-26.07）。出院时的肌肉质量与出院时以及出院后3个月和6个月时身体和情绪功能的客观和主观测量指标相关。与年轻患者相比，70岁以上患者在6个月时的功能恢复有所降低。医院获得性感染和年龄是肌肉萎缩的危险因素。
破伤风患者在住院期间出现明显的肌肉萎缩，其程度与功能预后相关。
