Gross H
Abteilung für Anästhesie und Intensivmedizin, Elisabeth-Diakonissen- und Krankenhaus Berlin.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1997 Sep;32(9):583-8. doi: 10.1055/s-2007-995112.
This is the case presentation of a forty-year old female patient, who had incurred a tetanus infection as a result of intravenous drug abuse. Clostridium tetani could be detected repeatedly in abscesses caused by injections. The patient had to be put on continuous relaxation, sedation and artificial respiration for 42 days. Besides the usual intensive care regimen, a high-dose antitoxin therapy was initiated. The areas of abscesses had to be eradicated surgically several times. With the exception of a thrombus of the vena cava superior (without haemodynamic consequences) and a pneumonia, the further course was without any other serious complications. After seven months of hospitalisation the patient could be dismissed at "restitutio ad integrum". The known immunosuppressive effect of a high dosed tetanus antitoxin therapy could be confirmed by the patient's antitoxin titre course. Repeated active immunisation attempts to produce a sufficient endogenous antitoxin titre failed. The existing therapeutic uncertainties regarding the dosage of the tetanus antitoxin therapy, the titre control and the proper antibiotic treatment are described.
这是一位40岁女性患者的病例报告，该患者因静脉注射毒品而感染破伤风。在注射所致脓肿中可反复检测到破伤风梭菌。患者不得不持续接受放松、镇静及人工呼吸治疗42天。除常规的重症监护方案外，还启动了大剂量抗毒素治疗。脓肿部位不得不进行多次手术切除。除了上腔静脉血栓形成（无血流动力学后果）和肺炎外，病程中未出现其他严重并发症。住院7个月后，患者得以痊愈出院。患者抗毒素滴度变化证实了大剂量破伤风抗毒素治疗已知的免疫抑制作用。多次进行主动免疫以产生足够的内源性抗毒素滴度均告失败。文中描述了破伤风抗毒素治疗在剂量、滴度控制及适当抗生素治疗方面现存的治疗不确定性。
