非新生儿破伤风诊疗规范

破伤风分为新生儿破伤风和非新生儿破伤风。我国已于2012年消除了新生儿破伤风,但非新生儿破伤风仍是一个严重的公共卫生问题。非新生儿破伤风重症患者在无医疗干预的情况下,病死率接近100%,即使经过积极的综合治疗,全球范围病死率仍为30%~50%,是一种极为严重的潜在致命性疾病。为规范我国非新生儿破伤风诊疗行为,提高医疗质量,保障医疗安全,特制定本规范。本规范包括了非新生儿破伤风的病原学、流行病学、发病机制、临床表现及实验室检查、诊断、鉴别诊断、分级、治疗等方面内容。     

新生儿破伤风治疗近况

解放后,在预防为主方针的指导下,普遍开展新法接生,新生儿破伤风已明显减少。但在部分农村地区仍有较高的发病率,病死率可占新生儿感染性疾病死亡的首位。因此,新生儿破伤风仍是危害农村新生儿生命的严重疾病。本文就近年来新生儿破伤风治疗的近况和进展综述如下,供临床参考。新生儿破伤风是一严重疾病,很多病儿由于严重痉挛导致窒息,全身衰竭或继发感染而死亡,因此在治疗上除尽早用抗     

哪种情况该打破伤风针

正破伤风,一个几乎快要被人忘记的古老的疾病。由于现在病人已很少,大多数人对破伤风就不以为然了。不知道这是一种极为严重的潜在致命性疾病。破伤风在没有医疗干预的情况下,尤其是老年人和婴幼儿,病死率接近100%,即便治疗,病死率仍高达30%～50%。可喜的是,破伤风的预防效果很好。开放性外伤(特别是伤口深、污染严重者)有感染破伤风的危险时,     

预防破伤风 你做对了吗

正说起破伤风,很多人都不陌生。这是一种极为严重的潜在致命性疾病,在没有医疗干预的情况下,尤其是老年人和婴幼儿,病死率接近100%,即便治疗,全球病死率仍高达30%～50%。所以,预防破伤风极为重要。但是,在我国,如何正确预防破伤风至今存在着很多的认知盲区和误区。本刊特地邀请了北京大学人民医院急诊外科主任王传林,详细解读如何正确预防破伤风。     

珠海市2006～2010年新生儿破伤风流行病学特征及影响因素分析

目的:了解珠海市新生儿破伤风流行病学特征,为制定干预措施提供依据。方法:利用新生儿破伤风监测系统获得新生儿破伤风资料并进行统计分析。结果:2006～2010年珠海市新生儿破伤风发病率呈逐年下降趋势,年均发病率为0.46‰,年均病死率为7.69%,年均死亡率为0.035‰,病例全部为外来流动人群,分娩方式均为非住院分娩。结论:外来流动人群是新生儿破伤风发病的高危人群,非住院分娩是新生儿破伤风发病的主要原因。应采取综合干预措施提倡和推广住院分娩,消除新生儿破伤风。     

新生儿破伤风预后的危险因素非条件Logistic回归分析

【目的】分析各项危险因素对新生儿破伤风患儿的综合作用。【方法】对297例新生儿破伤风患儿进行单因素分析，将单因素分析得出的显著性变量，进入非条件Logistic回归模式进行危险因素多元回归分析，计算OR值及其95％可信限等。筛选出相互独立的危险因素与新生儿破伤风病死率的关系。【结果】潜伏期、痉挛前期、痉挛发作持续时间、开始治疗的时间及并发症均为影响新生儿破伤风预后的主要危险因素。【结论】积极控制新生儿破伤风预后的各项危险因素，可降低新生儿破伤风病死率，改善预后。     

1999～2005年贵港市新生儿破伤风流行病学分析

目的了解新生儿破伤风(NT)发病原因,以便制定消除NT的策略。方法对贵港市1999～2005年新生儿破伤风进行流行病学分析。结果新生儿破伤风发病率在0.24～0.84‰,2003年前有1～2个县发病率≥1‰,病死率为3.45%～19.05%。全年均有病例发生,男女性别为4.211。新生儿破伤风病例96.62%在家分娩,其中87.84%是由非医务人员接生,所有的母亲几乎未接种过破伤风类毒素。结论经济落后、文化程度低、医疗保健水平薄弱和交通不便等是造成NT发病的主要原因,提高住院分娩率是控制NT的关健。     

新生儿破伤风40例综合治疗效果观察

目的了解新生儿破伤风的临床特征,观察新生儿破伤风临床治疗疗效,以提高新生儿破伤风抢救水平。方法对40例新生儿破伤风患者抗感染、应用破伤风抗毒素、控制痉挛、加强护理等治疗。结果本组40例患儿中有38例并发肺炎(95.0%),5例并发败血症(12.2%),10例合并皮肤感染(25.0%)如尿布疹、褥疮等。40例中治愈35例(87.5%),疗程30～90d;3例因家庭困难放弃治疗出院,2例因合并严重败血症死亡。结论新生儿破伤风临床症状典型,易诊断。新生儿破伤风关键在于预防,治疗较复杂,需注意控制惊厥,抗感染,营养支持,加强护理等综合治疗,方能取得较满意的临床疗效。     

59例新生儿破伤风的急救

新生儿破伤风(neonatal tetanus NT)是在新生儿出生时使用不洁的器械切断脐带或出生后对脐带进行不洁处理造成脐带残端破伤风杆菌感染引起的,在未经治疗的情况下,病死率几乎为100%.我们对1998～2002年我院收治的59例新生儿破伤风急救护理进行分析,现报告如下.     

鞘内注射破伤风抗血清及激素治疗新生儿破伤风

新生儿破伤风病死率很高,在印度农村为55%。作者报道用鞘内注射破伤风马抗血清(ATS)及皮质激素治疗破伤风,取得了一定的效果。1978年8～9月间把印度某儿童医院99     

外伤后破伤风疫苗和被动免疫制剂使用指南

外伤后破伤风是非新生儿破伤风的主要类型。为指导基层医疗机构做好外伤后破伤风的预防控制工作,尤其是外伤后的预防处置,降低破伤风发病率及病死率,中国疾病预防控制中心国家免疫规划技术工作组参考《2017年世界卫生组织破伤风立场文件》,以及国内外最新研究进展,制定了本指南。本指南主要介绍了外伤后破伤风预防处置的基本流程,破伤风疫苗和被动免疫制剂的使用方法及潜在外伤高危人群的暴露前免疫。     

Tetanus disease and deaths in men reveal need for vaccination

With efforts focused on the elimination of maternal and neonatal tetanus, less attention has been given to tetanus incidence and mortality among men. Since 2007 voluntary medical male circumcision has been scaled-up in 14 sub-Saharan African countries as an effective intervention to reduce the risk of human immunodeficiency virus (HIV) acquisition among men. As part of a review of adverse events from these programmes, we identified 13 cases of tetanus from five countries reported to the World Health Organization (WHO) up to March 2016. Eight patients died and only one patient had a known history of tetanus vaccination. Tetanus after voluntary medical male circumcision was rare among more than 11 million procedures conducted. Nevertheless, the cases prompted a review of the evidence on tetanus vaccination coverage and case notifications in sub-Saharan Africa, supplemented by a literature review of non-neonatal tetanus in Africa over the years 2003–2014. The WHO African Region reported the highest number of non-neonatal tetanus cases per million population and lowest historic coverage of tetanus-toxoid-containing vaccine. Coverage of the third dose of diphtheria–tetanus–polio vaccine ranged from 65% to 98% across the 14 countries in 2013. In hospital-based studies, non-neonatal tetanus comprised 0.3–10.7% of admissions, and a median of 71% of patients were men. The identification of tetanus cases following voluntary medical male circumcision highlights a gender gap in tetanus morbidity disproportionately affecting men. Incorporating tetanus vaccination for boys and men into national programmes should be a priority to align with the goal of universal health coverage.     

Factors affecting the immunogenicity and potency of tetanus toxoid: implications for the elimination of neonatal and non-neonatal tetanus as public health problems.

An estimated 400,000 deaths occur annually from neonatal tetanus (NT). In 1989 WHO adopted the goal of eliminating NT as a public health problem worldwide. To achieve this, and to control non-neonatal tetanus (non-NT), WHO recommends that newborns be passively protected at birth by the antepartum administration of at least two doses of tetanus toxoid (TT) to their mothers and that all children subsequently receive at least three doses of diphtheria-tetanus-pertussis (DTP) vaccine. For this strategy to be effective, the TT used must be immunogenic. Potential factors that may affect TT immunogenicity need to be evaluated if NT is to be eliminated and if non-NT is to be controlled. Although data are conflicting, concurrent malarial infection may decrease the immune response to TT; however, malarial chemoprophylaxis may enhance the immune response. Malnutrition does not appear to affect immunogenicity; nevertheless, one study suggests that vitamin A deficiency is associated with an impaired immune response. Although it has been postulated that placental transfer of tetanus antibody is impaired in African women, a survey of the published literature suggests that this is not the case. Freezing TT has been shown to decrease its potency, but its impact on immunogenicity needs more evaluation.     

Management of tetanus in the elderly.

BACKGROUND: Tetanus is primarily a disease of the elderly. Both the incidence and the case-fatality rates are higher in the elderly population. Physicians need to be aware of special needs concerning the treatment of tetanus in this population. METHODS: A comprehensive review of the literature concerning the treatment of tetanus was undertaken. Using the key words "tetanus," "geriatric," "elderly," and "aged," the MEDLINE files were searched from 1985 to the present. Articles dating before 1985 were accessed by cross-referencing the more recent articles. RESULTS AND CONCLUSIONS: Once the diagnosis of tetanus is suspected, intensive, expectant management is necessary. The patient should receive intensive care with treatment aimed at prevention of muscle spasms, prevention of respiratory tract and metabolic complications, and neutralization of circulating toxin. Potential complications of tetanus include pulmonary embolus, aspiration pneumonia, malnutrition, and pressure sores.     

破伤风高风险人群主动免疫制剂使用专家共识

目前在全球范围内破伤风仍然是一种极为严重的潜在致死性疾病。我国已于2012年消除新生儿破伤风,但外伤后破伤风的疾病负担较重。针对我国外伤后破伤风高发病风险人群做好暴露前主动免疫,对于降低我国外伤后破伤风疾病负担具有重要意义。本共识依据世界卫生组织破伤风疫苗立场文件以及中国发布的破伤风相关规范、标准,并结合国内外相关研究结果,介绍了国内外破伤风暴露前免疫预防策略、我国破伤风发病高风险人群的界定等内容,并对暴露前破伤风主动免疫制剂的使用形成了推荐意见,供疾病预防控制和预防接种相关工作人员参考使用。     

Listeria monocytogenes meningitis: serotype distribution and patient characteristics in The Netherlands, 1976-95

Two hundred and seven cases of listeria meningitis that occurred in The Netherlands over 20 years were reviewed to study associations between Listeria monocytogenes serotype, age, underlying disease, and outcome. The mean annual incidence per 100,000 population was 0.12 in 1981-90, decreasing to 0.07 in 1991-5. Underlying disease was present in 50% of non-neonatal patients, most often haematological malignancy (15%) and the use of immunosuppressive therapy (14%). The meningitis-related case fatality rate was 16%; a significantly higher rate was associated with the presence of underlying disease (30%) or age > or = 70 years (29%). Serotype 4b was most frequent (65%) and L. monocytogenes types 1/2a, 1/2b, or 1/2c (30% of cases) were significantly more often isolated from non-neonatal patients with underlying disease, suggesting a higher virulence of listerial serotype 4b.     

2005-2011年温州市新生儿破伤风疫情监测分析

目的 为监测新生儿破伤风发病及其趋势,为当地防控新生儿破伤风提供科学依据.方法 对2005-2011年全市县级以上医疗机构病案室登记的新生儿破伤风病例进行调查,并与国家疾病监测信息报告系统报告的新生儿破伤风病例进行核对;对病案室登记的新生儿破伤风病例的出生场所、户籍所在地也进行调查.结果 全市总的新生儿破伤风漏报率为19.90％;年均发病率为0.35/10万,呈逐年下降趋势;在家里分娩的占90.91％;发病者中以贵州籍为最多,占全部外省户籍的72.31％.结论 当地新生儿破伤风病例仍存在一定的漏报,故在评估新生儿破伤风疫情及其流行程度时需对此加以考虑.贵州等省籍的外来流动人群的孕妇选择在家里分娩是目前发生新生儿破伤风的主要高危因素,急需采取有效的干预措施,以减少和杜绝新生儿破伤风病例的发生.     

Mortality from neonatal tetanus in rural C?te d'Ivoire

A 30-cluster survey was carried out in order to estimate the incidence of neonatal tetanus in rural Côte d''Ivoire. Births in the 19 months preceding the survey were enumerated by interviewers in house-to-house visits. If a child born in that period had died, the interviewer asked a series of questions to establish a presumptive diagnosis of neonatal tetanus. A total of 41 deaths from neonatal tetanus was found in the study area among 2324 live births that occurred from 1 January 1981 to 31 July 1982. This gives a neonatal tetanus mortality rate of about 2%. Most deliveries and almost all deaths occurred at home, and only about 2% of neonatal tetanus cases were reported through the routine health information system. Birth in a clinic and antiseptic care of the umbilical cord protected infants from neonatal tetanus. Tetanus immunization of all women of child-bearing age is recommended as a preventive measure.     

清远市1999-2007年新生儿破伤风流行病学分析

目的探讨清远市新生儿破伤风（新破）发病情况及其影响因素和防制措施。方法采用描述性流行病学方法,对清远市1999—2007年新破专报系统的监测资料和个案调查材料进行统计分析。结果清远市1999—2007年共报告新破267例,年平均发病率0．80‰;死亡63例,年平均死亡率0．19‰;年平均病死率23．60％。报告发病率呈逐年下降趋势。病例主要集中在农村和边远山区。男、女要总发病率分别为1．08‰、0．46‰,差异有统计学意义（Х^2=8．734,P〈0.05）,男女性别比为2．84：1。在家中分娩的病例占94．70％;由未经培训的人员接生占93．63％;病例母亲94．01％未接种过破伤风类毒素,82．77％未接受过产前检查或不详;属计划外生育的病例占36．70％。结论产妇卫生知识缺乏和不安全接生是清远市新生儿破伤风发病的主要影响因素。普及住院分娩、新法接生,加强流动人口中育龄妇女的妇幼保健工作,育龄妇女接种破伤风类毒素是预防和消除新破的主要措施。