發(fā)布時(shí)間：2018-05-20 14:32

  本文選題：新生兒 + 破傷風(fēng)�。� 參考：《重慶醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的：探討影響新生兒破傷風(fēng)（Neonatal tetanus.NT)預(yù)后的危險(xiǎn)因素，，為臨床判斷病情輕重、選擇治療方案及改善其預(yù)后提供積極的指導(dǎo)作用。 方法：對(duì)2000年1月-2010年1月收住重慶醫(yī)科大學(xué)附屬兒童醫(yī)院新生兒病房的71例NT患兒進(jìn)行回顧性分析，根據(jù)病情狀況分為輕型、中型、重型，根據(jù)轉(zhuǎn)歸將其分為治愈組與病死組，通過調(diào)查表統(tǒng)計(jì)NT患兒的臨床資料，采用回顧性研究方法，比較它們之間預(yù)后的差異，單因素分析與死亡有關(guān)聯(lián)的高危因素。 結(jié)果：79例NT患兒中排除8例自動(dòng)出院，有效病例71例。對(duì)有效病例進(jìn)行統(tǒng)計(jì)分析，結(jié)果為71例病例中治愈45例，死亡26例，病死率為36.6%�；純撼錾鷷r(shí)均未注射破傷風(fēng)抗毒素（TAT）進(jìn)行預(yù)防，母孕期均未給予破傷風(fēng)內(nèi)毒素（TT)預(yù)防接種�；純焊改妇鶠檗r(nóng)村或外來打工人員家庭。舊法接生62例（占87.3%），當(dāng)?shù)蒯t(yī)院或診所接生9例（占12.7%）。男女比例1.4：1，平均出生體重2780.77±6.65g，早產(chǎn)兒25例（占35.2%），平均胎齡38.6±4.2w。入院時(shí)臨床表現(xiàn)：苦笑面容71例（占100%）、牙關(guān)緊閉71例（占100%）、四肢肌張力增高71例（占100%）、煩躁及哭吵不安68例（占95.8%）、張口困難65例（占91.5%）、頻繁抽搐63例（占88.7%）、角弓反張60例（占84.5%）、喂養(yǎng)困難及拒乳55例（占77.5%）、呼吸困難52例（占73.2%）、發(fā)紺49例（占69.1%）、窒息31（占43.7%）。 根據(jù)病情狀況輕型25例(潛伏期多在14d以上，表現(xiàn)為牙關(guān)緊閉或局部肌肉強(qiáng)直)，自動(dòng)出院1例，死亡1例，病死率占4.2%（1/24)；中型33例(潛伏期7～14d，發(fā)病48h以后出現(xiàn)痙攣，表現(xiàn)為牙關(guān)緊閉，吞咽困難，全身肌肉強(qiáng)直，并出現(xiàn)陣發(fā)性肌肉痙攣)，自動(dòng)出院3例，死亡9例，病死率占30.0%（9/30）；重型21例(潛伏期7d以內(nèi)，發(fā)病48h內(nèi)出現(xiàn)痙攣，表現(xiàn)為牙關(guān)緊閉，全身肌肉強(qiáng)直伴頻繁嚴(yán)重的痙攣，不易控制)。自動(dòng)出院4例，死亡16例，病死率占94.2%（16/17）。治愈的45例患兒中輕型23例，占51.1%（23/45），中型21例，占46.7%（21/45），重型1例，占2.2%（1/45）；死亡的26例病例中輕型1例，占3.8%（1/26），中型9例，占34.6%（9/26），重型16例，占61.5%（16/26）。 單因素分析發(fā)現(xiàn)影響NT預(yù)后的高危因素有：胎齡、開始治療的時(shí)間、潛伏期、痙攣前期、起病期、痙攣持續(xù)時(shí)間、痙攣發(fā)作間期、止痙藥劑量大小及合并肺炎、敗血癥、窒息、呼吸衰竭、硬腫癥、高血糖、低鈉血癥、白細(xì)胞異常（WBC≤5×109/L或≥20×109/L）、C反應(yīng)蛋白升高（CRP≥8g/L）、血小板減少(PLT＜100×109/L)。 結(jié)論：胎齡、開始治療的時(shí)間、潛伏期、痙攣前期、起病期、痙攣持續(xù)時(shí)間、痙攣發(fā)作間期、止痙藥劑量大小及合并肺炎、敗血癥、窒息、呼吸衰竭、硬腫癥、高血糖、低鈉血癥、白細(xì)胞異常（WBC≤5×109/L或≥20×109/L）、C反應(yīng)蛋白升高（CRP≥8g/L）、血小板減少(PLT＜100×10~9/L)是影響NT預(yù)后的危險(xiǎn)因素。積極防治影響NT患兒預(yù)后的高危因素，可降低病死率，提高治療的成功率。
[Abstract]:Objective: to explore the risk factors influencing the prognosis of Neonatal tetanus (NT), and to provide positive guidance for clinical judgement, selection of treatment plan and improvement of prognosis of Neonatal tetanus. Methods: from January 2000 to January 2010, 71 cases of NT in neonatal ward of affiliated Children's Hospital of Chongqing Medical University were retrospectively analyzed. According to the condition of the disease, they were divided into light, medium and severe. According to the outcome, the patients were divided into two groups: the cured group and the dead group. The clinical data of children with NT were analyzed by questionnaire, and the difference of prognosis between them was compared by retrospective study, and the high risk factors associated with death were analyzed by univariate analysis. Results among 79 cases of NT, 8 cases were excluded and 71 cases were effective. The results showed that 45 cases were cured, 26 cases died and the mortality rate was 36.6%. No tetanus antitoxin was injected into the children at birth, and no tetanus endotoxin TTT was given to the mother during pregnancy. The parents of the children were both rural or migrant workers' families. 62 cases (87.3%) were delivered by the old method, 9 cases (12.7%) were delivered in local hospitals or clinics. The ratio of male to female was 1.4: 1, the average birth weight was 2780.77 鹵6.65 g, and the average gestational age was 38.6 鹵4.2 wks in 25 premature infants (35.2%). Clinical manifestations on admission: 71 cases (100 cases) with bitter smile, 71 cases (100 cases) with closed jaw, 71 cases (100 cases) with increased muscular tension in limbs (100 cases), 68 cases (95.888%) with restlessness and crying, 65 cases (91.5%) with difficulty in opening mouth, 63 cases (88.77%) with frequent convulsions, and 63 cases (88.77%) with angle arch. There were 60 cases (84.5%) of regurgitation, 55 cases (77.5%) of difficulty in feeding and refusing milk, 52 cases (73.2%) of dyspnea, 49 cases of cyanosis (69.1%), 31 cases of asphyxia (43.7%). According to the condition of the disease, 25 cases were mild (the incubation period was more than 14 days). The symptoms were closed teeth or local muscular rigidity, 1 case was discharged automatically, 1 case died, the mortality rate was 4.22 / 24%, 33 cases (incubation period 7 days 14 days later) developed spasm 48 hours after onset. The symptoms included tight jaw, dysphagia, muscular rigidity, paroxysmal muscle spasm, automatic discharge from hospital in 3 cases, death in 9 cases, mortality rate of 30.030%, and severe cases (within 7 days of incubation period, spasm within 48 hours of onset). Systemic muscular ankylosis with frequent and severe spasms is difficult to control. 4 cases were discharged automatically, 16 cases died, the mortality rate was 94. 2% / 17%. Of the 45 cases cured, 23 were mild (51.1 / 23 / 45), 21 were moderate (46.7 / 45), 1 was severe (2.2 / 45 / 45), 1 was light (3.826 / 26), 9 were medium-sized (34.699 / 26), 16 were heavy (61.5 / 16 / 26). Univariate analysis showed that the high risk factors influencing the prognosis of NT were gestational age, time of beginning treatment, incubation period, prespasticity, onset stage, spasmodic duration, spasmodic interval, size of antispasmodic agent and complicated pneumonia, septicemia, asphyxia. Respiratory failure, scleres, hyperglycemia, hyponatremia, leukocyte abnormalities WBC 鈮

本文編號(hào)：1914994