五虎追风散配合咪达唑仑治疗重症破伤风患者痉挛的临床效果与安全性分析
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摘要
目的观察五虎追风散配合咪达唑仑治疗重症破伤风患者痉挛的临床效果,并分析其安全性。方法选择我院2014年1月-2017年12月收治的150例重症破伤风患者作为研究对象,采用随机数字表法,将患者分为对照组和观察组,每组75例。所有患者均采用肌肉注射破伤风免疫球蛋白、破伤风抗毒素,并采用青霉素或甲硝唑抗感染。对照组患者气管切开,行机械通气,并采用咪达唑仑静脉泵入镇静;观察组在对照组的基础上给予加味五虎追风散治疗,两组均为7 d一个疗程,治疗1～2个疗程。观察记录两组患者痉挛缓解时间、住院时间,治疗前后痉挛发作次数、发作持续时间以及张口大小,使用Ramsay评分法对患者意识状态进行评价,并记录镇静药物使用时间和并发症发生情况,对中医证候进行评分,评价疗效。结果治疗后,观察组痉挛发作次数、发作持续时间均少于对照组,张口大小大于对照组(P <0. 05),差异有统计学意义;观察组治疗后Ramsay评分低于对照组,且镇静药物使用时间低于对照组(P <0. 05),差异有统计学意义;观察组痉挛缓解时间、住院时间均低于对照组(P <0. 05),差异有统计学意义;治疗后,观察组中医证候评分低于对照组(P <0. 05),差异有统计学意义;观察组并发症发生率低于对照组(P <0. 05),差异有统计学意义;观察组有效率高于对照组(P <0. 05),差异有统计学意义。结论使用五虎追风散配合咪达唑仑治疗重症破伤风患者,能够明显改善患者痉挛症状,提高疗效,并且缩短住院时间,减少并发症发生,值得临床推广。
Objective To explore the clinical effects on spasticity in the patients with severe tetanus treated with wuhu zhuifeng san and midazolam and analyze its safety. Methods From January 2014 to December 2017,150 eligible patients with severe tetanus were collected. According to random number table,they were divided into a control group and an observation group,75 cases in each one. Every patient received intramuscular injection with tetanus immunoglobulin,tetanus antitoxin,as well as penicillin or metronidazole for anti-infection. In the control group,the tracheotomy for mechanical ventilation was used and the intravenous pumping with midazolam for sedation. In the observation group,on the base of the treatment as the control group,the modified wuhu zhuifeng san was added. The treatment for 7 days was as one session and 1 to 2 sessions were required. The remission time of spasm and hospital stays were observed in the two groups,as well as seizure frequency,attack duration and mouth-open size. Using Ramsay scale,the consciousness state was evaluated.The use time of sedative and incidence of complication were recorded. The TCM symptoms and therapeutic effects were evaluated. Results After treatment,seizure frequency and attack duration in the observation group were less than the control group and the mouth-open size was bigger than the control group( P < 0. 05),with statistical significance. In the observation group,Ramsay score after treatment was lower than the control group and the use time of sedative was less than the control group( P < 0. 05),indicating the statistical significance. After treatment,TCM symptom score in the observation group was lower than the control group( P < 0. 05),indicating the statistical significance. The incidence of complication in the observation group was lower than the control group( P < 0. 05),indicating the statistical significance. The effective rate in the observation group was higher than the control group( P < 0. 05),indicating the statistical significance. ConclusionThe co-medication of wuhu zhuifeng san and midazolam obviously relieves spasticity in the patients with severe tetanus,improves the therapeutic effects,shortens hospital stays and reduces the incidence of complication. Hence,this therapy deserves to be prompted in clinical practice.
Objective To explore the clinical effects on spasticity in the patients with severe tetanus treated with wuhu zhuifeng san and midazolam and analyze its safety. Methods From January 2014 to December 2017,150 eligible patients with severe tetanus were collected. According to random number table,they were divided into a control group and an observation group,75 cases in each one. Every patient received intramuscular injection with tetanus immunoglobulin,tetanus antitoxin,as well as penicillin or metronidazole for anti-infection. In the control group,the tracheotomy for mechanical ventilation was used and the intravenous pumping with midazolam for sedation. In the observation group,on the base of the treatment as the control group,the modified wuhu zhuifeng san was added. The treatment for 7 days was as one session and 1 to 2 sessions were required. The remission time of spasm and hospital stays were observed in the two groups,as well as seizure frequency,attack duration and mouth-open size. Using Ramsay scale,the consciousness state was evaluated.The use time of sedative and incidence of complication were recorded. The TCM symptoms and therapeutic effects were evaluated. Results After treatment,seizure frequency and attack duration in the observation group were less than the control group and the mouth-open size was bigger than the control group( P < 0. 05),with statistical significance. In the observation group,Ramsay score after treatment was lower than the control group and the use time of sedative was less than the control group( P < 0. 05),indicating the statistical significance. After treatment,TCM symptom score in the observation group was lower than the control group( P < 0. 05),indicating the statistical significance. The incidence of complication in the observation group was lower than the control group( P < 0. 05),indicating the statistical significance. The effective rate in the observation group was higher than the control group( P < 0. 05),indicating the statistical significance. ConclusionThe co-medication of wuhu zhuifeng san and midazolam obviously relieves spasticity in the patients with severe tetanus,improves the therapeutic effects,shortens hospital stays and reduces the incidence of complication. Hence,this therapy deserves to be prompted in clinical practice.
引文
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[11]王晓楠,李京培,唐媛媛,等.破伤风梭菌毒素致小鼠肌肉痉挛虚拟仿真实验建设[J].实验技术与管理,2017,34(5):119-121.
[12]邓英丽,蓝智.重症型破伤风病人鼻饲并发症原因分析及护理[J].护理研究,2013,27(30):3411-3412.
[13]李炬带,郭敏,刘力新,等.呼吸气囊辅助呼吸下紧急经皮气管切开术在重症破伤风的应用价值[J].中华传染病杂志,2016,34(4):248.
[14]韩屾,黄国金.丙泊酚联合东莨菪碱治疗重症破伤风的疗效[J].医药导报,2013,32(2):194-195.
[15]付国强,王伯良,王立鹤,等.中药埋线疗法致破伤风1例[J].中国急救医学,2017,37(6):534-535.
[2]丁茂乾,姚元章,屈纪富,等.咪达唑仑联合瑞芬太尼控制破伤风患者痉挛的疗效[J].创伤外科杂志,2017,19(6):466-468.
[3]冯爱东,杨淑岭,李荣香,等.中医情志理论对恢复期重型破伤风患者静脉留置针的护理效果观察[J].河北医药,2016,38(18):2862-2864.
[4]张本瑞,丁媛,张如青,等.《五十二病方》中的急症救治方法举例[J].中国中医急症,2013,22(9):1515-1517.
[5]吴孟超,吴在德.黄家驷外科学[M].北京:人民卫生出版社,2008:10.
[6]谭新华,陆德明.中医外科学[M].北京:人民卫生出版社,1999:440-443.
[7]史玉虎,焦常新,付耀武,等.中西医结合治疗破伤风验案[J].中国中医急症,2012,21(5):846.
[8]Desai SA,Rolston JD,Mc Cracken CE,et al. Asynchronous Distributed MultielectrodeMicrostimulation Reduces Seizures in theDorsal Tetanus Toxin Model of Temporal Lobe Epilepsy[J]. Brain Stimul,2016,9(1):86-100.
[9]陈佑邦.中医病证诊断疗效标准[M].南京:南京大学出版社,1994.
[10]王晓娟,桂月玲,李玉肖,等.皮肤清洁度对破伤风抗毒素皮肤过敏试验阳性率的影响[J].护理实践与研究,2012,9(20):123-124.
[11]王晓楠,李京培,唐媛媛,等.破伤风梭菌毒素致小鼠肌肉痉挛虚拟仿真实验建设[J].实验技术与管理,2017,34(5):119-121.
[12]邓英丽,蓝智.重症型破伤风病人鼻饲并发症原因分析及护理[J].护理研究,2013,27(30):3411-3412.
[13]李炬带,郭敏,刘力新,等.呼吸气囊辅助呼吸下紧急经皮气管切开术在重症破伤风的应用价值[J].中华传染病杂志,2016,34(4):248.
[14]韩屾,黄国金.丙泊酚联合东莨菪碱治疗重症破伤风的疗效[J].医药导报,2013,32(2):194-195.
[15]付国强,王伯良,王立鹤,等.中药埋线疗法致破伤风1例[J].中国急救医学,2017,37(6):534-535.