嚴重破傷風引起心肌病變案例報告

Severe Tetanus-Induced Cardiomyopathy

破傷風是一種會危及到生命的神經系統疾病，由破傷風桿菌之外毒素所引起，以肌肉痙攣與自律神經失調為最見症狀。治療準則包含終止毒素產生、中和游離態毒素、呼吸道處置、支持性照護、肌肉痙攣控制與自律神經失調治療。本案例64歲中年婦女送至本院急診經診斷為嚴重全身性破傷風，給予破傷風免疫球蛋白、破傷風類毒素、抗生素、傷口清創、鎮靜藥物、肌肉鬆弛劑與magnesium sulfate治療，因自律神經失調併發心肌病變與心衰竭，除了使用magnesium sulfate之後，同時加入dobutamine作為輔助治療，成功緩解人心肌變。希望藉此案例讓臨床醫療人員對該疾病的認識，並了解其治療藥物，才能提供病人最優質照護。

Tetanus is a life-threatening nervous system disorder characterized by muscle spasms and autonomic nervous system dysfunction that is caused by an exotoxin produced by Clostridium tetani. Treatment goals include interrupting the toxin production, neutralization of the unbound toxin, airway management, controlling muscle spasms and management of dysautonomia. Herein we reported a 64-year-old female who was admitted to our emergency department under the impression of severe tetanus. This patient was treated with tetanus immune globulin, tetanus toxoid, antimicrobial therapy, wound debridement, sedatives, neuromuscular blocking agents and magnesium sulfate. Due to the development of autonomic dysfunction complicated with cardiomyopathy and heart failure, after magnesium sulfate treatment, dobutamine was adjusted to treat cardiomyopathy successfully. Based on this case report, clinical medical staff should fully understand tetanus and it's medication to provide the best care to patients.