@article{oai:twinkle.repo.nii.ac.jp:00017681,
 author = {NAKAGAWA, Takao and SUGA, Hiroyasu and DEGUCHI, Yoshizumi and KIMURA, Toshihisa and SUZUKI, Tadashi},
 issue = {11},
 journal = {東京女子医科大学雑誌},
 month = {Nov},
 note = {破傷風は,Clostridium tetaniの産生毒素tetanospasminに起因する神経系疾患である.今日我が国では,予防接種の普及等により稀となった反面,軽微な外傷でも発症する本疾患は,外傷領域においては常に念頭に置くべき疾患である.その治療管理において痙攣,sympathetic overactivityに対する対処が重要となる.今回我々はsympathetic overactivityを伴った重症破傷風の2例を経験した.1例に対してはphenobartital,diazepam持続投与下の管理を約15日間要し,また他の1例はpancuronium bromide, midazolamを使用すると共に,循環動態安定のためfentanyl citrateを追加し,人工呼吸器管理期間は約28日を要した.いずれも軽快退院したものの,抗痙攣療法後の回復期に,筋力低下によるリハビリテーション,あるいはせん妄・自殺企図がみられ精神科的治療を要した.呼吸管理の進歩により生命予後は改善されたものの,抗痙攣療法後にも注意すべき合併症があり,全経過を通じ慎重な全身管理が必要である., Tetanus is a nervous system disease caused by tetanospasmin, a toxin produced by Clostridium tetani. In Japan, tetanus, which occurs in association with even a slight injury, should always be taken into consideration in the traumatology field, although there are rare cases of tetanus owing to the spread of vaccination, etc. Treatment of spasm and sympathetic overactivity plays an important role in the therapeutic control of this disease. We had an experience of treating two patients suffering from severe tetanus with sympathetic overactivity. For one patient, it took about 15 days to control the disease by continuous administration of phenobartital and diazepam. For the other patient, pancuronium bromide and midazolam were used and fentanyl citrate was added for circulatory dynamic stabilization, and control with a ventilator required about 28 days. Although both patients were cured from the tetanus and discharged, reduced myodynamia required rehabilitation, and delirium and suicide attempts required psychiatric treatment during the recovery period following the anti-spasm therapy. Careful systemic control of tetanus patients is necessary throughout the course of disease as complications to be watched may occur following the anti-spasm therapy as well, although the progress in respiratory control has contributed to the improvement in prognosis of tetanus patients.},
 pages = {694--701},
 title = {Severe Tetanus with Sympathetic Overactivity in Two Patients},
 volume = {69},
 year = {1999}
}