婴儿肉毒中毒14例临床表现及早期识别  

Clinical manifestations and early recognition of infant botulism in 14 cases

作　　者：范祎慕 武洁[1] 霍枫[1] 张哲哲[1] 刘霜君 王硕 王荃[2] Fan Yimu;Wu Jie;Huo Feng;Zhang Zhezhe;Liu Shuangjun;Wang Shuo;Wang Quan(Department of Emergency,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Bejing 100045,China;Department of Critical Care Medicine,Bejing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院急诊内科,北京100045 [2]国家儿童医学中心,首都医科大学附属北京儿童医院重症医学科,北京100045

出　　处：《中华实用儿科临床杂志》2024年第7期533-536,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨婴儿肉毒中毒的临床表现及早期识别特点。方法回顾性病例分析。对首都医科大学附属北京儿童医院2019年1月至2023年6月急诊内科收治的14例婴儿肉毒中毒患儿的临床资料进行回顾性分析。结果发病年龄4.2(1.9~8.6)月龄, 6月龄以下者10例(71.4%), 9例存在中毒诱因。首次就诊时间1(0~8) d, 13例(92.9%)主诉为纳差/拒奶, 其中12例(85.7%)瞳孔对光反射迟钝/消失, 11例(78.6%)存在便秘, 10例(71.4%)伴反应弱和/或嗜睡, 10例(71.4%)肠鸣音减弱或消失, 9例(64.3%)四肢无力和/或四肢活动减少。患儿均出现四肢对称性肌张力和肌力减低。首诊仅2例疑诊婴儿肉毒中毒。14例患儿粪便小鼠生物实验均阳性, 确诊时间3(1~10) d。11例(84.6%)存在不同程度肠淤张, 1例小肠生理积气减少。10例行新斯的明试验, 1例阳性, 1例可疑阳性。10例(71.4%)需机械通气者, 7例(50.0%)为有创呼吸支持。住院时间26(11~61) d, 所有患儿出院时基本痊愈。结论对于既往体健、意识清楚, 以主诉为纳差、反应弱、四肢无力急性起病的婴儿, 查体发现存在颅神经麻痹、急性弛缓性麻痹体征、腹胀及肠鸣音减弱者, 应考虑到婴儿肉毒中毒的可能, 尽早送检粪便标本进行肉毒毒素测定确诊。Objective To investigate the clinical presentations and early recognition features of infant botulism(IB).Methods Retrospective case analysis.The clinical data of 14 patients with IB admitted to the Department of Emergency of Beijing Children′s Hospital Affiliated to Capital Medical University between January 2019 and June 2023 were retrospectively analyzed.Results The age of onset was 4.2(1.9-8.6)months.Ten cases(71.4%)were under 6 months,9 of whom had a toxic trigger.The median time of first visit was 1(0-8)day.Thirteen cases(92.9%)complained of poor feeding/milk refusal,of whom pupillary light reflex was sluggish/absent in 12(85.7%)infants,11(78.6%)had constipation,10(71.4%)had weakness and/or lethargy,and 9(64.3%)had myasthenia of limbs and/or reduced movement of the extremities,decreased muscle tone and strength of the extremities occurred in all infants,and bowel sounds were diminished or vanished in 10 infants(71.4%).Only 2 infants were suspected of IB at the first visit.The mouse bioassay showed positive fecal specimens in all 14 infants,with a time of diagnosis of 3(1-10)days.Eleven cases(84.6%)had varying degrees of intestinal stasis,and 1 case had reduced physiologic pneumatosis in the small intestine.Ten infants underwent the neostigmine test:one was positive,and one was suspiciously positive.Ten cases(71.4%)required mechanical ventilation,7(50.0%)of whom used invasive respiratory support.The median length of hospital stay was 26(11-61)days.All the infants were essentially cured by the time they left the hospital.Conclusions If infants are previously fit and conscious but have an acute onset of illness with parental complaints of poor appetite,weak reactions,and weakness of the extremities and are found to have cranial nerve palsy,signs of acute flaccid paralysis,abdominal distension,and diminished bowel sounds during the examination,the possibility of IB should be considered,and a fecal specimen should be sent for botulinum toxin assay as soon as possible.

关 键 词：婴儿 肉毒中毒 肉毒杆菌 早期识别 

分 类 号：R725.9[医药卫生—儿科]