重症婴儿肉毒中毒的抗毒素治疗应用分析  

The application analysis of antitoxin therapy in severe infant botulism

作　　者：王丽娟[1] 王荃[1] 樊超男[1] 李科纯 刘珺[1] 李峥[1] 贾鑫磊[1] 武洁[2] 成怡冰 罗新辉 法吾丹·阿布都 钱素云[1] Wang Lijuan;Wang Quan;Fan Chaonan;Li Kechun;Liu Jun;Li Zheng;Jia Xinlei;Wu Jie;Cheng Yibing;Luo Xinhui;Abudu Fawudan;Qian Suyun(Department of Pediatric Intensive Care Unit,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Emergency Intensive Care Unit,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Pediatric Intensive Care Unit,Children's Hospital Affiliated to Zhengzhou University,Zhengzhou 450018,China;Xinjiang Hospital of Beijing Children's Hospital,Children's Hospital of Xinjiang Uygur Autonomous Region,Urumuqi 830091,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重症医学科,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急诊重症监护病房,北京100045 [3]郑州大学附属儿童医院重症医学科,郑州450018 [4]北京儿童医院新疆医院,新疆维吾尔自治区儿童医院,乌鲁木齐830091

出　　处：《中华儿科杂志》2025年第3期254-258,共5页Chinese Journal of Pediatrics

基　　金：高通量测序技术在感染性疾病中的临床应用研究(MTP2022B018)。

摘　　要：目的总结重症婴儿肉毒中毒抗毒素治疗的应用情况。方法回顾性病例总结。收集2020年7月至2024年8月3家儿童医疗中心收治的14例重症婴儿肉毒中毒患儿的临床资料。观察抗毒素使用剂量、时长、停药指征及不良反应等。结果14例患儿中男12例、女2例,年龄为5.0(3.8,7.0)月龄,肉毒毒素分型为B型10例、A型2例、未分型2例。发病至应用抗毒素的时间间隔为9.0(6.0,11.5)d,A型抗毒素起始给药剂量为12500(10000,22500)U,B型为5000(5000,5000)U,部分患儿在症状好转后减量使用,治疗时长为16.5(9.8,25.3)d。11例患儿在肌力好转后停药,3例因粪便小鼠生物实验转阴停药。其中2例发生不良反应,均出现皮疹,其中1例合并过敏性休克。所有患儿出院时均存活,随访时间为11 d至3年8个月,12例完全康复,2例仍在恢复中。结论应用抗毒素治疗重症婴儿肉毒中毒总体可行,安全性较高,预后良好。Objective To analyze the application of antitoxin therapy in severe infant botulism.Methods A retrospective analysis was conducted on 14 cases of severe infant botulism treated at 3 pediatric medical centers from July 2020 to August 2024.This study investigated antitoxin dosage,treatment duration,discontinuation criteria and adverse reactions.Results A total of 14 cases(12 males and 2 females)were included,with an age of 5.0(3.8,7.0)months.Botulinum toxin typing revealed 10 cases of Type B,2 cases of Type A and 2 untyped cases.The interval from symptom onset to antitoxin administration was 9.0(6.0,11.5)d.The initial dosage of type A antitoxin was 12500(10000,22500)U,while type B was 5000(5000,5000)U.The dosage was tapered in some cases after symptom improvement,the duration of treatment was 16.5(9.8,25.3)d.In total,11 infants discontinued medications after improvement in muscle strength,while 3 infants discontinued treatment after obtaining negative results from fecal mouse bioassays.Adverse events were reported in 2 cases,both of which resulted in rash,and 1 case was complicated with anaphylactic shock.All the patients survived upon discharge with a follow-up period of 11 d to 3 years and 8 months.Totally 12 infants had fully recovered,while 2 infants were still recovering after discharge.Conclusion Antitoxin therapy is a feasible and safe approach which showed favorable prognosis in severe infant botulism.

关 键 词：肉毒中毒 婴儿 肉毒抗毒素 治疗 不良反应 

分 类 号：R725.9[医药卫生—儿科]