摘要目的 分析肉毒杆菌食物中毒患者病例资料,总结其流行病学特征,以提高对食源性肉毒中毒的认识及诊治水平.方法 采用回顾性研究方法,选择2009年1月至2016年12月全军中毒救治中心收治的53例肉毒杆菌食物中毒患者,按照病情严重程度分为轻度组、中度组和重度组;收集各组患者病史、流行病学资料、入院后首次血常规和血生化、治疗前后生命体征和动脉血气分析的变化,以及首发临床症状、体征频次分布.结果 53例食源性肉毒中毒患者均纳入统计,轻度组33例,中度组13例,重度组7例.中毒患者以女性居多,年龄分布跨度较大;群体发病多见,多以家庭为单元;发病患者主要集中在河北、北京及河南;发病季节以春末夏初为主;自制发酵制品仍然是首位中毒原因,平均潜伏期(51.01±4.78)h;以轻度中毒及A型毒素中毒患者居多.随中毒程度加重,患者住院时间逐渐延长,入院后首次白细胞计数(WBC)、中性粒细胞比例(NEUT)以及治疗前呼吸频率(RR)、心率(HR)、吸入氧浓度(FiO2)均呈上升趋势,入院后首次白蛋白(ALB)及治疗前pH、动脉血氧分压(PaO2)和动脉血氧饱和度(SaO2)均呈下降趋势,以重度组表现最为严重,与轻度组比较差异有统计学意义〔住院时间(d):72.57±39.52比6.61±3.72,WBC(×109/L):13.01±6.44比6.85±2.07,NEUT:0.85±0.07比0.63±0.14,RR(次/min):32.14±4.33比15.18±1.70,HR(次/min):132.29±5.19比75.54±8.24,FiO2:0.32±0.05比0.21±0.01,ALB(g/L):38.57±4.65比42.09±4.57,pH:7.08±0.10比7.38±0.07,PaO2(mmHg,1 mmHg=0.133 kPa):75.16±5.24比98.39±1.50,SaO2:0.78±0.06比0.97±0.02,均P<0.05〕.53例食源性肉毒中毒患者首发症状、体征以头晕为主,其次为全身乏力、视物模糊、恶心,而其他症状、体征发生率均低于50%;其中排在首位的头晕症状发生率明显高于视物模糊和恶心的发生率(χ2值分别为7.209、10.502,P值分别为0.007、0.004).患者在第一时间应用肉毒抗毒素治疗后临床症状可很快得到缓解,均康复出院,无死亡病例.结论 对于肉毒杆菌食物中毒患者,应尽早给予足量肉毒抗毒素和相应器官功能支持,以促进患者病情恢复.

abstractsObjective To analyze the epidemiologic data of patients withClostridium botulinum food poisoning, and to improve the understanding, diagnosis and treatment of food borne botulism.Methods A retrospective study was conducted. Fifty-three patients withClostridium botulinum food poisoning admitted to Chinese PLA Center of Poisoning and Treatment from January 2009 to December 2016 were enrolled, and they were divided into mild, moderate, and severe groups according to the severity of disease. The clinical data including medical history, epidemiology data, routine blood test and blood biochemistry at hospital admission, the vital signs and arterial blood gas analysis before and after treatment, as well as the occurrence frequency of symptom and sign on set were collected.Results Fifty-three patients with food borne botulism were enrolled, with 33 patients in mild group, 13 in moderate group, and 7 in severe group. Most of the patients were female, the age distribution was in large span, the outbreak of disease was in groups mainly with the family, and patients were mainly located in Hebei Province, Beijing and Henan Province. The outbreaks were mainly happened in Spring and Summer, and homemade fermentation products were still the first cause of poisoning with the average latent period of (51.01±4.78) hours. The majority of patients with botulism were in mild resulted from the type A toxin. With the aggravation of disease, hospitalization time was gradually increased, white blood cell (WBC) and neutrophils (NEUT) at hospitalization admission, and respiratory rate (RR), heart rate (HR), fraction of inspired oxygen (FiO2) before the treatment were shown in obviously rising trend, albumin (ALB) at hospitalization admission and pH, arterial partial pressure of oxygen (PaO2), arterial oxygen saturation (SaO2) before treatment were in decline. The parameters in severe group were most severe, and had significant differences as compared with those of mild group [hospitalization time (days): 72.57±39.52 vs. 6.61±3.72, WBC (×109/L): 13.01±6.44 vs. 6.85±2.07, NEUT: 0.85±0.07 vs.0.63±0.14, RR (bpm): 32.14±4.33 vs. 15.18±1.70, HR (bpm): 132.29±5.19 vs. 75.54±8.24, FiO2: 0.32±0.05 vs. 0.21±0.00, ALB (g/L): 38.57±4.65 vs. 42.09±4.57, pH: 7.08±0.10 vs. 7.38±0.07, PaO2 (mmHg, 1 mmHg = 0.133 kPa): 75.16±5.24 vs. 98.39±1.50, SaO2: 0.78±0.06 vs. 0.97±0.02, allP < 0.05]. The symptom and sign on set of 53 patients with food borne botulism was dizziness, followed by fatigue, blurred vision, nausea, and other symptoms and signs were lower than 50%, and the occurrence of dizziness with rank one happen rate was significantly higher than blurred vision and nausea (χ2 values were 7.209 and 10.502 respectively, andP values were 0.007 and 0.004 respectively). After the on time prescription of botulinum antitoxins treatment, the clinical symptoms of patients could be relived quickly. All the patients were discharged without deaths.Conclusion In order to improve the recovery of the food borne botulism poisoning patients, adequate antitoxin and the related organ supports should be prescribed on time.