摘要目的 探讨肉毒毒素中毒的推荐治疗方案.方法 2016年1月至2017年8月上海交通大学医学院附属第九人民医院共收治8例A型肉毒毒素中毒患者,均为女性,年龄21 ～33岁,平均26.4岁,均表现出渐进性肌无力加重和肌电图异常.5例在整形外科行抗毒素治疗,注射前进行皮试,随后采用10 000～20 000 U抗毒素肌肉内注射,每日注射1次,连续注射2～3d.3例在神经内科行非抗毒素治疗,仅采用静脉滴注神经营养药物等支持治疗.观察患者四肢肌无力、上睑下垂等临床症状的改善情况并随访肌电图等指标.结果 5例抗毒素治疗组患者肌无力症状改善,复查肌电图示肌信号逐步恢复正常.3例非抗毒素治疗组的患者治疗5d后肌无力症状无明显改善,肌电图信号未恢复正常.结论 规范医疗美容市场是预防A型肉毒毒素中毒事件的关键.发生中毒事件后需及时明确诊断并及时干预,抗毒素具有更好的疗效,但还需深入研究来验证其安全性和有效性.

abstractsObjective The study aimed to explore the recommended treatment for toxicosis of botulism toxin type A.Methods From January 2016 to August 2017,8 patients with toxicosis of botulism toxin type A were hospitalized in Shanghai Ninth People's Hospital,Shanghai Jiaotong University School of Medicine.All patients were female,21-33 years of age,with an average age of 26.4 years.All patients showed progressive myasthenia and abnormal electromyography.The clinical manifestations and treatment outcomes of 8 patients in antitoxin group or non-antitoxin group were retrospectively analyzed.Five patients treated in plastic and reconstructive surgery department were included in the antitoxin group.They received skin test before injection,followed by intramuscular injection of 10 000-20 000 U antitoxins once a day for 2-3 days.Three patients treated in neurology department were included in the non-antitoxin group.They received only intravenous drip of neurotrophic drugs.After treatment,the improvement of clinical symptoms such as myasthenia and blepharoptosis was observed,and the electromyogram was followed up.Results The symptoms of myasthenia of the 5 patients in antitoxin treatment group were significantly improved,and the electromyogram signal returned to normal.However,for the 3 patients in non-antitoxin group,the symptoms of myasthenia did not significantly improve,and their electromyogram signal did not return to normal,even after 5 days'continuous treatment.Conclusions To regulate the cosmetic medical market is the key to prevent the accident of toxicosis of botulism toxin type A.It is necessary to make a definite diagnosis and medical intervene in time for the toxicosis.Antitoxin has a better curative effect,but further research is needed,to verify its safety and effectiveness.