Anderson Timothy D, Shah Udayan K, Schreiner Mark S, Jacobs Ian N
Division of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, University of Pennsylvania, 19104-4399, USA.
Otolaryngol Head Neck Surg. 2002 Mar;126(3):234-9. doi: 10.1067/mhn.2002.122385.
The study goal was to understand the incidence, etiology, and management of airway complications in infant botulism.
We conducted a retrospective review of the period from January 1, 1987, to December 31, 1997.
Urban tertiary care children's hospital.
Of 60 children with infant botulism, 37 (61.7%) required endotracheal intubation for a mean of 21 days. No patient required a tracheostomy. Airway complications (stridor, subglottic stenosis, granuloma formation) occurred in 5 (13.5%) of 37 patients, with 3 requiring surgical bronchoscopy. Of the 37 children, 14 (37.8%), including 4 with airway complications, had endotracheal tube leak pressures recorded. In 3 (50%) of 6 patients with measured leak pressures of greater than 40 cm H2O, airway complications developed. Complications did not develop in patients with leak pressures of less than 20 cm H2O. No correlation between length of intubation and complications could be established.
Airway complications in infant botulism may be accompanied by high leak pressures and can be managed with endoscopic techniques. The study data suggest that leak pressures should be measured on a regular basis and maintained at less than 20 to 25 cm H2O. A prospective trial to study this issue is warranted. Tracheotomy is not routinely necessary. A high index of suspicion, early diagnosis, and prompt intervention are required for the optimal management of airway complications in infant botulism.
本研究的目标是了解婴儿肉毒中毒气道并发症的发生率、病因及处理方法。
我们对1987年1月1日至1997年12月31日期间进行了回顾性研究。
城市三级儿童专科医院。
60例婴儿肉毒中毒患儿中，37例（61.7%）需要气管插管，平均插管21天。无患儿需要气管切开术。37例患者中有5例（13.5%）出现气道并发症（喘鸣、声门下狭窄、肉芽肿形成），其中3例需要手术支气管镜检查。37例患儿中，14例（37.8%）记录了气管导管漏气压力，其中4例有气道并发症。在6例测量漏气压力大于40 cm H₂O的患者中，3例（50%）出现气道并发症。漏气压力小于20 cm H₂O的患者未出现并发症。插管时间与并发症之间未发现相关性。
婴儿肉毒中毒气道并发症可能伴有高漏气压力，可通过内镜技术处理。研究数据表明，应定期测量漏气压力，并将其维持在小于20至25 cm H₂O。有必要进行前瞻性试验来研究这个问题。气管切开术并非常规必要。对于婴儿肉毒中毒气道并发症的最佳处理，需要高度怀疑、早期诊断和及时干预。
