Kaiser Permanente South Sacramento Medical Center, Department of Emergency Medicine, Sacramento, CA.
West J Emerg Med. 2009 Nov;10(4):251-6.
We sought to identify factors associated with need for mechanical ventilation (MV), length of intensive care unit (ICU) stay, length of hospital stay, and poor outcome in injection drug users (IDUs) with wound botulism (WB).
This is a retrospective review of WB patients admitted between 1991-2005. IDUs were included if they had symptoms of WB and diagnostic confirmation. Primary outcome variables were the need for MV, length of ICU stay, length of hospital stay, hospital-related complications, and death.
Twenty-nine patients met inclusion criteria. Twenty-two (76%) admitted to heroin use only and seven (24%) admitted to heroin and methamphetamine use. Chief complaints on initial presentation included visual changes, 13 (45%); weakness, nine (31%); and difficulty swallowing, seven (24%). Skin wounds were documented in 22 (76%). Twenty-one (72%) patients underwent mechanical ventilation (MV). Antitoxin (AT) was administered to 26 (90%) patients but only two received antitoxin in the emergency department (ED). The time from ED presentation to AT administration was associated with increased length of ICU stay (Regression coefficient = 2.5; 95% CI 0.45, 4.5). The time from ED presentation to wound drainage was also associated with increased length of ICU stay (Regression coefficient = 13.7; 95% CI = 2.3, 25.2). There was no relationship between time to antibiotic administration and length of ICU stay.
MV and prolonged ICU stays are common in patients identified with WB. Early AT administration and wound drainage are recommended as these measures may decrease ICU length of stay.
我们旨在确定与使用注射药物者（IDU）的伤口肉毒中毒（WB）患者机械通气（MV）需求、重症监护病房（ICU）入住时间、住院时间和不良预后相关的因素。
这是一项对 1991 年至 2005 年间住院的 WB 患者进行的回顾性研究。如果 IDU 出现 WB 症状且诊断明确，则将其纳入研究。主要观察结果变量为 MV 需求、ICU 入住时间、住院时间、医院相关并发症和死亡。
符合纳入标准的患者共 29 例。22 例（76%）仅承认使用海洛因，7 例（24%）承认同时使用海洛因和甲基苯丙胺。初次就诊时的主要症状包括视觉改变 13 例（45%）、虚弱 9 例（31%）和吞咽困难 7 例（24%）。22 例（76%）患者有皮肤伤口。21 例（72%）患者接受 MV。26 例（90%）患者使用了抗毒素（AT），但仅有 2 例在急诊科（ED）接受了 AT。从 ED 就诊到 AT 给药的时间与 ICU 入住时间延长有关（回归系数=2.5；95%置信区间 0.45，4.5）。从 ED 就诊到伤口引流的时间也与 ICU 入住时间延长有关（回归系数=13.7；95%置信区间=2.3，25.2）。抗生素给药时间与 ICU 入住时间之间无相关性。
在确诊为 WB 的患者中，MV 和 ICU 入住时间延长很常见。建议早期使用 AT 和伤口引流，因为这些措施可能会缩短 ICU 入住时间。
