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使用超声对肉毒中毒所致膈肌麻痹进行无创诊断。

Non-invasive diagnosis of diaphragmatic paralysis in botulism using ultrasound.

作者信息

Cheong Issac, Imbelloni Mariano Iván, Gómez Raúl Alejandro, Álvarez Vilariño Federico Matías, Baiona Gastón Adrián, Tamagnone Francisco Marcelo

机构信息

Department of Critical Care Medicine, Sanatorio de Los Arcos, Buenos Aires, Argentina; Argentinian Critical Care Ultrasonography Association (ASARUC), Argentina.

Department of Critical Care, Clínica de Internación Aguda en Rehabilitación y Cirugía (CIAREC), Buenos Aires, Argentina.

出版信息

Toxicon. 2024 Feb 23;239:107609. doi: 10.1016/j.toxicon.2024.107609. Epub 2024 Jan 10.

Abstract

This case study explores foodborne botulism, a severe illness caused by botulinum neurotoxin-contaminated food. It leads to bilateral descending paralysis, involving the diaphragm. We highlight diaphragmatic ultrasound as a non-invasive diagnostic tool. A 50-year-old obese male developed diplopia and weakness after consuming contaminated food, rapidly progressing to severe symptoms. Mechanical ventilation became necessary due to respiratory failure. Diaphragmatic ultrasound confirmed bilateral diaphragm paralysis despite early antitoxin treatment. The patient experienced complications, requiring tracheostomy and rehabilitation. After five months, he fully recovered diaphragmatic function. This study underscores botulism's life-threatening nature and the vital role of supportive care. Diaphragmatic ultrasound is a safe and effective method for assessing diaphragmatic function in such cases, obviating ionizing radiation exposure. We recommend its routine use for evaluating botulism-induced paralysis.

摘要

本病例研究探讨了食源性肉毒中毒,这是一种由受肉毒杆菌神经毒素污染的食物引起的严重疾病。它会导致双侧下行性麻痹,累及膈肌。我们强调膈肌超声作为一种非侵入性诊断工具的作用。一名50岁肥胖男性在食用受污染食物后出现复视和肌无力,并迅速发展为严重症状。由于呼吸衰竭,需要进行机械通气。尽管早期进行了抗毒素治疗,但膈肌超声证实双侧膈肌麻痹。患者出现了并发症,需要进行气管切开术和康复治疗。五个月后,他的膈肌功能完全恢复。本研究强调了肉毒中毒的危及生命的性质以及支持性护理的重要作用。膈肌超声是评估此类病例中膈肌功能的一种安全有效的方法,可避免电离辐射暴露。我们建议将其常规用于评估肉毒中毒引起的麻痹。

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