注射肉毒素导致严重呼吸功能衰竭一例报告及文献复习

Severe respiratory failure after injection of botulinum toxin： case report and review of the literature

目的提高对肉毒素A注射导致严重呼吸功能衰竭的认识。方法报道1例因美容注射肉毒素A导致呼吸功能衰竭的病例，并对相关文献进行复习。结果患者女，24岁，因腿部美容于2007年6月15日接受双小腿背侧多点肌内注射A型肉毒素200U，2d后在相同部位再次注射A型肉毒素100U。患者首次注射后无不适。再次注射后当天出现复视、全身乏力，无气促，以后病情逐渐进展出现上睑下垂、复视、吞咽困难、抬头乏力、四肢软弱无力及气促等全身肌肉迟缓性瘫痪及严重呼吸功能衰竭。入院后患者接受呼吸机辅助通气，对症支持治疗并积极进行肌肉功能锻炼，经治疗后肌力稍有恢复，双上肢近端肌力为Ⅲ级、远端V^-级、双下肢近端肌力Ⅳ级，远端V^-级。咳嗽反射、吞咽反射恢复，最终成功脱离呼吸机并步行出院。结论即使注射常规剂量的肉毒素A也会增加患者全身肌肉软弱无力甚至呼吸功能衰竭的风险；临床应用肉毒素治疗应该严格掌握适应证。

Objective To describe the manifestations and management of respiratory failure caused by cosmetic injections of botulinum toxin type A （BTA）. Methods A case of severe respiratory failure after cosmetic injections of BTA was reported and the literature was reviewed. Results A 24 year old female, seeking leg cosmetic therapy, received multiple point dorsal intramuscular injection of BTA （200 Units） in the legs. Two days later, 100 unit BTA was injected in the same sites. After the first injection, the patient felt no discomfort. But after the second injection, the patient developed diplopia and malaise but without breathlessness. Gradually, ptosis, dysphagia, and tetraparesis developed, and the patient felt difficult in raising her head, followed by systemic muscle paralysis and severe respiratory failure. After admission, the patient received mechanical ventilation, supportive therapies, active muscle functional exercise and she recovered slowly. The double proximal and distal upper limb strength were class Ⅲ and V^ - , and the double proximal and distal lower limbmuscle strength were class Ⅳ and Ⅴ^ -. Cough reflex and deglutition reflex recovered gradually. The patient was successfully weaned off mechanical ventilation, and was able to walk on discharge. Conclusion Even conventional doses of BTA injection could increase the risk of developing systemic muscle weakness and respiratory failure. Clinical application of botulinum toxin treatment should be strictly controlled.