| Objective: Botulism, known as botulinum toxin poisoning (Neurotoxinof BoNT), was produced by the anaerobic clostridium botulinum exotoxin,whose generally lethal dose was0.1-1μg. It was the most severe neurotoxinknown natural substance, which was listed as class A bioterrorism agents byU.S. Centers for Disease control and Prevention (CDC). Clostridiumbotulinum was a strict nature widely distributed anaerobic Gram-positivebacteria, which usually existed in spore form. It could grow and producebotulinum toxin only under suitable environmental conditions. Improving thetechnology of diagnosis and treatment of botulism has become the urgentneed of development about contemporary clinical medicine, especiallyemergency medicine. Foodborne botulism in our country was the main wayof botulism, which was the vast majority of common cases coming fromareas north of the Yangtze River, and most appeared sporadic. In the past,botulism in Hebei province of China was mainly type B. But in recent years,cases of type A were also detected in Hebei. Botulism was a serious illnesswith high mortality. In clinical works, the doctors continued to investigate thedetoxification of effects. In recent years, application of Human BotulismImmune Globulin Intravenous （BIG-IV） achieved satisfactorily effects.However, the use of antitoxin conventional therapy was still controversial.This paper was retrospective study of cases of botulism. The central meaningof this paper was to explore the clinical effects of the new therapy,which usedequine derived botulinum antitoxin with large enough dose and sufficientlylong course and objectively evaluate the equine derived botulinum antitoxin.Methods: In his study, collected five sporadic cases of botulism, whichwere very severe and used traditional therapy in the second hospital of Hebei medical universityfrom2003to2006, as well as ninety cases, which camefrom Hebei’s hospitals and employed the new therapy to strengthen the use ofequine derived botulinum antitoxin treatment of botulism. The new treatmentprogram was as follows：⑴mild patients'A、B type antitoxin10,000units,intramuscular injection or intravenous infusion q12h each; if the cases withshort incubation period, it was estimated that the disease may progress, thenAB antitoxin20000units intramuscular injection or intravenous infusion,q12h; generally3-5days, if the disease progression-free, gradually reduced thedose, usually applied at least5-7days. If the improvement was significant, theresearcher halved applications for two days.⑵moderate patients'A、B typeantitoxin20000units intramuscular injection or intravenous infusion q12heach; if the cases with incubation period were short, it was estimated that thedisease may progress,then A、B antitoxin might be appropriate to increase theamount of general disease progression-free day for5days or more, the gradualreduction usually applied at least7-10days. If the improvement could besignificant,researchers halved applications for two days.⑶severe and verysevere patients'A、B type antitoxin20000units intramuscular injection orintravenous infusion, q12h; extremely very severe patients type A、B antitoxinmight be appropriate to increase the amount of botulinum antitoxin, usuallymore than once every five days, the gradual reduction usually applicated notless than21days. Significant improvement in halving reduced the applicationfor five days. Disposal of the above programs,if botulism has confirmed, butdid not determine the serotype. If the serotype was determined, appropriatetreatment of the single type, such as the type A used only type A antitoxintreatment.All95patients were divided into conventional therapy group,5cases (5cases of very severe) used the traditional therapy. The other90patients (30cases of mild group,36cases of moderate group,12cases ofsevere group,12cases of very severe group) were named as the new type oftherapy group. Statistical processing deta of mild, moderate group patient dataand the group with severe, very severe two groups of patients with eatingcontaminated food time were compared in the incidence of the number of days. Sort out the two groups （Mild and moderate group、severe and very severegroup）number of days to the incidence of eating contaminated food to becompared. Sort out the two groups number of days of improvement、significantly improved group one is composed of24patients of new type oftherapy,which were severe and very severe,group two was composed of5patients of traditional therapy,which were very severe. Statistical processingdeta of12very severe patients with new therapy and5very severe patients oftraditional therapy in patients with very severe patients (In traditionaltreatment group,2patients were forced offline breathing machine).Number ofdays of offline breathing machine to be compared.The average number of daysfrom the onset to the first application of equine derived botulinum antitoxin ofnew type therapy group,90patients,were7.74days. The new type therapy ofsevere and very severe group of24patients were divided into early treatmentgroup (from the onset to the first application of equine derived botulinumantitoxin of the number of days≤7) and late treatment group (from the onsetto the first application of equine derived botulinum antitoxin of the number ofdays＞7). Sort out the two groups number of days of improvement、significantly improved and cure. Statistical methods: Statistical description ofthe three sets of data, normality test and homogeneity of variance test of thedata between the two groups. If the data conformed to normality andhomogeneity of variance, the researchers would use the independenttwo-sample T-test. If one would not complied that using two independentsamples nonparametric rank sum test was used to compare the statisticaldifference. The above two statistical methods set P≤0.05was statisticallydifference.Results:1Starting time about symptoms of severe and very severe patientssignificantly earlier than the mild and moderate patients.2Low dose of extremely severe treatment group,5patients died twocases, the mortality was40%. All90patients of the new type treatment werecured, the cure rate was100%. 3There were statistically significant differences between the24casesusing the new type of equine derived botulinum antitoxin treatment of evereand extremely severe patients and5cases of traditional therapy of equinederived botulinum antitoxin treatment of extremely severe patients about daysof improvement、significantly improved. There was statistically significantdifferences between the12cases using the new type of equine derivedbotulinum antitoxin treatment of evere and extremely severe patients and5cases of traditional therapy of equine derived botulinum antitoxin treatment ofdays of offline breathing machine.4About the new treatment of severe and very severe patients’ days ofimproved and significant improved, there were statistically differencesbetween early treatment group and late treatment group, the cure days werenot significant different.Conclusions:1The condition of Patients would more severe,if incubation periodmore shorter.2Patients using new therapy to strengthen the use of equine derivedbotulinum antitoxin treatment were successfully treated, there was nosignificant sequelae. Novel therapeutic dose and duration of treatment wasworthy of recognition. To treatment sooner could get better efficacy.3The less effect of traditional therapy might be related to insufficientdoses. |
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