| Objective As a medical cosmetic method with low invasiveness,low risk,and rapid onset,injection of botulinum toxin has rapidly swept the world since it was approved for use in the field of beauty.It provides more choices for those who seek beauty and young people.Although the safety and reliability of botulinum toxin in the field of beauty have been widely confirmed,as one of the most toxic toxins in nature,the potential risk of botulism caused by cosmetic injection of botulinum toxin cannot be ignored.In recent years,China's botulinum toxin market has developed rapidly,and the number of people who choose to inject botulinum toxin has become wider and wider.However,with this,the number of poisoning incidents caused by cosmetic injection of botulinum toxin has gradually increased.At present,domestic and foreign reports on botulism caused by cosmetic injection of botulinum toxin are still relatively rare.They have only been reported in some sporadic cases,and large-scale investigations and studies are lacking.This study is based on the relevant information of botulism cases caused by cosmetic injection of botulinum toxin treated by the Poisoning Treatment Center of the PLA,and discussed the epidemic characteristics and clinical features,to provide scientific basis for botulism caused by cosmetic injection of botulinum toxin of the prevention and control and clinical diagnosis and treatment.Methods A retrospective survey analysis method was used to collect the data of botulism patients caused by cosmetic injection of botulinum toxin treated by the poisoning treatment center of the PLA from March 2016 to June 2019 for analysis.Formulate the inclusion and exclusion criteria,and The epidemic characteristics of the included cases were sorted out,including age,gender,time of treatment,botulinum toxin injection location,brand type,time of injection of botulinum toxin,injection site and dose,etc.Analyze and discuss susceptibility factors,susceptibility groups,and susceptibility trends.Analyze the clinical features of the patients included in the group,including incubation period,clinical symptoms and signs,auxiliary examinations,treatment and prognosis,the relevant data of hospitalized cases and emergency observation cases were compared,and the length of stay in hospitalized cases was analyzed.Results 380 cases of botulism caused by cosmetic injection of botulinum toxin were included in this study,including 114 cases of hospitalization and 266 cases of emergency treatment.Women were the majority(97.4%),the most in the age group of 30-39(39.5%),followed by the age of 20-29(36.1%).The main sites were non-medical beauty institutions(92.9%),most of which were beauty salons or beauty studios.Most of the botulinum toxin injected was fake and inferior products;when the market supervision was strengthened,the occurrence of such poisoning incidents was significantly reduced.In this study,the incubation period of botulism caused by cosmetic injection of botulinum toxin was 3(2-6)days,mainly concentrated within 3-6 days.The common clinical manifestations were dizziness(67.6%),blurred vision(58.9%),weakness in opening eyes(53.2%),dysphagia(48.2%),chest tightness of breath(41.3%),fatigue(32.9%),diplopia(26.6%),nausea(22.9%),bilateral eyelid drooping(22.4%),dysarthria(22.1%),etc..Which were mainly mild to moderate poisoning.The proportion of dysphagia,dysphagia,weakness in opening eyes,blurred vision,choking in drinking water,weakness in chewing,bilateral eyelid drooping,decreased limb muscle strength,fatigue and chest tightness of breath were significantly higher than those in the emergency cases(all P<0.05).There were 309 patients who received botulinum antitoxin treatment.The interval between onset and use of botulinum antitoxin was 9(6-14)days.In emergency cases,the dose of botulinum antitoxin was 2(2-3)10,000 U.with a total treatment duration of 4(3-7)days.In the hospitalized cases,the dose of botulinum antitoxin was 3(3-5)10,000 U,and the total treatment time was 8(5-11)days,which were significantly higher than those in the emergency cases(P < 0.05).All cases were followed up with good prognosis.Cox regression model was introduced to analyze the factors that affect the length of hospital stay.The outcome of the patients in this study were all improved,and the longer the hospital stay,the more disadvantageous the patients.Therefore,in this study,the hazard ratio(HR)<1 was considered to affect the length of stay Risk factors,HR>1 represents protective factors that affect the length of hospital stay of patients.Univariate analysis showed weakness in opening eyes(HR = 0.742,95% CI 0.600-0.918),antitoxin use dose(HR = 0.859,95% CI 0.773-0.954),indwelling gastric tube(HR = 0.499,95% CI 0.282-0.882)and nasal feeding time(HR = 0.901,95% CI 0.836-0.971)were both influencing factors of hospitalization time.A multi-factor analysis showed that weakness in opening eyes(HR = 0.794,95% CI 0.638-0.990),antitoxin use dose(HR = 0.871,95% CI 0.785-0.965)and nasal feeding time(HR = 0.874,95% CI 0.769-0.993)were the risk factors influencing hospitalization time.Conclusion botulism caused by cosmetic injection of botulinum toxin is a type of public health problem that cannot be ignored.Illegal cosmetic injection of botulinum toxin is the main cause of such incidents;consumers should further understand the harm of illegal use of botulinum toxin,choose formal medical cosmetic institutions for medical cosmetology.The government to strengthen market supervision can significantly reduce the occurrence of such public events.botulism caused by cosmetic injection of botulinum toxin is generally mild to moderate poisoning.The severity of the disease has no significant relationship with the incubation period.Patients do not need to panic after symptoms appear,and they should seek medical treatment in a timely manner.Combined with the history of cosmetic injection of botulinum toxin and common clinical manifestations,diagnosis is generally not difficult,but timely and appropriate treatment requires the attending doctor to inquire about the medical history in detail and master the corresponding clinical characteristics,so as to accurately judge the patient's condition.We have put forward recommendations for the use of botulinum antitoxin in botulism patients caused by cosmetic injection of botulinum toxin,but further research is needed to determine the optimal use time and dosage. |
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