A型肉毒毒素局部注射注意事项

A型肉毒毒素通过阻断神经肌肉的传导的毒性作用，在特定条件下控制肌肉痉挛和缓解局灶性肌张力障碍，治疗人类疾病而被广泛应用于临床。目前在神经科领域，A型肉毒毒素可用于眼睑痉挛，面肌痉挛，痉挛性斜颈Meige综合征、构音障碍、书写痉挛、咬肌痉挛、胸瘫后遗症及其他一些疾病的治疗，现就我们注射A型肉毒毒素治疗面肌眼肌痉挛的一些注意事项总结如下：     

A型肉毒杆菌毒素

肉毒杆菌毒素是肉毒杆菌分泌的一种生物毒性蛋白质,其药理机制是与胆碱能神经末稍SNAP-25等蛋白产生作用,抑制乙酰胆碱释放,减少肌肉收缩和痉挛.目前,A型肉毒杆菌毒素获准用于治疗皱纹,其疗效平均持续4～6月,可以反复注射治疗.本文系统的回顾了A型肉毒杆菌毒的作用机制、临床试验、临床应用及不良反应.大量研究和病例分析已证明肉毒杆菌毒素注射术对于治疗面部各部位的皱纹是安全有效的.     

颞部除皱术联合A型肉毒毒素在面部除皱中的临床应用

目的：分析颞部除皱术联合A型肉毒毒素应用于面部除皱的效果。方法60例面部皱纹整容患者,随机分为观察组与对照组,各30例。对照组单纯采取A型肉毒毒素治疗,观察组联合应用颞部除皱术与A型肉毒毒素治疗,对比两组患者临床疗效。结果观察组术后皱纹消失保持时间明显长于对照组,猫眼样年轻化发生率高于对照组;观察组患者眼睑闭合困难、面部肿胀、面部僵硬等并发症发生率明显低于对照组;观察组患者对治疗效果满意率明显高于对照组,差异均有统计学意义(P<0.05)。结论在面部除皱中应用颞部除皱术联合A型肉毒毒素治疗,有利于延长除皱保持时间,降低并发症发生率,起到良好的年轻化效果,值得临床推广。     

A型肉毒毒素使用与管理情况分析

分析安徽医科大学第一附属医院门诊A型肉毒毒素使用现状, 探讨该药的规范管理。随机抽取安徽医科大学第一附属医院2019年1月至2020年12月A型肉毒毒素的门诊处方300张, 分析A型肉毒毒素门诊使用情况、处方的合格率和药事管理情况。300例使用A型肉毒毒素的患者中, 用于除皱、眼痉挛、咬肌肥大瘦脸、瘦小腿、组织无力、瘢痕和多汗症的分别为91例(30.33%)、94例(31.33%)、65例(21.67%)、47例(15.67%)、1例(0.33%)、1例(0.33%)和1例(0.33%)。发现不合格处方60张(20.00%), 其中未注明剩余药品处理方法的29张(48.33%), 无医师和药师双签的26张(43.33%), 诊断不明确3张(5%), 超说明书剂量用药和未注明处方日期各1张(1.67%)。肉毒素使用过程中出现未注明剩余药品处理、处方没有双签、超剂量、诊断不明确等不合理用药情况, 药师在发药审核中拦截并联系医生修改处方后, 基本符合国家对毒性药品的管理要求。     

A型肉毒毒素联合点阵激光治疗面部皱纹的疗效及预后分析

目的:研究A型肉毒毒素联合点阵激光治疗面部皱纹的疗效及预后。方法:选择2017年1月至2018年1月我院接诊的62例需要对面部皱纹进行改善的爱美者进行研究,随机分为两组,各31例,其中治疗组采用A型肉毒杆菌毒素联合点阵激光治疗,对照组采用A型肉毒杆菌毒素治疗,并对两组求美者的疗效进行比较。结果:治疗组女性的治疗总有效率明显高于对照组,差异有统计学意义(P0.05)。结论:A型肉毒毒素联合点阵激光治疗面部皱纹的美容效果较好,且安全性也较高,临床应用价值较高。     

美国用A型肉毒毒素美容的宣传降温

在美国食品和药物管理局 ( FDA)于 2 0 0 2年 4月批准 A型肉毒毒素用于美容消除额部皱纹后 ,美国约翰斯霍普金斯医学院发出请柬 ,给予任何对接受 A型肉毒毒素治疗感兴趣者进行当场治疗 ,许多机构也作出类似的宣传。但是此举遭到美国有识之士反对。　　A型肉毒毒素注射是美国发展最快的美容方法。据认为它是通过分解突触小体相关蛋白 SNAP- 2 5来阻断乙酰胆碱释放而起作用的。 FDA已于 1 998年批准 A型肉毒毒素治疗睑痉挛和斜视 ,于 2 0 0 0年批准治疗颈肌张力障碍 ,FDA告诫说 ,此美容制品正在超出范围用于消除其他皱纹 ,而这些应用都…     

电刺激引导 A 型肉毒毒素治疗痉挛型脑性瘫痪的疗效

目的：探讨电刺激定位引导A型肉毒毒素治疗痉挛型脑性瘫痪患儿的疗效。方法62例跖屈畸形的痉挛型脑性瘫痪患儿在电刺激引导下给予A型肉毒毒素局部注射,3d、1周、1个月、3个月和6个月后测量患儿踝关节活动度,并应用改良Ashworth痉挛评定量表评定小腿三头肌肌张力变化。结果62例患儿在注射后1个月和3个月小腿三头肌肌张力和踝关节活动度较注射前改善（P＜0．05）;注射前小腿三头肌痉挛程度越轻,则起效越快,维持时间越长。无一例患儿出现过敏反应。结论电刺激引导A型肉毒毒素局部肌肉注射能在较短时间缓解痉挛型脑性瘫痪患儿的肌肉痉挛,改善异常姿势及其运功功能。     

FDA批准肉毒杆菌毒素治疗皱纹

FDA于 2 0 0 2年 4月 12日批准肉毒杆菌A型增加治疗面部皱纹的新适应证。肉毒杆菌毒素是由A型肉毒杆菌分泌的纯化神经毒素复合物 ,其药理作用是阻断神经———肌肉接头间突触前膜乙酰胆感的释放 ,阻断神经冲动向肌肉的传递 ,从而缓解肌肉痉挛 ,导致其收缩无力。最早治疗使用肉毒杆菌可以追溯到 2 0世纪 6 0年代 ,FDA于 1989年 11月批准其治疗眼内肌内痉挛和功能紊乱 (睑痉挛和斜视 ) ,2 0 0 0年 11月批准肉毒杆菌毒素治疗颈部肌肉张力障碍 ,以及运动神经功能紊乱所致的严重的颈部、肩部肌肉痉挛。此次批准爱尔兰Allergan制药有限公司美…     

A型肉毒毒素对肌肉痉挛患者功能康复中的应用价值

目的:探讨A型肉毒毒素对肌肉痉挛患者功能康复中的应用效果.方法:选择2015年1月~2016年1月我院收治的80例肌肉痉挛患者为研究对象,均为运动神经元受损后肢体肌肉痉挛、应用BTX-A(A型肉毒毒素)治疗的患者,观察治疗后的肌张力变化情况、运动功能及日常生活能力改善情况.结果:治疗后的Ashworth评分(1.1±0.2)分明显低于治疗前,Fugl Meyer评分(61.5±6.9)分、ADL评分(60.5±5.8)分明显高于治疗前,治疗前后相比差异具有统计学意义(P<0.01);小腿三头肌、肱二头肌、屈指肌处不同剂量组在A型肉毒毒素治疗后Ashworth评分均明显下降,但同一位置内不同剂量组(A、B组)的Ashworth评分下降幅度并无明显差异(P>0.05).结论:A型肉毒毒素对肌肉痉挛患者功能康复的应用效果显著,能改善肌张力及运动功能,提高患者日常生活能力,值得推广.     

局部注射A型肉毒毒素治疗偏侧面肌痉挛及眼睑痉挛44例

目的:观察A型肉毒毒素治疗偏侧面肌痉挛及眼睑痉挛的疗效。方法:用A型肉毒毒素对38例偏侧面肌痉挛及6例眼睑痉挛患者行面部肌肉局部多点注射,分析其治疗效果。结果:38例偏侧面肌痉挛者,完全缓解12例(32%),明显缓解26例(68%);6例眼睑痉挛患者,2例完全缓解,3例明显缓解,1例无效。结论:A型肉毒毒素局部肌肉注射可有效控制局部肌张力过高,缓解局部肌肉痉挛。     

A型肉毒毒素在上面部除皱中的应用分析

目的:探讨A型肉毒毒素在上面部除皱治疗的应用方法。方法:用生理盐水将A型肉毒毒素稀释成25 u·mL-1分点注射,额横纹:10～14个注射点;鱼尾纹:3～4个注射点;眉间纹:4～5个注射点。结果:338例患者,注射后1～3 d可见皱纹减轻或消失,1～2周后出现最佳效果,可维持4～8个月,有效率达100%。1例发生休克,对症处理后好转;出现局部轻度水肿4例,局部瘀斑7例,眉型改变、眉下垂5例,以上并发症未做特殊处理,2～4周左右好转。结论:A型肉毒毒素注射除皱,虽然只能维持一定时间,但因有可逆性所以相对安全,是减少上面部动力性皱纹的有效方法。     

肉毒素A局部注射引起过敏反应

1例64岁男性,为美容在眼角和前额部多点注射肉毒素A除皱,每点约2～5U,总剂量〈50U。注射后1h出现头晕、心悸、颜面部红肿、睁眼困难、腹痛、腹泻和轻微呼吸困难。T36.7℃,R20次/min,P56次/min,BP120/75mmHg。考虑为肉毒素A过敏反应,立即给予地塞米松、西咪替丁、维生素C、苯海拉明及左西替利嗪抗过敏治疗,约1h后颜面肿胀和呼吸症状缓解,腹痛、腹泻症状消失。第2天,再次静脉滴注地塞米松,患者病情进一步好转。     

面部整形联合A型肉毒素注射行下面部轮廓重塑的疗效观察

目的:评价采用面部整形联合A型肉毒素注射行下面部轮廓重塑方法.方法:对68例术者使用下颌骨截骨(即伴有下颌骨肥大或外翻者)及颊脂肪垫摘除联合A型肉毒素咬肌内注射等综合术式进行下面部轮廓重塑,观察其临床效果.结果:68例术者中24例伴有下颌角肥大或外翻者进行下颌骨截骨,所有术者均行颊脂肪垫摘除及A型肉毒素咬肌内注射(1～2次),随访6～12个月,取得满意效果.结论:面部整形联合A型肉毒素咬肌内注射行下面部轮廓重塑安全可行,疗效肯定,值得临床推广.     

An Update on the Cosmetic Use of Botulinum Toxin: The Pattern of Practice among Korean Dermatologists

The efficacy and safety of botulinum toxin injection have made it a popular aesthetic procedure worldwide. A cross-sectional survey was performed in order to determine the pattern of type A botulinum toxin injections in cosmetic practice, for which an 18-item questionnaire was distributed to dermatologists. A total of 469 Korean board-certified dermatologists participated in the survey, with the following results: the main candidates for type A botulinum toxin injection were individuals in their 40–50 years (46.1%), followed by those in their 20–30 years (33.4%), and people over 60 years of age (20.5%). Overall, the upper face (the glabella, forehead, and crow’s line, in decreasing order) was the most favored area of injection (51%). In contrast, body contouring (i.e., shoulder, calf) and treatment for benign masseter hypertrophy were significantly more popular in the 20–30 years age group than their older counterparts. For wrinkle effacement, the most preferred dilution was 100 units/2.5 mL with isotonic sodium chloride injection (51.2%), and the most often used interval was six months (43.6%). About half (46.3%) of the dermatologists reported the experience of clinical cases which were suspicious of botulinum toxin resistance. Despite this, regarding the choice of the product, type A botulinum toxin products with greater cost-effectiveness were favored over products with a lower risk of antibody formation. Other than its cosmetic usage, botulinum toxin is applied for a variety of skin conditions. Further studies are suggested in order to identify the practice pattern of type A botulinum toxin for therapeutic uses in dermatology, such as hyperhidrosis and rosacea.     

Botulinum toxin treatment of adult spasticity : a benefit-risk assessment.

Injections of botulinum toxin have revolutionised the treatment of focal spasticity. Before their advent, the medical treatment for focal spasticity involved oral anti-spasticity drugs, which had decidedly non-focal adverse effects, and phenol injections. Phenol injections could be difficult to perform, could cause sensory complications and had effects that were of uncertain duration and magnitude. Furthermore, few neurologists knew how to perform them as they were mostly the province of rehabilitation specialists. Botulinum toxin can produce focal, controllable muscle weakness of predictable duration, without sensory adverse effects.Randomised clinical trials (RCTs) involving patients with spasticity resulting from a variety of diseases (mainly stroke and multiple sclerosis) have clearly shown that botulinum toxin type A (Dysport and Botox) can temporarily (for approximately 3 months) reduce spastic hypertonia in the elbow, wrist and finger flexors of the upper limbs, and the hip adductors and ankle plantar flexors in the lower limbs. The clinical benefits from this reduction of neurological impairment are best shown in the upper limb, with less disability of passive function and reduced caregiver burden. In the lower limbs, there is improved perineal hygiene from hip adductor injections. The benefits of reducing ankle plantar flexor tone are less well established. Pain is also reduced, possibly by mechanisms other than muscle weakness. Improved active function has not yet been clearly demonstrated in RCTs, only in open-label trials. The safety of botulinum toxin-A is impressive, with minimal (mainly local) adverse effects.There are little data on the use of botulinum toxin type B (Myobloc or Neurobloc) in spasticity and the only RCT that has examined this did not show tone reduction; dry mouth appeared to be a very common adverse effect. There are also very little data to allow a benefit-risk comparison of phenol and botulinum toxin injections; each have their clinical and technical advantages and disadvantages, and phenol is much less costly than botulinum toxin.     

Botulinum toxin type A and dynamic equinus in children with cerebral palsy: new indication. Better than repeat casts

(1) Botox degrees , a product based on type A botulinum toxin, has received a new licensed indication in the local treatment of dynamic equinus in children with spasticity due to cerebral palsy. (2) Three placebo-controlled trials show that intramuscular injections of type A botulinum toxin reduce spastic equinus and substantially improve walking for at least 3 months. Two small trials, each involving 20 children, show no difference in effects between type A botulinum toxin and successive stretching casts. (3) In this setting the risk of adverse effects is smaller with type A botulinum toxin than with stretching casts. (4) Treatment with type A botulinum toxin is costly.     

Botulinum neurotoxin type A in facial aesthetics

Injection of botulinum neurotoxin type A has rapidly become the most common non-surgical cosmetic procedure performed, due to its exceptional safety profile, as well as its ability to rejuvenate and enhance a number of facial areas. There are several marketed botulinum neurotoxin preparations, but products are not interchangeable as each possesses distinctive characteristics that are attributed to the unique toxin purification and manufacturing processes. These differences can emerge in the form of potency, duration of effect and the potential for migration outside targeted tissue, causing unwanted effects. However, although there are established preclinical pharmacologic and therapeutic differences between products, there are few well-controlled clinical comparisons in facial aesthetics. It is important for clinicians using these products to understand these differences as they relate to achieving desired outcomes for patients who seek improved facial aesthetics.     

Botulinum Neurotoxin Type A in the Treatment of Facial Seborrhea and Acne: Evidence and a Proposed Mechanism

Intradermal injection of botulinum neurotoxin is a frequently performed procedure in aesthetic dermatology to improve facial skin tone, texture, fine wrinkles, and enlarged pores. In practice, botulinum neurotoxin type A is also used to reduce skin oiliness of the face. There is increasing evidence that acetylcholine plays specific roles in sebum production, suggesting that botulinum neurotoxin type A may reduce sebum production by interfering with cholinergic transmission between sebaceous glands and autonomic nerve terminals. Botulinum neurotoxins can also inhibit several pathogenetic components of acne development, suggesting that botulinum neurotoxins can be used as a safe and effective treatment modality for acne and other skin disorders related to overactivity of sebaceous glands. This review aims to explore the current evidence behind the treatment of facial seborrhea and acne with botulinum neurotoxin type A.     

A case of type F botulism in southern California

BACKGROUND: Botulism caused by type F botulinum toxin accounts for less than 0.1% of all human botulism cases and is rarely reported in the literature. CASE REPORT: A 45-year-old woman presented to an emergency department complaining of blurred vision, difficulty focusing, and dysphagia. The treating physician initially considered the possibility of paralytic shellfish poisoning due to a report of shellfish ingestion, which was later determined to be frozen shrimp and a can of tuna, but no gastroenteritis or paresthesias were present. During the emergency department observation, the patient developed respiratory distress with hypercapnea and required intubation and mechanical ventilation. Within hours, ptosis, mydriasis, and weakness in the arms and legs developed. Bivalent (A, B) botulinum antitoxin was administered approximately 24 h from the onset of initial symptoms, but over the next two days complete paralysis progressed to the upper and lower extremities. Shortly thereafter a stool toxin assay demonstrated the presence of type F botulinum toxin. The patient subsequently received an experimental heptavalent botulinum antitoxin on hospital day 7 but paralysis was already complete. Her three-week hospital course was complicated by nosocomial pneumonia and a urinary tract infection, but she gradually improved and was discharged to a rehabilitation facility. Anaerobic cultures and toxin assays have yet to elucidate the source of exposure. CONCLUSION: We report a rare case of type F botulism believed to be foodborne in etiology. Administration of bivalent botulinum antitoxin did not halt progression of paralysis.