乙酰半胱氨酸注射液致血管性水肿1例分析

目的探讨乙酰半胱氨酸注射液致血管性水肿的原因及治疗方法。方法分析吉林大学第一医院血管外科2018年9月收治的1例动脉硬化闭塞症患者因注射乙酰半胱氨酸注射液致血管性水肿的可能性及治疗方法。结果 1例65岁女性患者因左下肢发凉、麻木、疼痛1年入院。入院第1天给予乙酰半胱氨酸注射液8 g+5%葡萄糖溶液250 mL静脉滴注,注射该药后约1小时20分钟,患者出现面部水肿、全身皮疹等血管性水肿症状,立即停药并给予抗过敏治疗,对症治疗后1 h患者上述症状消失,入院第14天病情好转出院。结论乙酰半胱氨酸注射液很可能引起该患者血管性水肿。注射该药物时应注意减小滴速,谨慎用于有药物过敏史、哮喘的患者,同时注射时应有专人陪护并注意观察。     

食用蝉幼虫引起血管性水肿一例

[病例]男,20岁.2000年7月20日晚食用油炸蝉幼虫数十个,1小时后出现全身瘙痒,自服阿司咪唑(息斯敏)10 mg后入睡,晨起觉头晕、恶心、口周麻木、张口受限,右面颊部、下唇、包皮水肿,来院就诊.查体:体温、脉搏、呼吸、血压均正常.心、肺、腹未见异常,眼睑元水肿,右面颊部水肿,有弹性,压痛,无指压性凹陷,下唇及包皮水肿,无疼痛.诊断:食蝉幼虫引起的血管性水肿.给予抗过敏治疗,3天后水肿消退.追问病史,患者3天前曾食油炸蝉幼虫数个,出现散在大小不等的"风团",并伴有痒感,后自行消失,未在意.     

食用蝉幼虫引起血管性水肿一例

[病例]男,20岁。2000年 7月20日晚食用油炸蝉幼虫数十个,1小时后出现全身瘙痒,自服阿司咪唑（息斯敏）10 mg后入睡,晨起觉头晕、恶心、口周麻木、张口受限,右面颊部、下唇、包皮水肿,来院就诊。查体:体温、脉搏、呼吸、血压均正常。心、肺、腹未见异常,眼睑无水肿,右面颊部水肿,有弹性,压痛,无指压性凹陷,下唇及包皮水肿,无疼痛。诊断:食蝉幼虫引起的血管性水肿。给予抗过敏治疗,3天后水肿消退。追问病史,     

蛇毒抗栓酶过敏水肿一例

患者女,45岁,因急性前壁心肌梗塞心力衰竭,于1994-01-13入我院循环监护病室。于当日给予蛇毒抗栓酶0.001u/ml,取0.1ml做皮试结果阴性。给予蛇毒抗栓酶1.0u加85％生理盐水300ml静脉滴注。当液体输入约100ml后,患者自诉眼睑肿胀,四肢水肿加重。因病人心力衰蝎,水肿较重,误认为是输液速度过快,只采取了减慢静脉输液速度,第二天当再次输入蛇毒抗栓酶溶液50ml时,病人再度出现眼睑及四肢水肿加重,并伴周身瘙痒红斑等。立即停止输入蛇毒抗栓酶,并给予25％葡萄糖20ml地塞米松10mg静脉注射。1h     

真性红细胞增多症误诊1例

1 病历摘要患者男,53岁,农民。因左小腿皮肤发红、疼痛、肿胀1周入院。患者入院前1周无明显诱因出现左侧膝关节疼痛,在当地村卫生室打"封闭"治疗后出现左小腿皮肤发红、疼痛、肿胀不适,疼痛较剧,左腿不能站立行走,在当地村卫生室抗感染治疗1周无好转,遂至本院就诊。问诊:患者10年     

氯霉素眼药水致过敏反应一例

氯霉素眼药水是一种常用的局部用抗生素制剂,在临床实践中,应用本品点眼引起过敏反应者较为少见,笔者见到1例,兹报告如下: 1 病例介绍 患者,男,48岁。因患沙眼、眼痒,于1998年5月8日,用氯霉素眼药水(石家庄市新华制药厂生产,批号971113)点双眼各2滴,1h后,患者感觉两眼肿胀,不能睁大,4h后加重,遂来就诊。检查:双眼睑球结膜无充血水肿、无分泌物,视力正常,眼周皮肤不红,但见双眼上下眼睑及鼻梁皮肤明显水肿,睁开困难,其它检查未见异常。给马来那敏(扑尔敏)8mg/次,tid,po,2h后肿胀感有所减轻,24h后水肿基本消失。后双眼再次各滴入1滴,1h后又出现上述相同症状。确诊为氯霉素眼药水所致过敏反应,     

中成药天王补心丹引起血管性水肿2例报告

中成药天王补心丹引起血管性水肿２例报告天王补心丹为常用中成药，临床应用很少有不良反应，笔者接诊２例因误服天王补心丹而致血管性水肿患者，报告如下。席×，男，９岁与其弟７岁，１９９３年３月１２日诊。患儿于３月１１日晚玩耍时，二人各服天王补心丹２丸。服后约１小时许，席×出现上唇肿胀伴微痒，其弟胸腹部及下肢出现黄豆大小红色皮疹，搔痒明显。次日上午入门诊就诊，查：席×上唇呈明显非可凹陷性水肿，皮肤紧张发亮，表面色白，质地柔软，境界不清。其弟胸腹部皮疹已基本消退，双下肢尚有少量皮疹，仍搔痒。给予赛庚啶片口眼，每次２ｍｇ，每日３次，１周后上唇水肿方消退痊愈。（太原市中心医院刘智太原市传染病医院韩转英）中成药天王补心丹引起血管性水肿2例报告@刘智，韩转英$太原市中心医院，太原市传染病医院     

甲硝唑致药疹

患者女,38岁,因牙痛来院就诊,查体发现牙龈红肿、给予甲硝唑0.4g口服,同时服解热止痛片1片,约4h后患者感口周麻木、瘙痒难忍、继之肿胀,次日右手中指伸侧面出现一褐色园形皮疹、瘙痒.     

阿司咪唑过敏2例

例1男,50岁。患者因服吲哚美辛后全身发痒,出现散在斑丘疹而就诊。停药7 d后瘙痒好转,皮疹渐退。自服阿司咪唑10 mg,6 h后下嘴唇严重肿胀,出现黄豆大小水泡数个,剧痛不能闭嘴,全身皮下水肿明显,密布麻疹样鲜红色斑丘疹,腹部、四肢为著,活动受限。左手根部指间出现数个黄豆大小水泡,阴囊严重水肿、发红。考虑阿司咪唑引起的过敏反应,立即停药,给予地塞米松、葡萄糖酸钙等药住院治疗1周,症状好转,皮疹、水肿渐退出院。例2女,46岁。因皮肤瘙痒自服阿司咪唑10 mg·d-1,第2天全身出现散在荨麻疹样风团,奇痒难忍。查体可见四肢、腹部大片红色风团…     

食用卤鸭头致血管性水肿及过敏性休克1例

患者,女,53岁,因下唇肿胀1小时来诊。1小时前食用卤鸭头后,下唇出现肿胀,无疼痛和瘙痒。体检：系统检查无异常。皮肤科情况：下唇轻度肿胀,皮肤黏膜无破溃,全身皮肤无红斑和丘疹。诊断：血管性水肿。予口服扑尔敏4mg,肌注苯海拉明20mg,静滴地塞米松7．5mg、复方甘草酸苷80mg、葡萄糖酸钙1g、维生素C3．5g,留急诊室观察,     

别嘌醇过敏综合征

1例46岁男性患者因血尿酸高给予别嘌醇0.2g,2次/d。28d后躯干及四肢出现大片水肿性红斑伴瘙痒。遂停用别嘌醇。随后症状加重,全身泛发性潮红、肿胀伴紫癜,眼睑水肿,口周渗出、结痂。实验室检查：WBC20.2×109/L,E0.32,ALT52U/L。骨髓涂片检查示嗜酸细胞增多。给予甲泼尼龙80mg加入5%葡萄糖注射液250mL静脉滴注。3d后症状好转。     

泛影葡胺致肾移植术后患者急性喉头水肿

1例29岁肾移植术后男性患者因移植肾功能不全行移植肾增强cT检查,静脉注射泛影葡胺注射液20m1（12g）。12h后患者出现咽部不适、分泌物增多,伴颈部轻度肿大。20h后其不适症状加重且伴有呼吸困难、吞咽困难、声音嘶哑等症状,查体发现颈部明显肿大、增粗,全身轻度水肿。立即静脉注射地塞米松10mg,雾化吸入布地奈德1mg,同时行心电监护及吸氧等治疗。约4h后患者病情缓解,2d后过敏症状消失。     

清开灵注射液所致眼过敏反应进展为严重眼睑内翻和泪道阻塞

1例8岁男性患儿因上呼吸道感染静脉滴注清开灵注射液(剂量不详)。输注约1 h,患儿出现面色潮红、双眼睑红肿、眼痛、流泪、畏光、睁眼困难,全身皮肤见大片红色斑疹伴瘙痒,但未予重视而未停药;2 h后输液完毕,其症状加重,继而出现口唇疱疹并逐渐形成溃疡。抗过敏治疗12 d后,患儿眼睑红肿、睁眼困难及全身皮肤表现渐减轻至消失,但双眼磨痛、畏光、流泪持续存在。约1.5年后形成双眼睑内翻、泪道阻塞,11岁时行睑内翻矫正术,术后症状明显改善。     

Adverse herbal interactions causing hypotension

A 57-year-old man consulted an herbalist for epigastric discomfort. Four hours after he drank a decoction made from 14 herbs, he developed nausea, epigastric pain, and dizziness. He also had two loose bowel movements. On arrival at the hospital 4 hours later, his blood pressure was 77/46 mm Hg, and his pulse was 60 beats/min. He was given intravenous fluids. In the next 3 hours, his blood pressure gradually returned to his usual level of 100/65 mm Hg. His other gastrointestinal symptoms gradually subsided during the next 24 hours. His white cell count was 17.8 x 109/L but was normal on recheck. Complete cell counts, renal function and liver function tests, and electrocardiogram were otherwise normal. He was discharged home on day 2. Seven of the 14 herbs taken by this patient are known to have vasodilatory or blood pressure-lowering effects, and 3 of these herbs are used to manage hypertension. In traditional Chinese medicine, practitioners often use a combination of herbs in an attempt to improve the efficacy but reduce the adverse effects of treatment. The risk of adverse herbal interactions will also be higher.     

胺碘酮相关双手震颤及抽搐

1例62岁男性患者,因心房颤动给予胺碘酮200mg口服,约6h后再给予胺碘酮200mg口服。第2次服药3h后,出现四肢间歇性乏力,每次持续数分钟。次日晨起乏力消失,再次口服胺碘酮200mg,半小时后出现双手震颤伴抽搐。实验室检查：Ca2＋2.38mmol/L。给予地西泮及葡萄糖酸钙5min后症状消失。之后未再应用胺碘酮,症状未再发作。     

双嘧达莫致幼儿严重过敏反应

1倒1岁9个月川崎病女性患儿，因血小板升高（684×10^9／L），给予双嘧达莫25mg口服。首次服药后约15min出现呕吐，全身大汗，面色苍白，口周发绀，口唇肿胀，呼吸困难，T36．3℃，HR130次／min，R32次／min，BP97／54mmHg，诊断为双嘧达莫过敏反应。立即给予肾上腺素肌内注射，5min后患儿症状缓解。30min后给予西替利嗪和甲泼尼龙，1h后完全恢复正常。     

酒石酸唑吡坦片致精神错乱

1例74岁男性患者,因胃癌化疗住院。次日晚因入睡困难给予酒石酸唑吡坦10mg口服。用药1h后患者出现烦躁,意识模糊,幻听,谵妄。肌内注射异丙嗪、氟哌啶醇对症处理,症状无改善。4h后患者症状自行消失,神志恢复,但不能回忆起之前发生的事情。停用此药,上述症状未再发生。     

那屈肝素钙致消化道出血及腹部血肿

1例77岁男性患者,因拟行射频消融术,术前给予预防性抗凝治疗,皮下注射那屈肝素钙6150U,1次/12h。2d后患者出现晨起头晕、晕厥、腹痛,腹部可触及包块。停用那屈肝素钙。之后患者呕吐咖啡样胃内容物约200mL,BP80/50mmHg,HR110次/min。CT检查示腹部肿块。次日左侧腰腹部出现瘀斑,腹部包块明显增大,张力增高,触痛明显。Hb74g/L。腹部超声检查：肝周、肾周、脾周及腹腔存在少量积液。那屈肝素钙停用48h后Hb80g/L。随后给予对症支持治疗,上述症状逐渐好转。停用4d后开始进流食,未再发生消化道出血。停用4周后Hb120g/L,随访8个月病情稳定。     

Envenomation by the Mexican beaded lizard: a case report

BACKGROUND: Envenomations by venomous lizards are rare. A single report of envenomation by a Mexican beaded lizard (Heloderma horridum) has been published. Further, anaphylaxis secondary to lizard envenomation has only been reported with the Gila monster. We report an envenomation that resulted in both systemic toxicity and anaphylaxis. CASE REPORT: A 40-year-old male was bitten on his hand by a captive Mexican beaded lizard. The patient experienced severe local pain, dizziness, vomiting, and diaphoresis. Upon arrival to the hospital, he was lethargic, vomiting, and in severe pain with marked swelling of his hand, lips, and tongue. His blood pressure was 110/63 mm/Hg with a pulse of 60 beats/minute. The patient's oxygen saturation decreased to 55%, and he required oxygen, although cyanosis was not observed. He was treated with normal saline, diphenhydramine, methylprednisolone, famotidine, ondansetron, morphine, and hydromorphone. The patient was admitted to intensive care where he continued to complain of severe pain requiring morphine. Local X-ray revealed only soft tissue swelling. Remarkable initial laboratory values included WBC 18,500 k/mm3 with 80% segs. Over the next eight hours, the patient's symptoms gradually improved. He had persistent local swelling at the bite site along with erythematous streaking up the forearm. He had an uneventful hospital course until his eventual discharge the following day. CONCLUSION: Significant envenomations by members of the Helodermatidae family are rare. Systemic toxicity usually resolves within one to two days with supportive care. Prior envenomations may predispose patients to anaphylactic reactions.     

唑吡坦引起睡行症

1名78岁男性面神经麻痹患者,入院后给予硝苯地平缓释片、维生素B1、腺苷钴胺、七叶皂苷钠及血塞通注射液。患者因入睡困难睡前服用唑吡坦。在服用唑吡坦的3d中,第1天,患者服用唑吡坦10mg后,1h内入睡,而3h后患者于睡眠中起床行走并和人交谈,但事后对此毫无记忆;第2天,患者服用唑吡坦5mg,未发生上述行为;第3天,患者再次服用唑吡坦10mg,5h后又出现上述行为。停用唑吡坦后,该行为未再出现。