Roberts Daniel S, Mahoney Elizabeth J, Hutchinson Christoph T, Aliphas Avner, Grundfast Kenneth M
Department of Otolaryngology, Head and Neck Surgery, Boston University School of Medicine and Boston Medical Center, Boston, MA 02118, USA.
Laryngoscope. 2008 Dec;118(12):2115-20. doi: 10.1097/MLG.0b013e318182f805.
OBJECTIVE/HYPOTHESIS: A known risk for patients taking angiotensin converting enzyme-inhibitors (ACE-Is) is angioedema that can involve the face, lips, oral cavity, and larynx. Such upper airway obstruction may be severe enough to require an emergency department visit or even necessitate prompt airway intervention. Once a patient has had an episode of ACE-inhibitor induced angioedema (AIIA), certainly a thrust of continuing case management would be to avoid the occurrence of subsequent episodes of AIIA that potentially can be life-threatening. Nevertheless, recurrent episodes of AIIA do occur. This study aims to characterize a patient's risk for recurrent AIIA, determine the cause for repeat episodes of AIIA and recommend steps to be taken to minimize the recurrence of AIIA.
Retrospective study.
A retrospective chart review of all patient encounters at our medical center between January 1, 1991 and December 30, 2005 with a diagnosis of angioedema was performed. The documented etiology of the angioedema, comorbidities, and documentation of an "allergy" to ACE-I were noted. Observations regarding risk factors for recurrent AIIA were made.
Recurrent AIIA occurred in 23 patients with a recurrence rate of 6.2%. Risk factors for recurrence were categorized as patient factors, physician factors, or systems factors. Physician error with failure to document in the medical record, the suspicion of AIIA, and failure to consider risk in prescribing ACE-I after an episode of angioedema had occurred were the most common causes of recurrent AIIA.
Angioedema can cause life-threatening airway compromise yet patients with a history of one episode of AIIA are at risk for a subsequent episode. Physicians can modify clinical practices to avert the potentially life-threatening side effects of ACE-inhibitors in patients with a prior episode of AIIA.
目的/假设：服用血管紧张素转换酶抑制剂（ACE-Is）的患者面临的一个已知风险是血管性水肿，可累及面部、嘴唇、口腔和喉部。这种上呼吸道梗阻可能严重到需要前往急诊科就诊，甚至需要立即进行气道干预。一旦患者发生过ACE抑制剂诱发的血管性水肿（AIIA），持续病例管理的一个重要举措肯定是避免随后发生可能危及生命的AIIA发作。然而，AIIA确实会复发。本研究旨在明确患者复发性AIIA的风险特征，确定AIIA复发的原因，并推荐采取措施以尽量减少AIIA的复发。
回顾性研究。
对1991年1月1日至2005年12月30日期间在我们医疗中心所有诊断为血管性水肿的患者会诊记录进行回顾性分析。记录血管性水肿的病因、合并症以及对ACE-I“过敏”的记录。观察复发性AIIA的危险因素。
23例患者出现复发性AIIA，复发率为6.2%。复发的危险因素分为患者因素、医生因素或系统因素。医生失误，包括未在病历中记录、对AIIA的怀疑以及在血管性水肿发作后开ACE-I时未考虑风险，是复发性AIIA最常见的原因。
血管性水肿可导致危及生命的气道损害，然而有过一次AIIA发作史的患者仍有再次发作的风险。医生可以改变临床实践，以避免在有AIIA发作史的患者中出现ACE抑制剂潜在的危及生命的副作用。
