急性缺血性脑卒中患者使用阿替普酶治疗后出现舌血管性水肿。
Lingual angioedema after alteplase treatment in a patient with acute ischemic stroke.
机构信息
Department of Emergency Medicine, Faculty of Medicine, Mersin University, Mersin, Turkey.
Department of Emergency Medicine, Diskapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey.
出版信息
World J Emerg Med. 2015;6(1):74-6. doi: 10.5847/wjem.j.1920-8642.2015.01.013.
BACKGROUND
In recent years, thrombolytic therapy has become the main treatment of ischemic stroke. But the increasing use of alteplase in ischemic stroke has made some complications more evident. Angioedema is a rare but potentially life-threatening complication of alteplase treatment. Only a few studies have examined the incidence of angioedema after treatment with alteplase for stroke.
METHODS
A 75-year-old man complaining of right hemiparesis was admitted to our emergency department. He was diagnosed as having acute ischemic stroke, and alteplase infusion was given two hours after the onset of stroke symptoms. Immediately after the completion of infusion he was noted to have a large swollen tongue.
RESULTS
His neurological symptoms resolved gradually within 4 hours, whereas his upper extremity strength improved to 4/5 and lower extremity 5/5. Lingual edema resolved within 16 hours without any complication. He died from presumed nosocomial infection 5 days later.
CONCLUSIONS
Lingual angioedema may appear as a possible complication in patients who were treated with alteplase. The management of these patients should be very careful.
背景
近年来，溶栓治疗已成为缺血性脑卒中的主要治疗方法。但随着阿替普酶在缺血性脑卒中中的应用日益增多，一些并发症也更加明显。血管性水肿是阿替普酶治疗的一种罕见但潜在危及生命的并发症。只有少数研究探讨了阿替普酶治疗后发生血管性水肿的发生率。
方法
一名 75 岁男性因右侧偏瘫被收入我院急诊科。他被诊断为急性缺血性脑卒中，在发病症状出现后 2 小时给予阿替普酶输注。输注完成后立即发现他的舌头肿大。
结果
他的神经系统症状在 4 小时内逐渐缓解，而上肢力量恢复至 4/5，下肢 5/5。舌部水肿在 16 小时内消退，无任何并发症。5 天后他死于疑似医院感染。
结论
阿替普酶治疗的患者可能会出现舌血管性水肿作为一种潜在并发症。这些患者的管理应非常谨慎。
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