雷米普利致血管性水肿

Angioedema induced by ramipril

1例62岁女性患者因高血压给予雷米普利2.5 mg口服、1次/d。用药约12 h后,患者出现呼吸困难,全身多处皮肤红疹(以胸、背部最多,伴瘙痒),眼结膜充血,唇部肿胀,口腔黏膜充血,咽部充血且疼痛,诊断为血管性水肿。考虑为雷米普利所致,停用该药,并给予肾上腺素、盐酸异丙嗪、地塞米松抗过敏治疗。1 h后,患者症状好转,生命体征平稳。第2天,患者无呼吸困难,无新发皮疹,给予甲泼尼龙、葡萄糖酸钙和枸地氯雷他定抗过敏,左旋氨氯地平降压治疗。第3天,患者皮疹消退并结痂,眼结膜、口腔和咽部充血减轻,唇部肿胀减轻。第6天,患者过敏症状完全消失,血压122/78 mmHg,血压126/83 mmHg(1 mmHg=0.133 kPa)。

A 62-year-old female patient received ramipril 2.5 mg orally once daily for hypertension. About 12 hours after the first administration, the patient developed difficulty breathing, multiple skin rashes all over the body (mostly on chest and back, accompanied with itching), conjunctival hyperemia, lip swelling, oral mucosal hyperemia, pharyngeal congestion with pain, and etc. She was diagnosed with angioedema, which was considered to be caused by ramipril. Ramipril was stopped and anti-allergy treatments with adrenaline, promethazine hydrochloride, and dexamethasone were given. One hour later, the patient had improved symptoms and stable vital signs. On day 2 after the anti-allergy treatments, the patient had neither difficulty breathing nor new skin rash, and the anti-allergy drugs were replaced by methylprednisolone, calcium gluconate, and desloratadine cirate disodium. Antihypertensive treatment with levoamlodipine was also given. On day 3 after treatments, the patient′s skin rashes subsided with scars, congestion of the conjunctiva, oral mucosa, and pharynx relieved, and the lip swelling improved. On day 6 after treatments, the patient′s allergic symptoms completely disappeared, and her blood pressure was 122/78 mmHg.