胃镜检查中利多卡因过敏一例
CHINESE JOURNAL OF DIGESTIVE ENDOSCOPY(2004)
Abstract
患者男,43岁,因纳差、胸骨烧灼感1 d入院,予以西米替丁、硫糖铝等药口服,效果欠佳,拟行胃镜检查.术前口服盐酸利多卡因胶浆一支作表面麻醉,胃镜检查顺利,见胃窦黏膜点状、斑状充血明显,操作结束患者无不适反应.返回病房2 h后出现左半面颊肿胀,咽部不适.查体:咽部略红,左脸颊仍有水肿现象.20 h后自觉四肢肿胀异样感,双眼睑、口唇、舌体明显肿胀.予以地塞米松葡萄糖酸钙后,颜面部肿胀消褪,四肢肿胀异样感消失.考虑患者对利多卡因过敏,排除气肿可能.为验证该推论,2 d后在争取患者同意后,予2%盐酸利多卡因针及2%盐酸利多因胶浆皮肤斑贴试验,对照为生理盐水和蒸馏水.20 h后,斑贴利多卡因针及利多卡因胶浆处分别出现直径6 cm和5 cm的斑丘红疹,压之褪色,无瘙痒.同时出现双眼及颜面处浮肿,手指脚趾肿胀感.予以地塞米松后症状消失,浮肿消退,通过试验该患者确认为利多卡因过敏症.
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