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本文报道一例食道上1/3鳞癌患者,在一个疗程的博莱霉素治疗结束之后48小时突发致死性血管性水肿。此反应不能被皮肤试验所预测。 病人男性,74岁,患食道癌,曾接受放疗,剂量为5,000rad。用顺氯氨铂和氟脲嘧啶化疗。因肺部发现孤立性小结病灶并因吞咽困难转重而用博莱霉素作姑息性治疗。当时肺功能、肾功能检查均正常。白细胞为8500/mm~3,中性分叶核80％,杆状核5％,淋巴细胞15％。皮下注射2ml试验剂量的硫酸博莱霉素,未引起任何反应,于是给予连续静滴,每24小时15mg/m~2,连用4天。发热37.7℃—38.3℃,曾用退热药。出院前,胸片提示肺部无变化。白细胞为3,700/mm~3,嗜酸性白细胞10％。48小时后,病人诉呼吸困难严重,眼睑和口唇肿胀。病人无荨麻疹或血管性水肿史,无发热或寒颤。检查面部发现眼睑,特别是上、下口唇
This article reports one case of a patient with 1/3 squamous cell carcinoma of the esophagus who developed sudden fatal angioedema 48 hours after the end of a course of bleomycin treatment. This reaction cannot be predicted by skin tests. The patient was a 74-year-old man with esophageal cancer and had received radiation therapy at a dose of 5,000 rad. Chemotherapy with cisplatin and fluorouracil. Palliative treatment with bleomycin was performed because the lungs found lesions with solitary nodules and turned heavy due to dysphagia. At that time, lung function and renal function tests were normal. White blood cells were 8500/mm~3, 80% of neutral lobe nuclei, 5% of rod-shaped nuclei, and 15% of lymphocytes. Subcutaneous injection of 2 ml of test dose of bleomycin sulfate did not cause any reaction, so continuous intravenous infusion was given at 15 mg/m~2 every 24 hours for 4 days. Fever 37.7°C-38.3°C, used antipyretics. Before discharge, the chest radiograph showed no change in the lungs. White blood cells are 3,700/mm~3 and eosinophils are 10%. After 48 hours, the patient complained of difficulty in breathing, swelling of the eyelids and lips. The patient had no history of urticaria or angioedema, and no fever or chills. Check the face to find the eyelid, especially the upper and lower lips