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患者女,52岁.高血压病史10年,发作性心前区疼痛1年,多次查心电图为心肌缺血,诊断为冠心病、心绞痛.平时眼潘生丁、维生素E、维生素B_6、巯甲丙脯酸,心绞痛发作时合服硝酸甘油可缓解.于入院前1天劳累后出现心前区疼痛,向左肩背部放射,伴胸闷,因当时无硝酸甘油,含服速效救心丸6粒,约20分钟后面部水肿,伴大片状风团样皮疹,搔痒,未予任何处理,症状持续约1小时后缓解.但仍感心前区疼痛而收住院.患者既往有氨苄青霉素过敏史(皮疹).查体:BP:23/16kPa,神志清,双肺音清,HR 80次/分,律整,肝脾未触及,心电图Ⅱ、Ⅳ、avF、ST段呈下斜型下移,pafv_1=—0.04mm·s,血、尿、便常规及血糖正常.经内科治疗,心绞痛消失.为进一步证实患者为速效救心丸过敏.嘱其再次服速效救心丸5粒,患者面部再次出现水肿、风团样皮疹.立即肌注氟美松、苯海拉明后症状消失.尽管再激发试验是确定单病例药物不良反应的重要手段之一,但应考虑患者原发疾病及医德,对可能诱发严重不良反应者,不要随意作再激发试
Patient female, 52 years old .Hypertension history 10 years, episodes of pre-cardiac pain for 1 year, many times check the electrocardiogram for myocardial ischemia, diagnosis of coronary heart disease, angina pectoris.Peptide dipyridamole, vitamin E, vitamin B_6, Preserved, angina pectoris when combined with nitroglycerin can ease.At the front of the hospital one day after exertion of precordial pain, radiation to the left shoulder back with chest tightness, because at that time no nitroglycerin, containing service speed save heart pills 6, about 20 Minute facial edema, accompanied by a large patchy wind-like rash, itching, without any treatment, the symptoms lasted about 1 hour after the relief, but still feel the pain in the anterior chamber and admitted to hospital in patients with past history of ampicillin allergy (rash). Examination: BP: 23 / 16kPa, conscious mind, lung sound clear, HR 80 beats / min, law of integrity, liver and spleen not touched, electrocardiogram Ⅱ, Ⅳ, avF, ST segment was downward downward, pafv_1 = 0.04mm · s, blood, urine, then routine and normal blood glucose .After medical treatment, angina disappears .To further confirm the patient for the quick save heart pill allergy.Instruct its service again save the heart pills 5, the patient again face edema, the wind group Like rash. Immediate intramuscular injection of flumethasone, diphenhydramine symptoms disappeared. Although the re-excitation test is indeed Order cases of adverse drug reactions one of the important means, but should consider the patient’s primary disease and medical ethics, may cause serious adverse reactions, who do not arbitrarily re-test