Lin Hwai-Jeng, Hsieh Yu-Hsi, Tseng Guan-Ying, Perng Chin-Lin, Chang Full-Young, Lee Shou-Dong
Division of Gastroenterology, Department of Medicine, VGH-TAIPEI, Taipei, Taiwan, ROC.
Gastrointest Endosc. 2002 May;55(6):615-9. doi: 10.1067/mge.2002.123271.
Endoscopic injection of epinephrine in the treatment of bleeding peptic ulcer is considered highly effective, safe, inexpensive, and easy to use. However, bleeding recurs in 6% to 36% of patients. The aim of this study was to determine the optimal dose of epinephrine for endoscopic injection in the treatment of patients with bleeding peptic ulcer.
One hundred fifty-six patients with active bleeding or nonbleeding visible vessels were randomized to receive small- (5-10 mL) or large-volume (13-20 mL) injections of a 1:10,000 solution of epinephrine.
The mean volume of epinephrine injected was 16.5 mL (95% CI [15.7, 17.3 mL]) in the large-volume group and 8.0 mL (95% CI [7.5, 8.4 mL]) in the small-volume group. Initial hemostasis was achieved in all patients studied. The number of episodes of recurrent bleeding was smaller in the large-volume group (12/78, 15.4%) compared with the small-volume group (24/78, 30.8%, p = 0.037). The volume of blood transfused after entry into the study, duration of hospital stay, numbers of patients requiring urgent surgery, and mortality rates were not statistically different between the 2 groups.
Injection of a large volume (>13 mL) of epinephrine can reduce the rate of recurrent bleeding in patients with high-risk peptic ulcer and is superior to injection of lesser volumes of epinephrine when used to achieve sustained hemostasis.
内镜下注射肾上腺素治疗消化性溃疡出血被认为高效、安全、廉价且易于操作。然而，6%至36%的患者会再次出血。本研究的目的是确定内镜下注射肾上腺素治疗消化性溃疡出血患者的最佳剂量。
156例有活动性出血或可见非出血血管的患者被随机分为两组，分别接受小剂量（5 - 10 mL）或大剂量（13 - 20 mL）的1:10000肾上腺素溶液注射。
大剂量组肾上腺素的平均注射量为16.5 mL（95%可信区间[15.7, 17.3 mL]），小剂量组为8.0 mL（95%可信区间[7.5, 8.4 mL]）。所有研究患者均实现了初始止血。与小剂量组（24/78，30.8%，p = 0.037）相比，大剂量组再次出血的发作次数较少（12/78，15.4%）。两组在进入研究后输注的血量、住院时间、需要紧急手术的患者数量以及死亡率方面无统计学差异。
注射大剂量（>13 mL）肾上腺素可降低高危消化性溃疡患者的再出血率，在实现持续止血方面优于注射较小剂量的肾上腺素。
