Liou Tai-Cherng, Lin Shee-Chan, Wang Horng-Yuan, Chang Wen-Hsiung
Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Section 2, Chungshan North Road, Taipei, Taiwan, China.
World J Gastroenterol. 2006 May 21;12(19):3108-13. doi: 10.3748/wjg.v12.i19.3108.
To define the optimal injection volume of epinephrine with high efficacy for hemostasis and low complication rate in patients with actively bleeding ulcers.
This prospective, randomized, comparative trial was conducted in a medical center. A total of 228 patients with actively bleeding ulcers (spurting or oozing) were randomly assigned to three groups with 20, 30 and 40 mL endoscopic injections of an 1:10000 solution of epinephrine. The hemostatic effects and clinical outcomes were compared between the three groups.
There were no significant differences in all background variables between the three groups. Initial hemostasis was achieved in 97.4%, 98.7% and 100% of patients respectively in the 20, 30 and 40 mL epinephrine groups. There were no significant differences in the rate of initial hemostasis between the three groups. The rate of peptic ulcer perforation was significantly higher in the 40 mL epinephrine group than in the 20 and 30 mL epinephrine groups (P < 0.05). The rate of recurrent bleeding was significantly higher in the 20 mL epinephrine group (20.3%) than in the 30 (5.3%) and 40 mL (2.8%) epinephrine groups (P < 0.01). There were no significant differences in the rates of surgical intervention, the amount of transfusion requirements, the days of hospitalization, the deaths from bleeding and 30 d mortality between the three groups. The number of patients who developed epigastric pain due to endoscopic injection, was significantly higher in the 40 mL epinephrine group (51/76) than in the 20 (2/76) and 30 mL (5/76) epinephrine groups (P < 0.001). Significant elevation of systolic blood pressure after endoscopic injection was observed in the 40 mL epinephrine group (P < 0.01). Significant decreasing and normalization of pulse rates after endoscopic injections were observed in the 20 mL and 30 mL epinephrine groups (P < 0.01).
Injection of 30 mL diluted epinephrine (1:10000) can effectively prevent recurrent bleeding with a low rate of complications. The optimal injection volume of epinephrine for endoscopic treatment of an actively bleeding ulcer (spurting or oozing) is 30 mL.
确定肾上腺素的最佳注射量，以在活动性出血性溃疡患者中实现高效止血且并发症发生率低。
本前瞻性、随机、对照试验在一家医疗中心进行。总共228例活动性出血性溃疡（喷射性或渗血）患者被随机分为三组，分别接受20、30和40 mL 1:10000肾上腺素溶液的内镜注射。比较三组的止血效果和临床结局。
三组之间所有背景变量均无显著差异。20、30和40 mL肾上腺素组患者的初始止血率分别为97.4%、98.7%和100%。三组之间初始止血率无显著差异。40 mL肾上腺素组消化性溃疡穿孔率显著高于20 mL和30 mL肾上腺素组（P < 0.05）。20 mL肾上腺素组（20.3%）复发出血率显著高于30 mL（5.3%）和40 mL（2.8%）肾上腺素组（P < 0.01）。三组之间手术干预率、输血量、住院天数、出血死亡人数和30天死亡率无显著差异。40 mL肾上腺素组因内镜注射出现上腹部疼痛的患者数量（51/76）显著高于20 mL（2/76）和30 mL（5/76）肾上腺素组（P < 0.001）。40 mL肾上腺素组内镜注射后收缩压显著升高（P < 0.01）。20 mL和30 mL肾上腺素组内镜注射后脉搏率显著下降并恢复正常（P < 0.01）。
注射30 mL稀释肾上腺素（1:10000）可有效预防复发出血，并发症发生率低。内镜治疗活动性出血性溃疡（喷射性或渗血）时肾上腺素的最佳注射量为30 mL。
