Cockerill E M, Miller R E, Chernish S M, McLaughlin G C, Rodda B E
AJR Am J Roentgenol. 1976 Mar;126(3):512-23. doi: 10.2214/ajr.126.3.512.
Twelve patients with known esophageal varices and willingness to cooperate were included in the study. Medications administered were placebo, 2 mg of glucagon, and 30 mg of propantheline bromide. All medications were given double-blind and crossover. On the basis of this study the authors believe that for optimal visualization of esophageal varices the following is the procedure of choice: (1) the patient should remain horizontal (this is best done in the left lateral position for comfort and ease of expectoration) for ten minutes after swallowing high density barium; (2) the patient should "clear his throat" frequently and expectorate all saliva (barium sticks to the pharynx and makes the patient want to swallow and "clearing his throat" by forced expiration helps the patient to expectorate this coating and prevents swallowing); (3) filming should be done in expiration in the supine (left posterior oblique to table top) position; and (4) in equivocal cases the examination can be repeated with an anticholinergic drug if the patient has no contraindications to its use. The patient should empty his bladder just before administration of the drug. The intelligent use of these factors should result in a saving of both fluoroscopic time and film, and give the radiologist a safe optimal diagnostic yield.
12名已知患有食管静脉曲张且愿意配合的患者被纳入该研究。所使用的药物有安慰剂、2毫克胰高血糖素和30毫克溴丙胺太林。所有药物均采用双盲交叉给药。基于这项研究，作者认为，为了最佳地显示食管静脉曲张，以下是首选的操作步骤：（1）患者在吞咽高密度钡剂后应保持水平姿势（以左侧卧位为宜，这样舒适且便于咳痰）10分钟；（2）患者应频繁“清嗓”并咳出所有唾液（钡剂会黏附在咽部，导致患者想要吞咽，通过用力呼气“清嗓”有助于患者咳出这种附着物并防止吞咽）；（3）应在呼气时于仰卧位（左后斜位与桌面呈一定角度）进行拍摄；（4）在诊断不明确的情况下，如果患者没有使用抗胆碱能药物的禁忌证，可使用抗胆碱能药物重复检查。患者应在给药前排空膀胱。合理运用这些因素应能节省透视时间和胶片，并为放射科医生提供安全且最佳的诊断结果。
