Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Song Hsiang 833, Kaohsiung, Taiwan.
World J Gastroenterol. 2010 Nov 21;16(43):5490-5. doi: 10.3748/wjg.v16.i43.5490.
To identify the predictors of rebleeding after initial hemostasis with epinephrine injection (EI) in patients with high-risk ulcers.
Recent studies have revealed that endoscopic thermocoagulation, or clips alone or combined with EI are superior to EI alone to arrest ulcer bleeding. However, the reality is that EI monotherapy is still common in clinical practice. From October 2006 to April 2008, high-risk ulcer patients in whom hemorrhage was stopped after EI monotherapy were studied using clinical, laboratory and endoscopic variables. The patients were divided into 2 groups: sustained hemostasis and rebleeding.
A total of 175 patients (144, sustained hemostasis; 31, rebleeding) were enrolled. Univariate analysis revealed that older age (≥ 60 years), advanced American Society of Anesthesiology (ASA) status (category III, IV and V), shock, severe anemia (hemoglobin < 80 g/L), EI dose ≥ 12 mL and severe bleeding signs (SBS) including hematemesis or hematochezia were the factors which predicted rebleeding. However, only older age, severe anemia, high EI dose and SBS were independent predictors. Among 31 rebleeding patients, 10 (32.2%) underwent surgical hemostasis, 15 (48.4%) suffered from delayed hemostasis causing major complications and 13 (41.9%) died of these complications.
Endoscopic EI monotherapy in patients with high-risk ulcers should be avoided. Initial hemostasis with thermocoagulation, clips or additional hemostasis after EI is mandatory for such patients to ensure better hemostatic status and to prevent subsequent rebleeding, surgery, morbidity and mortality.
确定肾上腺素注射（EI）初始止血后高危溃疡再出血的预测因素。
最近的研究表明，内镜热凝治疗，或夹闭术单独或联合 EI 优于 EI 单独用于控制溃疡出血。然而，在临床实践中，EI 单一疗法仍然很常见。从 2006 年 10 月至 2008 年 4 月，研究了 EI 单一疗法止血后高危溃疡患者的临床、实验室和内镜变量。患者分为 2 组：持续止血和再出血。
共纳入 175 例患者（144 例持续止血；31 例再出血）。单因素分析显示，年龄较大（≥60 岁）、美国麻醉医师协会（ASA）分级较高（Ⅲ、Ⅳ和Ⅴ级）、休克、严重贫血（血红蛋白＜80g/L）、EI 剂量≥12mL 和严重出血征象（SBS）包括呕血或血便，是预测再出血的因素。然而，只有年龄较大、严重贫血、高 EI 剂量和 SBS 是独立的预测因素。在 31 例再出血患者中，10 例（32.2%）接受了手术止血，15 例（48.4%）发生延迟性止血导致严重并发症，13 例（41.9%）因这些并发症死亡。
应避免在高危溃疡患者中进行内镜 EI 单一疗法。对于此类患者，必须进行初始热凝治疗、夹闭术或 EI 后附加止血，以确保更好的止血状态，防止随后的再出血、手术、发病率和死亡率。
