Laine L
Department of Medicine, University of Southern California School of Medicine, Los Angeles.
Gastroenterology. 1990 Nov;99(5):1303-6. doi: 10.1016/0016-5085(90)91154-x.
This study prospectively compares multipolar electrocoagulation and injection therapy in high-risk patients with bleeding ulcers. Patients were considered for entry if they had a bloody nasogastric aspirate, melena, or hematochezia and unstable vital signs, transfusion of greater than or equal to 2 U of blood in 12 hours, or a decrease in hematocrit of greater than or equal to 6% in 12 hours. Sixty patients with endoscopic evidence of an ulcer with active bleeding (n = 26) or a nonbleeding visible vessel (n = 34) were randomly assigned to receive multipolar electrocoagulation or injection with absolute ethanol. Hemostasis was achieved in 14 of 14 actively bleeding patients with multipolar electrocoagulation vs. 10 of 12 (83%) treated with injection. No significant differences were observed between electrocoagulation and injection therapy in any parameter assessed during the hospitalization: incidence of further bleeding (6% vs. 10%), units of blood transfused after treatment (1.8 +/- 0.6 vs. 1.3 +/- 0.4), incidence of surgery for bleeding (6% vs. 7%), length of hospital stay in days (5.8 +/- 0.9 vs. 7.2 +/- 2.5), cost of hospitalization (+7160 +/- +1630 vs. +8520 +/- +2960), or mortality rate (3% vs. 3%). Treatment induced bleeding in nonbleeding visible vessels in 35% of subjects in each group, but this was controlled with continued treatment in all patients. One delayed perforation occurred 9 days after multipolar electrocoagulation. Multipolar electrocoagulation and injection therapy are of comparable efficacy in the treatment of patients with clinical evidence of a major upper gastrointestinal bleed and endoscopic evidence of an ulcer with active bleeding or a nonbleeding visible vessel.
本研究前瞻性比较了多极电凝术与注射疗法在高危出血性溃疡患者中的应用。若患者有血性鼻胃吸引物、黑便或便血且生命体征不稳定，12小时内输血≥2单位，或12小时内血细胞比容下降≥6%，则考虑纳入研究。60例有内镜证据显示溃疡伴有活动性出血（n = 26）或可见非出血血管（n = 34）的患者被随机分配接受多极电凝术或无水乙醇注射。多极电凝术治疗的14例活动性出血患者中有14例实现止血，而注射治疗的12例患者中有10例（83%）实现止血。在住院期间评估的任何参数方面，电凝术与注射疗法之间均未观察到显著差异：再次出血发生率（6%对10%）、治疗后输血量（1.8±0.6对1.3±0.4）、因出血进行手术的发生率（6%对7%）、住院天数（5.8±0.9对7.2±2.5）、住院费用（+7160±+1630对+8520±+2960）或死亡率（3%对3%）。每组35%的受试者在非出血可见血管处出现治疗诱发的出血，但所有患者通过持续治疗均得到控制。多极电凝术后9天发生1例延迟穿孔。在治疗有临床证据表明存在上消化道大出血且内镜证据显示溃疡伴有活动性出血或可见非出血血管的患者时，多极电凝术和注射疗法具有相当的疗效。
