Laine L
University of Southern California School of Medicine, Los Angeles.
Ann Intern Med. 1989 Apr 1;110(7):510-4. doi: 10.7326/0003-4819-110-7-510.
To assess the efficacy and safety of treatment with endoscopic multipolar electrocoagulation in patients who have ulcers with nonbleeding visible vessels.
Prospective, randomized, sham-controlled trial; patients were followed until their discharge from the hospital.
Urban, nonreferral county hospital.
Consecutive sample of 75 patients who had a bloody nasogastric aspirate sample, melena, or hematochezia; unstable vital signs, a transfusion of at least two units of blood in 12 hours, or a drop in the hematocrit of at least 0.06 in 12 hours; and endoscopic evidence of an ulcer with a nonbleeding visible vessel.
Sham or real multipolar electrocoagulation at the time of diagnostic endoscopy.
Compared with the control group, the group receiving multipolar electrocoagulation showed marked improvement in the following variables; rebleeding (18% compared with 41%, P less than 0.05; difference, 23%; 95% CI, 3% to 43%); need for emergency surgery (8% compared with 30%, P less than 0.05; difference, 22%; CI, 5% to 39%); mean number of hospital days (4.3 +/- 0.4 compared with 6.2 +/- 0.7, P less than 0.05; difference, 1.9; CI, 0.4 to 3.4); and cost of hospitalization ($3790 +/- $410 compared with $5730 +/- $650, P less than 0.05; difference, $1940; CI, $400 to $3480). The mean transfusion requirement in the treatment group was 1.6 +/- 0.3 as compared with 3.0 +/- 0.6 units in the control group (P = 0.13; difference, 1.4; CI, 0 to 2.8). The overall mortality was extremely low: Only 1 (1%) of 75 patients died. Bleeding was induced in 7 (18%) of the 38 patients treated with electrocoagulation, and 1 patient required urgent surgery.
Endoscopic treatment with multipolar electrocoagulation is beneficial in patients who present with major upper gastrointestinal hemorrhage and are found to have an ulcer with a nonbleeding visible vessel.
评估内镜多极电凝治疗非出血性可见血管溃疡患者的疗效和安全性。
前瞻性、随机、假对照试验；患者随访至出院。
城市非转诊县医院。
连续纳入75例患者，这些患者有血性鼻胃吸引物样本、黑便或便血；生命体征不稳定，12小时内至少输注两单位血液，或12小时内血细胞比容至少下降0.06；内镜检查有非出血性可见血管溃疡的证据。
诊断性内镜检查时进行假或真正的多极电凝。
与对照组相比，接受多极电凝治疗的组在以下变量上有显著改善；再出血（18% 对比41%，P<0.05；差异23%；95%可信区间，3%至43%）；急诊手术需求（8%对比30%，P<0.05；差异22%；可信区间，5%至39%）；平均住院天数（4.3±0.4对比6.2±0.7，P<0.05；差异1.9；可信区间，0.4至3.4）；住院费用（3790±410美元对比5730±650美元，P<0.05；差异1940美元；可信区间，400美元至3480美元）。治疗组平均输血需求量为1.6±0.3单位，对照组为3.0±0.6单位（P = 0.13；差异1.4；可信区间，0至2.8）。总体死亡率极低：75例患者中仅1例（1%）死亡。接受电凝治疗的38例患者中有7例（18%）诱发出血，1例患者需要紧急手术。
内镜多极电凝治疗对出现严重上消化道出血且发现有非出血性可见血管溃疡的患者有益。
