Sherman L M, Shenoy S S, Cerra F B
Ann Surg. 1979 Mar;189(3):298-302. doi: 10.1097/00000658-197903000-00007.
A retrospective analysis of results obtained over a three year period in 66 patients receiving selective intra-arterial vasopressin (SIAV) for control of 69 episodes of massive gastrointestinal bleeding was presented. SIAV was used when there was a failure of conventional medical therapy and the patient's pathology and/or complicating medical conditions necessitated an attempt at controlling an emergent condition by nonoperative means. Hemmorrhage was completely controlled in 43% of variceal bleeds, 67% of hemorrhage gastritis, 45% of bleeding ulcers, and in 62% of colonic sources. The incidence of rebleeding following initial control was 16%. The surgical mortality for patients who were initial failures of SIAV was 50%. Patients undergoing elective surgery after complete control by SIAV had an 8% mortality. There were five catheter related complications. Minor complications occurred in 41% of patients, but required no treatment. Major complications occurred in 40% of cirrhotic and 21% of noncirrhotic bleeding episodes; and were a contributing factor in five cirrhotic deaths and three noncirrhotic deaths. In critically ill patients in the setting of an Intensive Care Unit, selective intra-arterial vasopressin appears: 1) to be an effective means of controlling certain types of gastrointestinal hemorrhage; 2) to provide an opportunity for an increase in survival rate.
对66例患者进行了回顾性分析，这些患者在三年期间接受选择性动脉内血管加压素（SIAV）治疗以控制69次严重胃肠道出血发作。当传统药物治疗失败且患者的病理状况和/或并发疾病需要尝试通过非手术手段控制紧急情况时，使用SIAV。静脉曲张出血的43%、出血性胃炎的67%、出血性溃疡的45%以及结肠出血源的62%的出血得到了完全控制。初始控制后再出血的发生率为16%。SIAV初始治疗失败的患者手术死亡率为50%。在SIAV完全控制后接受择期手术的患者死亡率为8%。有5例与导管相关的并发症。41%的患者出现轻微并发症，但无需治疗。40%的肝硬化出血发作和21%的非肝硬化出血发作出现严重并发症；严重并发症是导致5例肝硬化患者死亡和3例非肝硬化患者死亡的一个因素。在重症监护病房的重症患者中，选择性动脉内血管加压素似乎：1）是控制某些类型胃肠道出血的有效手段；2）提供了提高生存率的机会。
