Koval G, Benner K G, Rösch J, Kozak B E
Dig Dis Sci. 1987 Mar;32(3):248-53. doi: 10.1007/BF01297049.
To assess the value of recently developed aggressive pharmacologic angiographic techniques for the diagnosis of acute lower gastrointestinal hemorrhage, we reviewed our experience with 63 consecutive patients referred for angiography. Hemorrhage was severe as indicated by a mean blood transfusion requirement of 9.4 units. Extravasation of contrast (46%), or an obvious vascular abnormality suggestive of a bleeding site (32%), was identified in 78% of patients. Extravasation was seen more frequently in patients with greater than or equal to 3 units of transfusion (66%) than in those with less than 3 units of transfusion (17%, P less than 0.001). After the introduction of pharmacologic techniques using heparin, tolazoline, streptokinase, and indwelling arterial catheters, the percentage of studies with extravasation of contrast increased from 32 to 65% (P less than 0.01). Application of aggressive angiographic techniques increases the diagnostic yield of angiography in acute severe lower gastrointestinal hemorrhage while exposing the patient to modest increased procedure-related risks which can be accepted in selected patients.
为评估近期开发的积极药物血管造影技术在诊断急性下消化道出血中的价值，我们回顾了连续63例因血管造影而转诊患者的经验。出血严重，平均输血需求量为9.4单位。78%的患者发现有造影剂外渗（46%）或提示出血部位的明显血管异常（32%）。输血≥3单位的患者造影剂外渗更常见（66%），而输血<3单位的患者则较少见（17%，P<0.001）。在引入使用肝素、妥拉唑啉、链激酶和留置动脉导管的药物技术后，造影剂外渗研究的百分比从32%增加到65%（P<0.01）。应用积极的血管造影技术可提高急性严重下消化道出血血管造影的诊断率，同时使患者面临适度增加的与操作相关的风险，在特定患者中这些风险是可以接受的。
