肾上腺素注射单药治疗在 Forrest Ib 级高危出血性溃疡患者中与肾上腺素注射联合治疗具有相似的止血疗效。
Epinephrine injection monotherapy shows similar hemostatic efficacy to epinephrine injection combined therapy in high-risk patients (Forrest Ib) with bleeding ulcers.
机构信息
Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China.
Queen Mary School, Nanchang University, Nanchang, 330001, Jiangxi, China.
出版信息
Surg Endosc. 2023 Sep;37(9):6954-6963. doi: 10.1007/s00464-023-10152-4. Epub 2023 Jun 19.
BACKGROUND
Whether combination therapy has higher hemostatic efficacy than epinephrine injection monotherapy in different Forrest classifications is not clear. This study aimed to compare hemostatic efficacy between epinephrine injection monotherapy (MT) and combination therapy (CT) based on different Forrest classifications.
METHODS
We retrospectively analyzed peptic ulcer bleeding (PUB) patients who underwent endoscopic epinephrine injections or epinephrine injections combined with a second therapy between March 2014 and June 2022 in our center, and the patients were divided into MT group or CT group. Subsequently, a propensity score matching analysis (PSM) was performed and rebleeding rates were calculated according to Forrest classifications via a stratified analysis.
RESULTS
Overall, 605 patients who met the inclusion criteria were included, and after PSM, 173 patients in each of the CT and MT groups were included. For PUB patients with nonbleeding visible vessels (FIIa), the rebleeding rates by Days 3, 7, 14, and 30 after PSM were 8.8%, 17.5%, 19.3%, and 19.3% in the MT group, respectively, and rates were 0%, 4.1%, 5.5%, and 5.5% in the CT group, respectively, with significant differences observed between the two groups by Days 3, 7, 14, and 30 (P = 0.015, P = 0.011, P = 0.014, and P = 0.014, respectively). However, for PUB patients with oozing bleeding (FIb), the rebleeding rates by Days 3, 7, 14, and 30 after PSM were 14.9%, 16.2%, 17.6%, and 17.6% in the MT group, respectively, and rates were 13.2%, 14.7%, 14.7%, and 16.2% in the CT group, respectively, with no significant differences observed between the two groups by Days 3, 7, 14, and 30 (P = 0.78, P = 0.804, P = 0.644 and P = 0.825).
CONCLUSION
Combined therapy has higher hemostatic efficacy than epinephrine injection monotherapy for PUB patients with visible blood vessel (FIIa) ulcers. However, epinephrine injection monotherapy is equally as effective as combined therapy for PUB patients with oozing blood (FIb) ulcers.
背景
不同 Forrest 分级下，肾上腺素注射单药治疗与联合治疗相比是否具有更高的止血疗效尚不清楚。本研究旨在根据 Forrest 分级比较肾上腺素注射单药治疗（MT）与联合治疗（CT）的止血疗效。
方法
我们回顾性分析了 2014 年 3 月至 2022 年 6 月在我院接受内镜肾上腺素注射或肾上腺素注射联合二线治疗的消化性溃疡出血（PUB）患者，将患者分为 MT 组或 CT 组。随后进行倾向评分匹配分析（PSM），并根据 Forrest 分级进行分层分析，计算再出血率。
结果
总体而言，纳入了符合纳入标准的 605 例患者，PSM 后，CT 组和 MT 组各纳入 173 例患者。对于非可见血管性出血（FIIa）的 PUB 患者，PSM 后第 3、7、14 和 30 天的再出血率分别为 MT 组 8.8%、17.5%、19.3%和 19.3%，CT 组为 0%、4.1%、5.5%和 5.5%，两组在第 3、7、14 和 30 天的差异有统计学意义（P=0.015、P=0.011、P=0.014 和 P=0.014）。然而，对于渗血（FIb）的 PUB 患者，PSM 后第 3、7、14 和 30 天的再出血率分别为 MT 组 14.9%、16.2%、17.6%和 17.6%，CT 组为 13.2%、14.7%、14.7%和 16.2%，两组在第 3、7、14 和 30 天的差异无统计学意义（P=0.78、P=0.804、P=0.644 和 P=0.825）。
结论
对于可见血管（FIIa）溃疡的 PUB 患者，联合治疗比肾上腺素注射单药治疗具有更高的止血疗效。然而，对于渗血（FIb）溃疡的 PUB 患者，肾上腺素注射单药治疗与联合治疗的疗效相当。
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