Chung S C, Leung J W, Leong H T, Lo K K, Li A K
Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin.
Gastrointest Endosc. 1993 Sep-Oct;39(5):611-5. doi: 10.1016/s0016-5107(93)70208-4.
We compared the efficacy of epinephrine injection and epinephrine injection followed by sodium tetradecyl sulfate in controlling active ulcer bleeding. Out of 2814 patients who underwent endoscopy for gastrointestinal bleeding, 200 patients with actively bleeding ulcers seen at the time of endoscopy were randomized to receive epinephrine injection alone (99 patients) or epinephrine injection followed by 3% sodium tetradecyl sulfate (101 patients). After the procedure the patients were transferred to the surgical gastroenterology ward and were treated by surgeons who were unaware of the mode of treatment. The patients underwent routine endoscopy 24 hours later, and epinephrine injection was repeated if active bleeding was seen again. Emergency surgery was performed for the following: (1) arterial spurting not controlled endoscopically, (2) failure of the blood pressure or pulse to stabilize after 4 units of blood, (3) total transfusion of more than 8 units of blood, or (4) rebleeding as defined by hematemesis with pulse greater than 100 beats/min or blood pressure less than 100 mm Hg after stabilization. The two groups were comparable in age, sex, site of ulcer, and severity of bleeding. Initial hemostasis was obtained at the time of endoscopy in 94% of the epinephrine group and 97% of the epinephrine plus sodium tetradecyl sulfate group. No difference in outcome was seen in the two groups as measured by emergency surgery requirement, blood transfusion, hospital stay, and hospital mortality. Endoscopic epinephrine injection is effective in controlling active ulcer bleeding. The additional injection of sodium tetradecyl sulfate confers no additional advantage.
我们比较了肾上腺素注射以及肾上腺素注射后再注射十四烷基硫酸钠在控制活动性溃疡出血方面的疗效。在2814例接受胃肠道出血内镜检查的患者中，200例在内镜检查时发现有活动性出血溃疡的患者被随机分为两组，一组仅接受肾上腺素注射（99例），另一组接受肾上腺素注射后再注射3%的十四烷基硫酸钠（101例）。操作完成后，患者被转至外科胃肠病病房，由不知道治疗方式的外科医生进行治疗。患者在24小时后接受常规内镜检查，如果再次出现活动性出血，则重复注射肾上腺素。在出现以下情况时进行急诊手术：（1）内镜下无法控制的动脉喷血；（2）输注4单位血液后血压或脉搏仍未稳定；（3）总输血量超过8单位；（4）稳定后出现呕血且脉搏大于100次/分钟或血压低于100 mmHg定义的再出血。两组在年龄、性别、溃疡部位和出血严重程度方面具有可比性。肾上腺素组94%的患者和肾上腺素加十四烷基硫酸钠组97%的患者在内镜检查时实现了初步止血。在急诊手术需求、输血量、住院时间和医院死亡率方面，两组的结果没有差异。内镜下注射肾上腺素在控制活动性溃疡出血方面是有效的。额外注射十四烷基硫酸钠并无额外优势。
