Kubba A K, Lessells A, Palmer K R
Gastro-intestinal Unit, Western General Hospital, Edinburgh, UK.
Br J Surg. 1997 Apr;84(4):551-4.
Endoscopic injection therapy is a well established method of controlling peptic ulcer haemorrhage but the optimum injection solution and the mechanism involved in inducing haemostasis are unknown.
The efficacy and effects on tissue of various therapeutic agents used in the control of gastric mucosal haemorrhage were studied in ten rabbits. Thirty-eight bleeding mucosal ulcers (blood loss above 1.5 ml/min) created at gastrotomy were studied. Adrenaline (1:100,000), thrombin, fibrin (thrombin plus fibrinogen), 5 per cent ethanolamine and 50 per cent dextrose were injected; a fibrin suspension was also sprayed around bleeding ulcers.
Sclerosants were found to be least effective in the control of bleeding and were associated with significant tissue necrosis. Although all the other solutions significantly decreased blood loss within 30 min of injection (median blood loss 0.25 ml/min), only an injected mixture of adrenaline plus thrombin and sprayed fibrin achieved complete haemostasis within 2 min of treatment and with no recurrence of bleeding. Neither agent caused significant tissue damage. Histological examination showed that no solution caused arterial thrombosis when injected next to a major ear artery.
Sclerosants caused extensive tissue necrosis and were least effective in the control of ulcer haemorrhage. A combination of dilute adrenaline and human thrombin may represent optimal haemostatic therapy for peptic ulcer haemorrhage.
内镜注射治疗是控制消化性溃疡出血的一种成熟方法，但最佳注射溶液及止血机制尚不清楚。
在10只兔子身上研究了用于控制胃黏膜出血的各种治疗药物的疗效及其对组织的影响。研究了通过胃切开术制造的38个出血性黏膜溃疡（失血超过1.5毫升/分钟）。注射了肾上腺素（1:100,000）、凝血酶、纤维蛋白（凝血酶加纤维蛋白原）、5%乙醇胺和50%葡萄糖；还在出血性溃疡周围喷洒了纤维蛋白悬液。
发现硬化剂在控制出血方面效果最差，且与明显的组织坏死有关。虽然所有其他溶液在注射后30分钟内均显著减少了失血量（中位失血量为0.25毫升/分钟），但只有注射的肾上腺素加凝血酶混合物以及喷洒的纤维蛋白在治疗后2分钟内实现了完全止血且无出血复发。两种药物均未引起明显的组织损伤。组织学检查显示，当在主要耳动脉旁注射时，没有一种溶液会导致动脉血栓形成。
硬化剂导致广泛的组织坏死，在控制溃疡出血方面效果最差。稀释的肾上腺素和人凝血酶联合使用可能是消化性溃疡出血的最佳止血疗法。
