血凝酶与肾上腺素在内镜下黏膜切除、息肉电切术中预防出血作用的随机对照研究

Hemocoagulase vs. Epinephrine in Endoscopic Mucosal Resection:Prospective Randomized Controlled Study

目的比较血凝酶与1∶10000肾上腺素用于消化内镜下黏膜切除术(endoscopic mucosal resection,EMR)、扁平息肉摘除术的预防出血作用和安全性。方法选择2007年4～11月在我院内镜中心因食管、胃、结肠局部病变行内镜下EMR者60例,随机分为血凝酶组和肾上腺素组,每组30例。于病变基底部注射血凝酶或肾上腺素液体垫至病变抬起,行EMR或分次内镜下黏膜切除术(endoscopic piecemeal mucosal resection,EPMR)。切除后观察切缘残端有无出血。操作中监测患者血压、心率,记录不良反应(心悸、头晕、疼痛、恶心等)。结果即刻出血血凝酶组1例(1/30,3%),肾上腺素组6例(6/30,20%),2组差异无显著性(χ2=2.588,P=0.108),24小时2组均无出血病例。血凝酶组和肾上腺素组液体垫注射剂量分别为(11.0±6.0)ml(5～30ml)和(11.9±7.0)ml(5～28ml),差异无显著性(t=-0.535,P=0.595)。肾上腺素组注射液体垫后平均动脉压和心率均较注射前明显升高[平均动脉压:注射前(96.9±7.9)mmHg,注射后(99.9±8.1)mmHg,t=-3.005,P=0.005;心率:注射前(79.8±7.9)次/min,注射后(84.3±8.1)次/min,t=-3.585,P=0.001],血凝酶组无显著性变化。注射后肾上腺素组5例出现一过性头晕伴心悸,2例食管病变患者出现注射部位明显疼痛,血凝酶组患者无明显不适。结论血凝酶作为内镜下黏膜切除术、扁平息肉摘除的液体垫成分,预防出血效果与肾上腺素相同而无明显不良反应。

Objective To compare the anti-hemorrhage effect and safety of hemocoagulase and epinephrine （1：10 000） during endoscopic mueosal resection （EMR） or polyps eleetroeautery. Methods Between April and November 2007, totally 60 patients received EMR or endoscopic piecemeal mucosal resection （EPMR） in our hospital because of local lesions in the esophagus, stomach or colon. The patients were randomly divided into hemocoagulase and epinephrine groups （30 cases in each） before receiving the operation. After the resection, the hemorrhage at the surgical area was measured. During the operation, the blood pressure, heart rate, and adverse effects including palpitation, dizziness, pain, and nausea were recorded. Results Immediate hemorrhage was detected in 1 case of hemocoagulase group （1/30, 3% ） , and 6 cases of epinephrine group （6/30,20% , X^2 = 2. 588, P = 0. 108 ）. No hemorrhage was observed at 24 hours in both the groups. No significantly difference was noticed in the injection volume between the two groups [（11.0±6.0） ml （5-30 ml） in hemocoagulase group vs. （11.9 ±7.0） ml （5 -28 ml）; t = -0.535, P=0.595]. In epinephrine group, the mean artery blood pressure and heart rate increased significantly after the injection [ （96.9 ± 7.9） mm Hg vs. （99.9±8.1） mm Hg, t= -3.005, P=0.005; 79.8±7.9/min vs. 84.3 ±8.1/min, t= -3.585, P=0.001]. Whereas, no such differences were noticed in hemoeoagulase group. Five cases in epinephrine group showed transient dizziness and palpitation, and 2 patients who had esophageal lesions complained of pain at the injection site. None of the hemocoagulase group had postoperative complications. Conclusions Hemocoagulase shows same anti-hemorrhage effect as epinephrine during EMR without leading to adverse effect.