摘要
目的:评价内镜黏膜下剥离术(ESD)术中黏膜下注射肾上腺素生理盐水的安全性和有效性,并探讨其最佳浓度。方法128例上消化道疾病患者按入组先后顺序采用数字表法随机均分成4组,A 组使用生理盐水作为黏膜下注射液,B 组、C 组和 D 组则分别使用浓度为0.001%、0.002%和0.004%的肾上腺素生理盐水。记录各组 ESD 手术完成情况、患者血压及心率变化情况、并发症发生情况、黏膜下注射液用量、手术时间,并行组间或组内对比分析。结果各组均能顺利完成手术,组内术前与术中比较最高血压及最快心率差异均无统计学意义(P >0.05),无一例出现穿孔及术中急性大量出血。术中急性少量出血发生率,A 组(28.1%,9/32)明显高于 B 组(9.4%,3/32)、C 组(6.3%,2/32)和D 组(6.3%,2/32),差异均有统计学意义(P <0.05),而 B 组、C 组、D 组间差异均无统计学意义(P >0.05)。各组间术后迟发性出血发生率比较差异均无统计学意义(P >0.05)。黏膜下注射液用量,A 组为(39.5±10.8)ml,明显高于 B 组的(29.4±9.4)ml、C 组的(27.3±8.2)ml 和 D 组的(20.4±11.8)ml,差异均有统计学意义(P <0.05),而 B 组、C 组、D 组间差异均无统计学意义(P >0.05),但 D 组较 B 组有减少趋势。手术时间,A 组为(82.3±24.78)min,明显长于 B 组的(60.7±25.35)min、C 组的(54.7± 31.72)min 和 D 组的(59.2±28.49)min,差异均有统计学意义(P <0.05),而 B 组、C 组、D 组间差异均无统计学意义(P >0.05)。结论ESD 术中黏膜下注射肾上腺素生理盐水安全有效,可减少注射液用量,缩短手术时间,减少术中出血的发生,但增加肾上腺素浓度未能发现明显优势。
Objective To evalute and compare the efficacy and safety of epinephrine-saline submu-cosal injection of different concentrations on endoscopic submucosal dissection (ESD),and to discuss the best concentration of submucosal injection.Methods A total of 128 patients who underwent ESD were ran-domly assigned to submucosal normal saline injection group (group A,n =32),0.001% epinephrine-saline injection group (group B,n =32),0.002% epinephrine-saline injection group (group C,n =32),and 0.004% epinephrine-saline injection group (group D,n =32).The incidence of bleeding during and after ESD were counted,the blood preasure and heart rate of preoperative and intraoperative,the amount of sub-mucosal injection,the time of operation were observed.Results ESD was successfully performed on all pa-tients.There were no difference in highest blood preasure and fastest heart rate between preoperative and in-traoperative results of each group.No perforation or intraoperative acute massive bleeding occurred.Intraop-erative acute minimal bleeding during ESD occurred in 9 patients in group A and 3 in group B,2 in group C and 2 in group D (P〈0.05),but there were no differences among group B,C and D.The amount of submu-cosal injection of group A was(39.5 ±10.8)ml,which was more than that of group B(29.4 ±9.4)ml,group C(27.3 ±8.2)ml and group D(20.4 ±11.8)ml with significant difference.There were no differences a-mong group B,C and D,but there was less in group D than group B.The operation time of group A was(82.3 ±24.78 minutes),which was longer than that of group B (60.7 ±25.35minutes),group C (54.7 ± 31.72minutes)and group D(59.2 ±28.49 minutes),but there was no difference among B,C and D group. Conclusion Epinephrine-saline submucosal injection assiting ESD is safe and effective and reduces the op-eration time and bleeding than normal saline.The increase of the epinephrine-saline concentrations has not been found to be more beneficial.
出处
《中华消化内镜杂志》
北大核心
2015年第2期107-110,共4页
Chinese Journal of Digestive Endoscopy
关键词
内镜黏膜下剥离术
注射
肾上腺素
出血
Endoscopic submucosal dissection
Injections
Epinephrine
Bleeding