摘要
AIM： To define the optimal injection volume of epinephrine with high efficacy for hemostasis and low complication rate in patients with actively bleeding ulcers. METHODS： This prospective, randomized, comparative trial was conducted in a medical center. A total of 228 patients with actively bleeding ulcers （spurting or oozing） were randomly assigned to three groups with 20, 30 and 40 mL endoscopic injections of an 1：10000 solution of epinephrine. The hemostatic effects and clinical outcomes were compared between the three groups. RESULTS： There were no significant differences in all background variables between the three groups. Initial hemostasis was achieved in 97.4%, 98.7% and 100% of patients respectively in the 20, 30 and 40 mL epinephrine groups. There were no significant differences in the rate of initial hemostasis between the three groups. The rate of peptic ulcer perforation was significantly higher in the 40 mL epinephrine group than in the 20 and 30 mL epinephrine groups （P 〈 0.05）. The rate of recurrent bleeding was significantly higher in the 20 mL epinephrine group （20.3%） than in the 30 （5.3%） and 40 mL （2.8 %） epinephrine groups （P 〈 0.01）. There were no significant differences in the rates of surgical intervention, the amount of transfusion requirements, the days of hospitalization, the deaths from bleeding and 30 d mortality between the three groups. The number of patients who developed epigastric pain due to endoscopic injection, was significantly higher in the 40 mL epinephrine group （51/76） than in the 20 （2/76） and 30 mL （5/76） epinephrine groups （P 〈 0.001）. Significant elevation of systolic blood pressure after endoscopic injection was observed in the 40 mL epinephrine group （P 〈 0.01）. Significant decreasing and normalization of pulse rates after endoscopic injections were observed in the 20 mL and 30 mL epinephrine groups （P 〈 0.01）.CONCLUSION： Injection of 30 mL diluted epinephrine （1：10000） can effectively prevent recurrent bleeding with a low rate of complications. The optimal injection volume of epinephrine for endoscopic treatment of an actively bleeding ulcer （spurting or oozing） is 30 mL.
瞄准：与活跃地为溃疡放血在病人为血壅滞和低复杂并发症率与高功效定义肾上腺素的最佳的注射体积。方法：这未来的、使随机化的、比较试用在一个医学中心被进行。有活跃地为溃疡放血的 228 个病人的一个总数(喷射或流着) 随机与 20， 30 和 40 mL 被分到三个组肾上腺素的一个 1:10000 答案的内视镜的注射。止血效果和临床的结果在三个组之间被比较。结果：在在三个组之间的所有背景变量没有有效差量。起始的血壅滞在 97.4% 被完成， 98.7% 并且百分之百，病人，分别地，在 20， 30 和 40 mL，肾上腺素组织。处于在三个组之间的起始的血壅滞的率没有有效差量。消化性溃疡穿孔的率比在 20 和 30 个 mL 肾上腺素组在 40 mL 肾上腺素组是显著地更高的(P < 0.05 ) 。周期性的流血的率比在在 20 mL 肾上腺素组(20.3%) 是显著地更高的 30 (5.3%) 并且 40 个 mL (2.8%) 肾上腺素组(P < 0.01 ) 。处于外科的干预，输送要求的数量，住院的日子，从流血的死亡和在三个组之间的 30 d 死亡的率没有有效差量。由于内视镜的注射形成了腹上部的疼痛的病人的数字，比在在 40 mL 肾上腺素组(51/76 ) 是显著地更高的 20 (2/76 ) 并且 30 个 mL (5/76 ) 肾上腺素组(P < 0.001 ) 。在内视镜的注射以后的收缩血压的重要举起在 40 mL 肾上腺素组被观察(P < 0.01 ) 。在内视镜的注射以后的重要减少和脉搏率的正规化在 20 mL 和 30 个 mL 肾上腺素组被观察(P < 0.01 ) 。结论：30 mL 的注射冲淡了肾上腺素(1:10000 ) 能有效地阻止与复杂并发症的低率的周期性的流血。为活跃地流血的溃疡的内视镜的治疗的肾上腺素的最佳的注射体积(喷射或流着) 是 30 mL。
