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目的 :本研究旨在证明过氧化氢在急诊内镜时是否可以作为一种溶剂以改变血凝块的性质 ,使内镜下出血部位视野较清晰。方法 :急性上消化道出血患者 2 0例 ,急诊内镜对可疑出血部位先用 2 0 0ml生理盐水喷洒 ,再用 2 5～ 1 75ml 3%过氧化氢喷洒。分别在生理盐水和过氧化氢冲洗前后照相 ,然后将这些照片送给 3名消化病专家运用视野清晰度评分系统进行评分。为了评价 3 %过氧化氢的安全性 ,分别在喷洒前和喷洒后胃窦和十二指肠球部钳取组织并送病理。结果 :单独用生理盐水冲洗与用过氧化氢冲洗的视野清晰度评分 (2 .41∶0 .37)差异有显著性 (P <0 .0 5)。过氧化氢冲洗后的胃窦和十二指肠球部组织学检查均未发现有临床意义的变化。结论 :急诊内镜治疗急性上消化道出血时 ,过氧化氢可以清晰视野 ,明确出血部位 ,是一种安全、有效的方法 ,仅有轻微的不良反应。
Objectives: This study was designed to demonstrate whether hydrogen peroxide can be used as a solvent to change the nature of blood clots during emergency endoscopy so that the field of endoscopic bleeding is clearly defined. Methods: Twenty patients with acute upper gastrointestinal bleeding were treated with emergency endoscopy. The suspicious bleeding site was sprayed with 200 ml normal saline and then sprayed with 25-175 ml 3% hydrogen peroxide. Photographs were taken before and after flushing with saline and hydrogen peroxide, respectively, and the pictures were sent to three digestive specialists for scoring using a visual field sharpness scoring system. In order to evaluate the safety of 3% hydrogen peroxide, the tissues were dissected and sent to the antrum and duodenal bulb before and after spraying, respectively. Results: There was a significant difference (P <0.05) in visual field clarity (2.41: 0.37) between saline flushing alone and hydrogen peroxide flushing. There was no clinically significant change in histological examination of gastric antrum and duodenal bulb after hydrogen peroxide flushing. Conclusion: Emergency endoscopic treatment of acute upper gastrointestinal bleeding, hydrogen peroxide can be a clear field of vision, clear bleeding site, is a safe and effective method, with only minor adverse reactions.