正腎上腺素劑量對診斷腸胃道出血的影響

Effect of Norepinephrine Dosage on Gastrointestinal Bleeding Diagnosis

這個研究主要探討腸胃道出血病患接受血管攝影檢查時降低正腎上腺素滴注量以降低腸胃道出血的假陰性率。

統計2018年1月至2022年12月總共34個腸胃道出血病患(19位男性，15位女性，平均64.8歲)於某醫學中心接受血管攝影檢查。這些病患平均血壓為77/58mmHg，心跳為121bpm。所有患者皆有接受輸血及正腎上腺素治療，將血壓控制在平均123/87 mmHg。

緊急安排血管攝影檢查，其中有24位患者發現明顯腸胃道出血並施行動脈栓塞止血。10位患者於初次血管攝影檢查時並無發現出血。我們於術中降低正腎上腺素滴注量使患者血壓控制在平均91/61 mmHg並再次施行血管攝影，3位患者發現出血點並施行動脈栓塞止血。

綜合以上發現若病患因腸胃道出血接受正腎上腺素滴注治療時，若施行血管攝影檢查無發現出血點，降低正腎上腺素滴注量後再次施行血管攝影可降低血管攝影的假陰性率。

 

This study examined whether reducing the infusion dosage of norepinephrine during angiography of patients with gastrointestinal (GI) bleeding reduces the rate of false negative results. The study cohort comprised 34 patients (male: 19, female: 15, mean age of 64.8 years) with GI bleeding who underwent angiography at a medical center in Taiwan between January 2018 and December 2022. The mean initial blood pressure was 77/58 mmHg, and the average heart rate was 121 beats per minute. All patients received blood transfusion and norepinephrine infusion (mean dose: 3.8 mcg/min) maintain a mean blood pressure of 123/87 mmHg.

Angiography was arranged on an emergency basis. Among these patients, 24 exhibited clear evidence of GI bleeding and subsequently underwent embolization. In the remaining 10 patients, no bleeding was identified during the initial angi-ography. The norepinephrine infusion dosage of the patients during angiography was reduced about 1.0-1.5 mcg/min until their mean blood pressure was maintained at 91/61 mmHg. Repeat angiography revealed bleeding sites in three patients, who subsequently underwent successful embolization. These findings suggest that in pa-tients receiving norepinephrine infusion for GI bleeding, repeat angiography after a controlled reduction in norepinephrine dosage may reduce the rate of false negative results.