Clinical studies have demonstrated the efficacy of submucosal epinephrine injection in the control of bleeding ulcers. Since endoscopic techniques for assessing gastroduodenal blood flow are limited, we employed an animal model to study the mechanism of control of bleeding. The effect of submucosal epinephrine injection on local gastric blood flow was studied in the rat using laser Doppler flowmetry and reflectance spectrophotometry. Submucosal injection of 0.1 ml of 1/10,000 epinephrine caused a significantly greater drop in local gastric blood flow (laser Doppler flowmetry) compared with vehicle (10% sodium metabisulfite) injection. The reduction persisted for up to 120 min. This vasoconstrictive effect of epinephrine was confirmed by observations with reflectance spectrophotometry, which documented a pattern of ischemia without congestion (lower index of hemoglobin concentration, lower index of oxygen saturation). The autoregulatory escape from adrenergic vasoconstriction was not evident in either instance. We conclude that, after submucosal injection of epinephrine, the absence of autoregulatory escape from adrenergic vasoconstriction and the marked and prolonged decrease in local gastric blood flow enhance the homeostatic mechanisms (eg, platelets and other coagulative factors) to effect hemostasis in bleeding ulcers.

译文

:临床研究证明粘膜下肾上腺素注射液在控制出血性溃疡中的功效。由于评估胃十二指肠血流的内窥镜技术是有限的,我们采用了动物模型来研究控制出血的机制。使用激光多普勒血流仪和反射分光光度法研究了大鼠粘膜下肾上腺素注射对局部胃血流的影响。与媒介物(10%的焦亚硫酸钠)注射相比,粘膜下注射0.1 ml的1 / 10,000肾上腺素导致局部胃血流量(激光多普勒血流仪)的下降明显更大。减少持续长达120分钟。肾上腺素的这种血管收缩作用已通过反射分光光度法的观察得到了证实,该光谱法记录了缺血而无充血的模式(血红蛋白浓度指数降低,氧饱和度指数降低)。在这两种情况下,肾上腺素能血管收缩的自动调节性逃逸均不明显。我们得出的结论是,在粘膜下注射肾上腺素后,没有肾上腺素能血管收缩引起的自动调节逃逸以及局部胃血流量的明显和长期下降增强了稳态机制(例如血小板和其他凝血因子),从而影响了出血性溃疡的止血。

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