比较血凝酶与肾上腺素对纤维支气管镜检查中气道出血的止血效果。

选取2011年1月至2014年12月因气道疾病在北京老年医院行纤维支气管镜活检导致气道出血的60岁以上老年患者160例，其中给予血凝酶止血治疗80例（血凝酶组），给予肾上腺素止血治疗80例（肾上腺素组），出血后立即给予相应药物局部注入止血治疗：0.9%氯化钠溶液稀释的血凝酶2～4 U；1:10 000肾上腺素0.5～2.0 mg。观察记录两组患者活检部位止血10、20、30 s以及30 s后的出血情况，以及术后12、24 h的痰中带血情况；并观察记录两组患者不良反应发生情况，主要包括心率≥100次/min、收缩压≥150 mmHg、舒张压≥95 mmHg、SPO₂下降≥10%、心慌、呼吸困难、头痛、面色苍白等。计数资料的组间比较采用χ²检验。

血凝酶组患者10 s止血及30s后仍出血例数少于肾上腺素组，20、30 s止血例数略多于肾上腺素组，但差异均无统计学意义（χ² =2.770、1.440、1.290、0.360，均P>0.05）；血凝酶组患者12、24 h痰中带血例数均显著少于肾上腺素组，差异均有统计学意义（χ² =5.370、5.770，均P<0.01）。血凝酶组患者止血后心率、收缩压、舒张压、SPO₂、心慌、头痛、面色苍白的不良反应发生率均明显低于肾上腺素组，差异均有统计学意义（χ² =13.580、17.320、13.090、12.690、10.420、4.100、5.620，P<0.05或0.01）。

血凝酶和肾上腺素止血效果基本相同，但血凝酶止血治疗的不良反应明显少于肾上腺素。老年人年龄大、合并症多、凝血效果差，建议首选血凝酶止血治疗。

To observe the hemostatic effects of hemocoagulase and epinephrine on airway bleeding caused by fibrobronchoscopy.

160 patients in whom fibrobronchoscopy for airway diseases produced bleeding were enrolled and Adopt random figure table, randomized into A and B groups between Jan, 2011 and Dec, 2014, A group treated with hemocoagulase (n=80) and B group with epinephrine (n=80). The aforesaid drugs were immediately injected locally once bleeding due to fibrobronchoscopy. A group were given 2-4 units of hemocoagulase diluted in saline, and B group were given 0.5-2 mg of epinephrine at 1:10 000 dilution. Hemostatic effects were observed at 10, 20, and 30 seconds in biopsy locations, blood in sputum 12, and 24 h post operation, and complications including HR≥100 bpm, SBP≥150 mmHg, DBP≥95 mmHg, SPO₂decreased≥10%, palpitation, dyspnea, headache, and paleness were recorded.χ²test was applied to compare between groups.

At 10 seconds hemostatic effects of epinephrine were better than hemocoagulase, at 20 and 30 seconds hemostatic effects of the two drugs had no significant difference (χ²=2.770, 1.440, 1.290, 0.360, P> 0.05). Incidence of bloody sputum at 12 and 24h were significantly lower in A group (χ²=5.370, 5.770,P< 0.01). Presentations of elevated heart rate, increased blood pressure, declined blood oxygen saturation, palpitation, chest distress were significantly less in A group (χ²=13.580, 17.320, 13.090, 12.690, 10.420, 4.100, 5.620,P< 0.05 or 0.01).

Hemostatic effects of hemocoagulase and epinephrine are similar. Hemocoagulase treatment has less complications compared with epinephrine. Hemocoagulase should be the first choice of hemostatic therapy for older adults.