福島医学雑誌 59 巻 2 号　2009

〔原著〕

胃粘膜生検後の止血剤投与の必要性と
食事開始時期に関する検討

中條　麻理¹⁾²⁾³⁾，引地　拓人¹⁾⁵⁾，水野　順子¹⁾²⁾³⁾，山田ゆき江¹⁾³⁾⁴⁾，菅野美佐子¹⁾²⁾
板橋　正子¹⁾²⁾，齋藤　ゆり¹⁾²⁾，末永　洋子²⁾³⁾，鈴木　史子²⁾³⁾，渡辺美恵子²⁾³⁾
富樫　恭子²⁾，鈴木　　玲⁵⁾，池田　恒彦⁵⁾，佐藤　匡記⁵⁾，佐藤　　愛⁵⁾
今村　秀道⁵⁾，若槻　　尊⁵⁾，澁川　悟朗⁵⁾，入澤　篤志⁵⁾，小原　勝敏¹⁾

¹⁾福島県立医科大学附属病院内視鏡診療部，²⁾看護部，³⁾消化器内視鏡技師
⁴⁾検査部，⁵⁾福島県立医科大学医学部内科学第二講座

（受付2008年12月8日　受理2009年2月12日）

Necessity of Hemostatic Agent and Validity of the Duration in Meal Restart after Forceps Biopsy of Gastric Mucosa during Esophagogastroduodenoscopy

MARI NAKAJYO¹⁾²⁾³⁾, TAKUTO HIKICHI¹⁾⁵⁾, YORIKO MIZUNO¹⁾²⁾³⁾, YUKIE YAMADA¹⁾³⁾⁴⁾,
MISAKO KANNO¹⁾²⁾, MASAKO ITABASHI¹⁾²⁾, YURI SAITO¹⁾²⁾, YOKO SUENAGA²⁾³⁾, FUMIKO SUZUKI²⁾³⁾, MIEKO WATANABE²⁾³⁾, KYOKO TOGASHI²⁾, REI SUZUKI⁵⁾, TSUNEHIKO IKEDA⁵⁾, MASAKI SATO⁵⁾, AI SATO⁵⁾, HIDEMICHI IMAMURA⁵⁾, TAKURU WAKATSUKI⁵⁾, GORO SHIBUKAWA⁵⁾, ATSUSHI IRISAWA⁵⁾ and KATSUTOSHI OBARA¹⁾

¹⁾Department of Endoscopy, and ²⁾Division of Nursing, and ³⁾Gastroenterological Endoscopy Technician, ⁴⁾Division of Clinical Laboratory, Fukushima Medical University Hospital, and ⁵⁾Department of Internal Medicine II, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan

要旨: 上部消化管内視鏡下に胃粘膜生検を施行した外来患者59例を対象に，生検後の出血予防に対するヘモコアグラーゼの必要性と食事開始時間の妥当性を明らかにし，今後の方針を立案することを目的に前向き研究を施行した。ヘモコアグラーゼを使用する医師（ヘモ群）と使用しない医師（非ヘモ群）を固定し，ヘモ群では，検査終了直後にヘモコアグラーゼを筋肉注射（筋注）した。患者には検査終了1時間以降で可能な時間で食事を開始させた。ヘモ群26例（44.1%)，非ヘモ群33例（55.9%）であり，両群の患者背景に差はなく，生検後出血をきたした患者はいなかった。55例（93.2%）で食事開始時間を確認でき，平均125.9分（55-275）であった。2時間以内の29例（52.7%）でも生検後出血をきたした患者はいなかった。以上から，胃粘膜生検後，止血を確認して内視鏡を抜去すれば，ヘモコアグラーゼを投与する必要はなく，食事開始は検査終了1時間以降で良いと考えられた。

索引用語: 内視鏡，胃生検，出血，止血剤，食事開始

Abstract: This study prospectively assessed the necessity of hemocoagulase for preventing post-biopsy bleeding on 59 outpatients who underwent endoscopic gastric biopsy. Further, appropriate fasting after gastric biopsy was also assessed. Fifty-nine patients were divided into two groups (by the doctor in charge), ‘hemo group' and ‘non-hemo group'. Twenty-six patients (44.1%) were in ‘hemo group' where intramuscular injection of hemocoagulase was prescribed just after biopsy, while 33 patients (55.9%) were in ‘non-hemo group' where no hemocoagulase was prescribed. There was no significant difference in the patients' characteristics between the two groups. All the patients were allowed to start taking food anytime from one hour after the biopsy, and we could confirm with 55 patients when they actually started. The average fasting duration after biopsy was 125.9 min. (range 55-125 min.) in 55 patients, where 29 started taking food within 2 hours after biopsy. No post-biopsy bleeding was observed. In conclusion, administration of hemocoagulase is not necessary to prevent post-biopsy bleeding on condition that hemostasis is confirmed before withdrawing the endoscope. Further, it is considered appropriate that patients are allowed to start taking food anytime from one hour after biopsy.

Key words: endoscopy, gastric biopsy, bleeding, hemostatic agent, start taking food