Gray R J, Levitin A, Buck D, Brown L C, Sparling Y H, Jablonski K A, Fessahaye A, Gupta A K
Department of Radiology, Washington Hospital Center, DC 20010, USA.
J Vasc Interv Radiol. 2000 Oct;11(9):1121-9. doi: 10.1016/s1051-0443(07)61352-9.
To compare central dialysis catheter patency rates after stripping procedures with those after urokinase (UK) infusion.
Fifty-seven tunneled catheters with either (i) flow rates less than 250 mL/min and established baseline flow rates > or = 300 mL/min or (ii) flow rates 50 mL/min less than higher established baseline flows were prospectively randomized to undergo stripping procedures (n = 28) or UK infusion (n = 29) at 30,000 U/h via each port concurrently, for a total 250,000 U. Success and patency were determined by dialysis at normal flow rates (> or = 300 mL/min) or at the previously established higher baseline rate. Flow rates were monitored weekly. Primary patency ended with catheter malfunction or removal. Kaplan-Meier survival analysis was used to construct survival curves.
In the stripping group, initial clinical success was 89% (25 of 28). The 15-, 30-, and 45-day primary patency rates were 75% (n = 20), 52% (n = 13), and 35% (n = 8), respectively. The median duration of additional function was 32 days (95% CI: 18-48 d). In the UK group, initial clinical success was 97% (28 of 29). The 15-, 30-, and 45-day primary patency rates were 86% (n = 21), 63% (n = 13), and 48% (n = 9), respectively. The median duration of additional patency was 42 days (95% CI: 22-153 d). The Wilcoxon test for equality detected no significant difference in the survival curves for the two treatment groups (P = .236).
There is no significant difference in time to primary patency between the two methods. Both allow temporary catheter salvage in most patients.
比较剥脱术与尿激酶（UK）注入术后中心透析导管的通畅率。
57根带隧道的导管，（i）流量小于250 mL/分钟且已确定的基线流量≥300 mL/分钟，或（ii）流量比更高的已确定基线流量少50 mL/分钟，被前瞻性随机分为两组，分别接受剥脱术（n = 28）或通过每个端口以30,000 U/小时的速度同时注入UK（n = 29），总量为250,000 U。通过正常流量（≥300 mL/分钟）或先前确定的更高基线流量进行透析来确定成功和通畅情况。每周监测流量。主要通畅情况以导管故障或拔除告终。采用Kaplan-Meier生存分析构建生存曲线。
在剥脱术组，初始临床成功率为89%（28例中的25例）。15天、30天和45天的主要通畅率分别为75%（n = 20）、52%（n = 13）和35%（n = 8）。额外功能的中位持续时间为32天（95% CI：18 - 48天）。在UK组，初始临床成功率为97%（29例中的28例）。15天、30天和45天的主要通畅率分别为86%（n = 21）、63%（n = 13）和48%（n = 9）。额外通畅的中位持续时间为42天（95% CI：22 - 153天）。Wilcoxon相等性检验未检测到两个治疗组生存曲线的显著差异（P = 0.236）。
两种方法在达到主要通畅的时间上无显著差异。两种方法都能使大多数患者的临时导管得以挽救。
