Aquino Victor M, Sandler Eric S, Mustafa Mahmoud M, Steele Jill W, Buchanan George R
Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9063, USA.
J Pediatr Hematol Oncol. 2002 Dec;24(9):710-3. doi: 10.1097/00043426-200212000-00005.
This study was undertaken to determine if central venous catheter (CVC)-related infection in children with cancer could be prevented by monthly flushing of the catheter with urokinase.
Between August 1994 and July 1998, 103 patients with cancer were randomized at the time of subcutaneous CVC placement to receive monthly flushing of their catheters with either 5000 IU of urokinase-heparin or heparin alone. Patients subsequently had blood cultures taken from their CVCs during an episode of fever.
Seventy-four of the 103 patients (72%) enrolled in the study received at least 6 catheter flushes: 40 with urokinase-heparin and 34 with heparin. The median number of flushes was 9.5 in the urokinase-heparin group and 10.2 in the heparin-only group (P = 0.62). There were 5 positive blood cultures in the urokinase-heparin group and seven in patients receiving heparin alone (P = 0.27). Staphylococcus epidermidis was isolated from the blood of 3 patients receiving urokinase-heparin and 6 in those receiving heparin alone (P = 0.17).
Prophylactic monthly catheter flushes with 5000 IU urokinase did not significantly decrease the number of documented bacteremic events in children with cancer who have CVCs.
本研究旨在确定癌症患儿中心静脉导管（CVC）相关感染能否通过每月用尿激酶冲洗导管来预防。
1994年8月至1998年7月期间，103例癌症患者在皮下置入CVC时被随机分组，分别接受每月用5000国际单位尿激酶 - 肝素或仅用肝素冲洗导管。随后在发热期间从患者的CVC采集血培养样本。
103例纳入研究的患者中有74例（72%）接受了至少6次导管冲洗：40例接受尿激酶 - 肝素冲洗，34例接受肝素冲洗。尿激酶 - 肝素组冲洗次数中位数为9.5次，仅肝素组为10.2次（P = 0.62）。尿激酶 - 肝素组有5次血培养阳性，仅接受肝素冲洗的患者中有7次血培养阳性（P = 0.27）。从接受尿激酶 - 肝素冲洗的3例患者血液中分离出表皮葡萄球菌，接受肝素冲洗的患者中有6例分离出表皮葡萄球菌（P = 0.17）。
对于有CVC的癌症患儿，每月用5000国际单位尿激酶进行预防性导管冲洗并不能显著减少记录在案的菌血症事件数量。
