Falk A, Samson W, Uribarri J, Vassalotti J A
Department of Radiology, Division of Nephrology, The Mount Sinai-NYU Medical Center, New York, NY, USA.
Clin Nephrol. 2004 Jan;61(1):47-53. doi: 10.5414/cnp61047.
This is a retrospective study of reteplase efficacy for restoration of flow in occluded and poorly functioning hemodialysis catheters.
From May 1, 2001 to December 31, 2001, all hemodialysis patients seen at our university dialysis center with occluded or poorly functioning (< 200 ml/min blood flow) catheters treated with reteplase were included in the study. All catheters had been in place for more than 48 hours. Reteplase 0.4 U was instilled into each port; dwell time was 30 minutes. If aspiration had not been possible, reteplase had remained in the catheter for an additional 30 minutes. If flow was established (> 200 ml/min), the catheter was used for dialysis. If flow was not adequately established after 1 hour, the patient was referred for catheter exchange.
Reteplase (0.4 U) was used in 50 instances to restore or improve blood flow rates in a total of 23 catheters in 19 patients. Reteplase was effective in establishing adequate blood flow rates during the current and next dialysis session in 44/50 (88%) cases; 6 cases required 1-hour dwell time. Six cases (in 5 patients) required catheter exchange; in these, an anatomic or pathologic complication was responsible for catheter malfunction. No adverse events were related to reteplase instillation during the study.
Data suggest that reteplase is safe and effective in restoring flow to malfunctioning hemodialysis catheters. Results are comparable to those achieved with alteplase.
本研究旨在回顾性分析瑞替普酶恢复闭塞及功能不良的血液透析导管血流量的疗效。
选取2001年5月1日至2001年12月31日期间，在我校透析中心接受瑞替普酶治疗的所有导管闭塞或功能不良（血流量<200 ml/min）的血液透析患者。所有导管留置时间均超过48小时。向每个端口注入0.4 U瑞替普酶；保留时间为30分钟。若无法抽吸，则让瑞替普酶在导管内再保留30分钟。若血流量恢复（>200 ml/min），则该导管用于透析。若1小时后血流量仍未充分恢复，则患者转至导管置换。
共对19例患者的23根导管使用了50次瑞替普酶（0.4 U）以恢复或改善血流量。在44/50（88%）的病例中，瑞替普酶在本次及下次透析过程中有效建立了足够的血流量；6例需要保留1小时。6例（5名患者）需要进行导管置换；在这些病例中，解剖学或病理学并发症导致导管功能障碍。研究期间，未发生与瑞替普酶注入相关的不良事件。
数据表明，瑞替普酶恢复功能不良的血液透析导管血流量安全有效。结果与阿替普酶相当。
