Division of Neonatology, Department of Pediatrics, University of Toronto, Ontario, Canada.
J Pediatr. 2010 Feb;156(2):197-201.e1. doi: 10.1016/j.jpeds.2009.09.007. Epub 2009 Dec 6.
To evaluate the efficacy of local instillation of tissue plasminogen activator (tPA) for restoring function to occluded central venous catheters (CVCs) in the neonatal population.
This was a retrospective review of patients admitted to the neonatal intensive care unit during September 2000 to April 2006 who received instillation of tPA for occluded CVCs.
Among 18 infants who received tPA for occluded CVCs, gestational age at birth was 32.5 weeks, birth weight was 1550 g, and gestational age at tPA administration was 39 weeks, with 4 neonates < or =32 weeks' gestational age at tPA administration; age at tPA use was 39 days (medians reported). Ten of 18 (55%) of CVC occlusions were successfully opened after using tPA. No bleeding complications of tPA were noted, including increased or new-onset intraventricular hemorrhage, overt bleeding, or changes in INR or partial thromboplastin time attributed to tPA use. Three patients (16.5%) had bacteremia within 7 days of tPA administration, and no catheter ruptures occurred.
Local instillation of tPA was successful in restoring function to occluded CVCs in a significant proportion of neonates, although success rates were lower than that reported in populations of older age. Despite the vulnerability of neonates to the potential complications of tPA, no major complications were detected even among premature infants.
评估局部注射组织型纤溶酶原激活剂（tPA）恢复新生儿人群中闭塞中心静脉导管（CVC）功能的疗效。
这是一项对 2000 年 9 月至 2006 年 4 月期间入住新生儿重症监护病房并接受 tPA 治疗闭塞 CVC 的患者进行的回顾性研究。
在 18 例接受 tPA 治疗闭塞 CVC 的婴儿中，出生时的胎龄为 32.5 周，出生体重为 1550g，tPA 给药时的胎龄为 39 周，有 4 例新生儿在 tPA 给药时胎龄<或=32 周；tPA 使用时的年龄为 39 天（中位数报告）。在使用 tPA 后，18 例（55%）CVC 闭塞中有 10 例成功开通。未观察到 tPA 的出血并发症，包括颅内出血增加或新发、显性出血、或因 tPA 使用导致 INR 或部分凝血活酶时间改变。3 例患者（16.5%）在 tPA 给药后 7 天内发生菌血症，且未发生导管破裂。
尽管成功率低于年龄较大人群的报告，但在很大一部分新生儿中，局部注射 tPA 成功恢复了闭塞 CVC 的功能。尽管新生儿易受到 tPA 潜在并发症的影响，但即使在早产儿中也未发现重大并发症。
