Monturo C A, Dickerson R N, Mullen J L
Nutrition Support Service, Hospital of the University of Pennsylvania, Philadelphia.
JPEN J Parenter Enteral Nutr. 1990 May-Jun;14(3):312-4. doi: 10.1177/0148607190014003312.
Nineteen ambulatory outpatients requiring a tunneled central venous access device with catheter occlusion were studied. Mean catheter life was 7.9 +/- 8.2 months (range, from 1-36 months) at the time of the occlusion. Urokinase (5000 units/ml) was injected in sufficient amount to fill the internal volume of the catheter and allowed to stay for 5 to 10 min before attempting to aspirate. Repeated aspiration attempts were performed every 5 to 10 min for a maximum of 30 to 60 min or patency. In the event catheter patency was not restored, the thrombolytic solution was aspirated from the catheter and a maximum of two additional trials were instituted. Results included clearance of four out of 15 withdrawal occlusions (27%) and two out of four resistance to infusion occlusions (50%). Overall, successful catheter clearance occurred in six out of 19 occlusions (32%). The efficacy rate of thrombolytic therapy for successfully clearing occluded catheters at our institution using conventional low-dose thrombolytic therapy is markedly lower than previously reported rates of 57 to 100%. The reasons for this discrepancy may reflect differences in dosage of thrombolytic agent, method of administration, frequency of monitoring of catheter patency, and catheter life.
对19名需要带隧道式中心静脉通路装置且导管堵塞的门诊患者进行了研究。在堵塞时，导管的平均使用时长为7.9±8.2个月（范围为1至36个月）。注入足量的尿激酶（5000单位/毫升）以充满导管内部容积，并在尝试抽吸前留置5至10分钟。每隔5至10分钟重复进行抽吸尝试，最长持续30至60分钟或直至通畅。如果导管仍未恢复通畅，则从导管中抽出溶栓溶液，并最多再进行两次尝试。结果包括15例抽吸堵塞中有4例通畅（27%），4例输注阻力堵塞中有2例通畅（50%）。总体而言，19例堵塞中有6例成功使导管通畅（32%）。在我们机构使用传统低剂量溶栓疗法成功清除堵塞导管的溶栓治疗有效率明显低于先前报道的57%至100%的比率。这种差异的原因可能反映在溶栓剂的剂量、给药方法、导管通畅监测频率以及导管使用时长等方面的不同。
