Mokha Jasmeet S, Davidovics Zev H, Samela Kate, Emerick Karan
1 Division of Pediatric Gastroenterology, Hepatology and Nutrition, Connecticut Children's Medical Center, Hartford, Connecticut, USA.
JPEN J Parenter Enteral Nutr. 2017 May;41(4):625-631. doi: 10.1177/0148607115625057. Epub 2016 Jan 29.
Although use of 70% ethanol lock therapy (ELT) has been shown to decrease the rate of catheter-related bloodstream infections (CRBSIs) in patients with intestinal failure and central venous catheters (CVCs), concerns have been raised about its association with higher rates of mechanical problems and CVC replacements (CVC-Rs). We sought to compare the rates of CRBSI, mechanical problems, and CVC-Rs in a cohort of pediatric patients with intestinal failure, with and without ELT (ELT and ELT, respectively).
Data were collected in a retrospective chart review from February 2007 to May 2014. Mann-Whitney and Wilcoxon signed-rank tests were used to compare nonparametric and paired data, respectively.
Twenty-nine children had 9033 catheter days (CDs). The ELT group (vs ELT) had lower rate of infection and significantly fewer CVC-Rs due to infection but significantly more mechanical events and related CVC-Rs with significantly shorter mean CVC survival. In 13 children who had a pre-ELT and post-ELT period, ELT was associated with a decrease in the rate of CVC-Rs due to infection (0.36 vs 4.74/1000 CDs, P = .046) and an increase in the rate of CVC-Rs due to mechanical problems (5.05 vs 0/1000 CDs, P = .018).
While ELT is associated with a lower rate of CRBSIs and related CVC-Rs, it is also associated with higher rates of mechanical problems and related CVC-Rs. In addition to investigating the ideal concentration, duration, and timing of ELT to preserve the integrity of the CVC, alternatives to exclusively ethanol-based lock solutions should be developed.
尽管70%乙醇封管疗法（ELT）已被证明可降低肠衰竭患者及中心静脉导管（CVC）患者的导管相关血流感染（CRBSI）发生率，但人们对其与更高的机械问题发生率及CVC更换率（CVC-R）之间的关联表示担忧。我们试图比较一组有或没有接受ELT（分别为ELT组和非ELT组）的小儿肠衰竭患者的CRBSI、机械问题及CVC-R发生率。
通过回顾性病历审查收集2007年2月至2014年5月的数据。分别使用曼-惠特尼检验和威尔科克森符号秩检验来比较非参数数据和配对数据。
29名儿童共有9033个导管日（CD）。ELT组（与非ELT组相比）感染率较低，因感染导致的CVC-R显著减少，但机械事件及相关CVC-R显著增多，且平均CVC存活时间显著缩短。在13名有ELT前和ELT后阶段的儿童中，ELT与因感染导致的CVC-R发生率降低相关（0.36对4.74/1000 CD，P = 0.046），与因机械问题导致的CVC-R发生率升高相关（5.05对0/1000 CD，P = 0.018）。
虽然ELT与较低的CRBSI及相关CVC-R发生率相关，但它也与较高的机械问题及相关CVC-R发生率相关。除了研究ELT的理想浓度、持续时间和时机以保持CVC的完整性外，还应开发非单纯乙醇封管溶液的替代方案。
