Kumwenda Mick John, Mitra Sandip, Khawaja Aurangzaib, Inston Nicholas, Nightingale Peter
Renal & Diabetes Centre, Glan Clwyd Hospital, Denbighshire, UK.
Department of Renal Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
J Vasc Access. 2019 Nov;20(6):752-759. doi: 10.1177/1129729819869095. Epub 2019 Aug 30.
Tunnelled central venous catheters dysfunction can be defined as failure to provide blood flow above 200 mL/min during dialysis often caused by thrombosis. Although urokinase is used routinely for thrombolysis, there is wide variation in dose regimens. A multidisciplinary group was formed to address this issue and offer guidance.
Dialysis centres that used urokinase in the United Kingdom took part in a prospective study to determine the safety and outcomes of thrombolysis using agreed protocols. Data were collected anonymously from September 2017 until February 2018. Catheter blood flow was measured before and after the following interventions: catheter dwell or push locks with 12,500-50,000 IU or catheter infusion with 100,000-250,000 IU of urokinase. Interventions were repeated if the blood flow remained below 200 mL/min.
10 centres took part and recruited 200 patients; 45.5% were female and 54.5% were male with mean age of 63.6 (±15.2) years. The cumulative success rate for thrombolysis was 90.5% after first intervention, 97% after second intervention, and 99% after more than 2 interventions. Although there was trend towards benefit with dose increments, the success rate between push/dwell locks and high-dose infusion of urokinase was not significantly different (p = 0.069). Seventeen (8.5%) tunnelled central venous catheters were removed due to failure of treatment. No urokinase-related adverse events were reported.
In this study, urokinase was safe and efficacious; there was no difference between dwell and push locks. There was some benefit with high-dose infusion of urokinase compared to the dwell and push lock.
隧道式中心静脉导管功能障碍可定义为在透析期间无法提供高于200毫升/分钟的血流量，这通常由血栓形成引起。尽管尿激酶常用于溶栓治疗，但剂量方案存在很大差异。为此成立了一个多学科小组来解决这一问题并提供指导。
英国使用尿激酶的透析中心参与了一项前瞻性研究，以确定使用商定方案进行溶栓治疗的安全性和效果。从2017年9月至2018年2月匿名收集数据。在以下干预措施前后测量导管血流量：用12,500 - 50,000国际单位进行导管留置或推注封管，或用100,000 - 250,000国际单位进行导管输注尿激酶。如果血流量仍低于200毫升/分钟，则重复干预措施。
10个中心参与研究，招募了200名患者；45.5%为女性，54.5%为男性，平均年龄为63.6（±15.2）岁。首次干预后溶栓的累积成功率为90.5%，第二次干预后为97%，超过2次干预后为99%。尽管随着剂量增加有获益趋势，但推注/留置封管与高剂量输注尿激酶之间的成功率无显著差异（p = 0.069）。17根（8.5%）隧道式中心静脉导管因治疗失败而被拔除。未报告与尿激酶相关的不良事件。
在本研究中，尿激酶安全有效；留置封管和推注封管之间无差异。与留置封管和推注封管相比，高剂量输注尿激酶有一定益处。
