Kellam B, Fraze D, Kanarek K S
Department of Pediatrics, University of South Florida/Tampa General Hospital 33606.
J Perinatol. 1987 Summer;7(3):242-4.
Central venous catheters (CVC) in pediatric patients provide a reliable method for administration of total parenteral nutrition and chemotherapy. Catheter thrombotic occlusion is a major complication and, until recently, the only therapeutic option was removal and surgical replacement of the catheter. Two fibrinolytic agents, streptokinase and urokinase, have been used successfully in adults to dissolve the clots. Few side effects have been reported when these agents were administered for this purpose. The Physician's Desk Reference advises against the use of such agents in the pediatric population. However, several reports of successful use of these agents in pediatric patients have been reported. They have also been infused systemically to relieve both arterial and venous thrombi. We prospectively evaluated the safety and efficacy of thrombolytic drugs in infants and children with CVCs who were receiving parenteral nutrition and/or hemodialysis. Abbokinase was used on 14 occasions to unclot silastic catheters in 10 pediatric patients. All catheters restored to patency were cleared within 50 minutes with an average clearance time of 19.3 minutes. Only one catheter could not be salvaged. Protime levels were obtained whenever possible before and after administration of the abbokinase. No significant elevations were noted after abbokinase administration. No allergic reactions or other complications occurred. Abbokinase was found to clear clotted central lines in a shorter time frame than has previously been reported in this patient population.
中心静脉导管（CVC）在儿科患者中为全胃肠外营养和化疗的给药提供了一种可靠的方法。导管血栓形成闭塞是一种主要并发症，直到最近，唯一的治疗选择是拔除并手术更换导管。两种纤溶药物，链激酶和尿激酶，已在成人中成功用于溶解血栓。当这些药物用于此目的时，报告的副作用很少。《医生案头参考》建议不要在儿科人群中使用此类药物。然而，已有数篇关于在儿科患者中成功使用这些药物的报道。它们也已全身输注以缓解动脉和静脉血栓。我们前瞻性评估了溶栓药物在接受肠外营养和/或血液透析的CVC患儿中的安全性和有效性。在10例儿科患者中，有14次使用阿伯激酶来溶解硅胶导管内的血栓。所有恢复通畅的导管在50分钟内清除，平均清除时间为19.3分钟。只有一根导管未能挽救。尽可能在使用阿伯激酶前后测定凝血酶原时间水平。使用阿伯激酶后未发现明显升高。未发生过敏反应或其他并发症。发现阿伯激酶清除堵塞中心静脉导管的时间比此前在该患者群体中报道的时间更短。
