Jones G R, Konsler G K, Dunaway R P, Lacey S R, Azizkhan R G
Division of Pediatric Hematology/Oncology, University of North Carolina, School of Medicine, Chapel Hill 27599.
J Pediatr Surg. 1993 Mar;28(3):350-5; discussion 355-7. doi: 10.1016/0022-3468(93)90230-i.
Use of right atrial catheters (RACs) in children with cancer improves the comfort and efficacy of therapy. However, catheter-related infections are responsible for significant morbidity leading to the removal of approximately 20% of implanted RACs. Sepsis has been linked to thrombus and fibrin sheath formation within the RAC. Gram-negative and fungal infections appear to be particularly resistant to antibiotic therapy alone and most of these infections have required catheter removal. Urokinase has been effectively used for reopening thrombus occluded RACs. Theoretically, thrombolytic agents could improve the treatment of catheter-related infections by removing luminal sites of bacterial/fungal colonization. We prospectively monitored the use of urokinase and antibiotics for catheter-related sepsis in our pediatric hematology/oncology population from 1985 to 1991. Sepsis episodes were treated with 2 doses of urokinase and antibiotics (10 to 42 days) infused through the RAC. One to 2 mL of urokinase (5,000 U/mL) was instilled in the RAC for 1 hour, then removed and repeated 24 hours later. During the study, 224 RACs were placed in 177 children. RACs were in place for a total of 71,134 days (median, 274 days). There were 67 blood culture-positive sepsis episodes occurring in 50 RACs. Fifty-nine sepsis episodes were treated with urokinase and antibiotics and all responded by clearance of organisms from the blood. Three patients (5.1% of urokinase treated) had recurrent sepsis with the same organism within 2 months, were considered treatment failures and had RACs removed. Only 1 of 16 episodes of multiple organism/Candida sepsis led to RAC removal due to inability to cure the infection.(ABSTRACT TRUNCATED AT 250 WORDS)
在患有癌症的儿童中使用右心房导管（RAC）可提高治疗的舒适度和疗效。然而，导管相关感染会导致显著的发病率，致使约20%的植入RAC被拔除。脓毒症与RAC内血栓和纤维蛋白鞘的形成有关。革兰氏阴性菌和真菌感染似乎对单纯抗生素治疗特别耐药，并且这些感染中的大多数都需要拔除导管。尿激酶已被有效地用于重新开通血栓阻塞的RAC。从理论上讲，溶栓剂可通过清除细菌/真菌定植的管腔部位来改善导管相关感染的治疗。我们前瞻性地监测了1985年至1991年期间在我们儿科血液学/肿瘤学患者群体中尿激酶和抗生素用于导管相关脓毒症的情况。脓毒症发作采用通过RAC输注2剂尿激酶和抗生素（10至42天）进行治疗。将1至2毫升尿激酶（5000 U/毫升）注入RAC持续1小时，然后拔除，24小时后重复。在研究期间，177名儿童共置入了224根RAC。RAC共留置71134天（中位数为274天）。50根RAC出现了67次血培养阳性的脓毒症发作。59次脓毒症发作采用尿激酶和抗生素治疗，所有发作均通过血液中病原体清除而得到缓解。3名患者（接受尿激酶治疗患者的5.1%）在2个月内出现同一病原体的复发性脓毒症，被视为治疗失败并拔除了RAC。在16次多种病原体/念珠菌脓毒症发作中，只有1次因无法治愈感染而导致RAC被拔除。（摘要截短于250字）
