Appelgren P, Ransjö U, Bindslev L, Espersen F, Larm O
Department of Internal Medicine, Karolinska Hospital, Stockholm, Sweden.
Crit Care Med. 1996 Sep;24(9):1482-9. doi: 10.1097/00003246-199609000-00009.
To evaluate in vitro and in vivo the efficacy of covalent end point-attached heparin to single-lumen polyurethane central venous catheters in reducing microbial adherence and colonization.
In vitro study: A controlled bench study. In vivo study: A prospective, randomized, double-blind, clinical trial.
Intensive care unit in a 1200-bed teaching hospital.
In vitro study: Adhesion of 17 radiolabeled clinical isolates of Staphylococci to catheters was examined in vitro. In vivo study: The outcome of heparinized and control catheters was compared in vivo in patients receiving long-term parenteral nutrition. Fifty-five adult patients were prospectively, blindly randomized to heparinized or control central venous catheters. The catheters, removed on clinical grounds, were analyzed with semiquantitative and quantitative cultures. Blood cultures were done at catheter removal.
In vitro study: Coagulase-negative Staphylococci adhered less in vitro to heparinized catheters than to control catheters (p < .05). In vivo study: Among 32 central venous catheters, or patients who completed the study, catheter-associated bacteremia or fungemia was observed in five patients in the control group (n = 19) and in no patient with a heparinized catheter (n = 13) (p = .047). Four of 13 catheters in the heparin group were colonized compared with 14 of 19 in the control group (p = .03). Coagulase-negative Staphylococci were the most frequent microorganisms in both groups. The numbers of organisms found on colonized catheters were larger in the control group than in the heparin group.
Covalent end point surface heparinization appears to have a great impact on both in vitro and in vivo bacterial colonization of central venous catheters. Such heparinization can be a practical and economical approach to the prevention of catheter-associated bacteremia or fungemia.
在体外和体内评估共价末端连接肝素的单腔聚氨酯中心静脉导管在减少微生物黏附和定植方面的效果。
体外研究：一项对照实验台研究。体内研究：一项前瞻性、随机、双盲临床试验。
一所拥有1200张床位的教学医院的重症监护病房。
体外研究：在体外检测17株放射性标记的葡萄球菌临床分离株对导管的黏附情况。体内研究：在接受长期肠外营养的患者体内比较肝素化导管和对照导管的结果。55名成年患者被前瞻性、盲法随机分配至肝素化中心静脉导管组或对照导管组。根据临床情况拔除导管，并用半定量和定量培养法进行分析。拔除导管时进行血培养。
体外研究：凝固酶阴性葡萄球菌在体外对肝素化导管的黏附少于对照导管（p < 0.05）。体内研究：在32根中心静脉导管或完成研究的患者中，对照组（n = 19）有5名患者发生导管相关菌血症或真菌血症，肝素化导管组（n = 13）无患者发生（p = 0.047）。肝素组13根导管中有4根发生定植，而对照组19根中有14根发生定植（p = 0.03）。两组中凝固酶阴性葡萄球菌都是最常见的微生物。对照组定植导管上发现的微生物数量多于肝素组。
共价末端表面肝素化似乎对中心静脉导管的体外和体内细菌定植都有很大影响。这种肝素化可能是预防导管相关菌血症或真菌血症的一种实用且经济的方法。
