Horne M K, Mayo D J
Clinical Pathology Department, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA.
J Clin Oncol. 1997 Jul;15(7):2709-14. doi: 10.1200/JCO.1997.15.7.2709.
This study was undertaken to determine the role of low-dose urokinase infusions in treating fibrinous occlusions of venous access devices (VADs) in cancer patients.
Forty-two patients with VAD occlusions refractory to routine urokinase instillations were documented by x-ray (cathetergram) to have fibrin sleeves at the catheter tips. They were randomized to receive infusions of either urokinase (40,000 U/h) or urokinase with heparin (320 U/h) through their catheters. After 1, 3, 6, and 12 hours of treatment, the function of the VADs was reassessed. Whenever the obstruction had been relieved, the infusion was stopped and a repeat cathetergram was performed. The status of the unoccluded catheters was followed to determine the longevity of the restored function.
Twenty-one catheters were treated with urokinase alone and 21 with the combination of urokinase and heparin. In each group, 16 VADs opened within 12 hours of treatment and five did not. By actuarial analysis, the probability was only 0.28 that a reopened catheter would reocclude within 6 months.
Low-dose urokinase infusions can restore function to the majority of catheters occluded by fibrin sleeves. Adding heparin to the urokinase does not enhance the efficacy of the infusions. The restored function often persists until the VADs are removed.
本研究旨在确定低剂量尿激酶输注在治疗癌症患者静脉通路装置（VAD）纤维蛋白性阻塞中的作用。
42例VAD阻塞患者经X线（导管造影）记录显示导管尖端有纤维蛋白套，且对常规尿激酶灌注治疗无效。他们被随机分为两组，分别通过导管接受尿激酶（40,000 U/h）或尿激酶联合肝素（320 U/h）输注。治疗1、3、6和12小时后，重新评估VAD的功能。一旦阻塞解除，停止输注并进行重复导管造影。对未阻塞导管的状态进行随访，以确定恢复功能的持续时间。
21根导管单独接受尿激酶治疗，21根导管接受尿激酶与肝素联合治疗。每组中，16根VAD在治疗12小时内开通，5根未开通。通过精算分析，重新开通的导管在6个月内再次阻塞的概率仅为0.28。
低剂量尿激酶输注可使大多数被纤维蛋白套阻塞的导管恢复功能。在尿激酶中添加肝素并不能提高输注的疗效。恢复的功能通常会持续到VAD被移除。
