Ethanol lock therapy in pediatric patients: A multicenter prospective study
Ethanol lock therapy in pediatric patients: A multicenter prospective study
复制标题
儿科患者乙醇锁定治疗的多中心前瞻性研究
DOI：
10.1111/ped.14096
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发表时间：
2020-03-01
影响因子：
1.4
通讯作者：
Toki, Akira
中科院分区：
文献类型：
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作者：
Chiba, Masahiro;Yonekura, Takeo;Toki, Akira
乙醇封管疗法（ELT）用于中心静脉导管相关血流感染（CRBSI）中的中心静脉导管（CVC）保存，但其有效性的证据尚未建立。我们进行了一项多中心，前瞻性研究ELT协议，以确定其安全性和有效性对CRBSI。方法受试者是年龄超过1年的潜在发展CRBSI谁有长期留置硅胶CVC的患者。在培养导管插入的血液后，每天进行70%乙醇封管，持续2-4小时，持续7天。结果2014年9月至2018年8月，来自6家医院的49例患者接受ELT单疗程和多疗程治疗，观察治疗4周内CRBSI有无复发，以及治疗4周后CVC能否挽救。1例发生导管堵塞，取出CVC。ELT单疗程治疗有效率为88%（42/48）。在单疗程ELT后失败的其余3次发作中，进行了第二次ELT;然而，所有发作均无效。在93%（40/42）的发作中，在治疗结束后4周内未观察到CRBSI复发。在84%（41/49）的事件中，导管可在治疗结束后保存4周或更长时间。面部潮红被认为是在两个案件的不良事件，然而，这是短暂的，很快就消失了。结论ELT是有效的CRBSI和84%的导管可以挽救，因此，该协议被认为是有用的。试验注册号：UMIN 000013677。
Background Ethanol lock therapy (ELT) has been performed for the purpose of preserving central venous catheters (CVC) in central venous catheter-related blood stream infection (CRBSI), but evidence for its effectiveness is not established. We conducted a multicenter, prospective study on the ELT protocol to ascertain its safety and effectiveness against CRBSI.Methods The subjects were patients aged over 1 year with potential for developing CRBSI who had long-term indwelling silicone CVCs. After culturing the catheterized blood, a 70% ethanol lock was performed daily for 2-4 h for 7 days. The effectiveness rate of ELT for single and multiple courses, the presence or absence of relapse of CRBSI within 4 weeks of treatment, and whether the CVC could be salvaged after 4 weeks were examined.Results From September 2014 to August 2018, 49 cases from six hospitals were enrolled in the study. Catheter blockage was seen in one case and the CVC was removed. A single course of ELT was effective in episodes 88% (42/48). In the remaining three episodes that failed after a single course of ELT, a second ELT was performed; however, all were ineffective. In episodes 93% (40/42), no CRBSI relapse was seen up to 4 weeks after the end of treatment. In episodes 84% (41/49), the catheter could be preserved for 4 weeks or more after the end of treatment. Facial flushing was seen in two cases as an adverse event; however, this was transient and soon disappeared.Conclusion ELT is effective for 88% of CRBSI and 84% of catheters can be salvaged; therefore, this protocol is considered useful. Trial registration: UMIN000013677.