Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity, mortality and prolonged hospitalization in pediatric patients with home parenteral nutrition (HPN). In recent years, new proph...Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity, mortality and prolonged hospitalization in pediatric patients with home parenteral nutrition (HPN). In recent years, new prophylactic and treatment options have been evaluated to reduce the incidence of CRIs and infection related catheter removals. In children, two retrospective studies have shown the efficacy of ethanol lock treatment (ELT) in reducing the incidence of CRIs in pediatric oncology patients. However, prospective data are missing. Our aim of the present study was to evaluate prospectively the effect of ELT on the cure and recurrence rate of CRIs, duration of hospitalization and antibiotic use in HPN pediatric patients. Methods: HPN children older than three months with a clinical suspicion of a CRI were included and randomised to ELT or standard flushing treatment (heparin or taurolidine). The primary outcomes were persistence and recurrence of the bacteraemia and Central Venous Access Device (CVAD) removal. Secondary outcomes included duration of antibiotic use, duration of hospitalization and side effects. Results: Data from eight HPN children experiencing 14 suspected CRI were analysed. Seven patients had proven CRIs by positive blood cultures. Four were treated with ELT and three with their standard flushing treatment. One CRI persisted in the control group. In one single patient, bacteraemia recurred three times within 24 weeks. This patient had been enrolled in both study arms. A CVAD removal was needed in one patient because of occlusion. Conclusions: This small study showed no additional efficacy of the use of ELT on cure rate or recurrences of CRIs compared to standard therapy in HPN treated children. There were also no differences in duration of hospitalization, the use of antibiotics or CVAD removal between both groups.展开更多
目的评价枸橼酸盐溶液在成人血液透析导管封管中的效果。方法计算机检索NGC、Cochrane Library、Joanna Briggs Institute Library(JBI)、MEDLINE、EMbase、RNAO、PubMed、CBM、Web of Knowledge、CNKI及万方数据资源系统中关于经中心...目的评价枸橼酸盐溶液在成人血液透析导管封管中的效果。方法计算机检索NGC、Cochrane Library、Joanna Briggs Institute Library(JBI)、MEDLINE、EMbase、RNAO、PubMed、CBM、Web of Knowledge、CNKI及万方数据资源系统中关于经中心静脉导管血液透析患者应用枸橼酸盐和肝素钠封管的随机对照实验,同时筛检纳入文献的参考文献。2名研究者对文献进行质量评价并提取有效数据,采用RevMan5.0软件进行Meta分析。结果纳入11项研究(RCT),共1 016例患者。Meta分析结果显示,枸橼酸盐封管组导管相关性感染的发生率(P=0.03)、出血并发症的发生率(P<0.01)显著低于肝素钠封管组;但两者在溶栓治疗次数(P=0.96)、导管功能障碍所致拔管的发生率(P=0.95)、导管内血栓形成的发生率(P=0.94)及导管相关的住院率(P=0.34)方面比较,差异无统计学意义(均P>0.05)。结论采用枸橼酸盐溶液封管,可显著降低经静脉导管血液透析患者导管相关性感染的发生率、出血相关并发症的发生率。因此,推荐枸橼酸盐作为血液透析患者中心静脉导管的封管液。展开更多
比较枸橼酸钠和肝素钠用于成人血液透析导管封管的效果。将68例使用中心静脉置管的血液透析患者随机分为实验组和对照组,每组各34例,透析结束后,分别以枸橼酸钠和肝素钠对实验组和对照组的患者进行封管,持续8周后,比较两组患者的PT、APT...比较枸橼酸钠和肝素钠用于成人血液透析导管封管的效果。将68例使用中心静脉置管的血液透析患者随机分为实验组和对照组,每组各34例,透析结束后,分别以枸橼酸钠和肝素钠对实验组和对照组的患者进行封管,持续8周后,比较两组患者的PT、APTT、感染发生率、出血发生率、导管堵塞发生率以及导管功能良好率是否有差异。实验组和对照组封管后1 h和4 h PT,APTT时间与封管前相比都有升高,但对照组指标有显著的统计学差异（p〈0.05）,实验组则没有;对照组有8例患者出现出血状况,实验组有一例,同时对照组有7例患者在透析期间出现感染,实验组有2例,两组在封管后出血发生率和感染发生率均有显著性的统计学差异（p〈0.05）;而在导管堵塞发生率以及导管功能良好率方面没有显著的统计学差异（p〉0.05）。对于中心静脉置管的血液透析患者,枸橼酸钠较之肝素钠临床效果更好,并发症更少。展开更多
[目的]系统评价采用乙醇封管与肝素封管预防长期静脉留置导管病人发生导管相关性感染的效果。[方法]检索PubMed、EMbase、Cochrane Library、Web of Science、中国生物医学文献数据库、中国期刊全文数据库及数字化全文数据库等资源,纳...[目的]系统评价采用乙醇封管与肝素封管预防长期静脉留置导管病人发生导管相关性感染的效果。[方法]检索PubMed、EMbase、Cochrane Library、Web of Science、中国生物医学文献数据库、中国期刊全文数据库及数字化全文数据库等资源,纳入对比乙醇与肝素封管预防导管相关性感染的随机对照试验(RCT)。采用Cochrane系统评价手册5.1.0版提供的偏倚风险评估工具对纳入研究进行质量评价,采用Stata12.0软件进行统计分析。[结果]共纳入5项RCT,共266例病人。Meta分析结果显示:与肝素封管相比,乙醇封管能有效预防导管相关性血流感染的发生[OR=0.25,95%CI(0.12,0.52),P=0.000 3)],且不增加血栓形成及不良反应的风险(P>0.05)。两组病人隧道感染、出口感染等指标差异无统计学意义(P>0.05)。[结论]乙醇封管相比肝素封管能有效降低长期静脉留置导管病人发生导管相关性血流感染的风险,是一种有效、安全的封管方式,且不增加血栓形成及不良反应的风险。展开更多
文摘Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity, mortality and prolonged hospitalization in pediatric patients with home parenteral nutrition (HPN). In recent years, new prophylactic and treatment options have been evaluated to reduce the incidence of CRIs and infection related catheter removals. In children, two retrospective studies have shown the efficacy of ethanol lock treatment (ELT) in reducing the incidence of CRIs in pediatric oncology patients. However, prospective data are missing. Our aim of the present study was to evaluate prospectively the effect of ELT on the cure and recurrence rate of CRIs, duration of hospitalization and antibiotic use in HPN pediatric patients. Methods: HPN children older than three months with a clinical suspicion of a CRI were included and randomised to ELT or standard flushing treatment (heparin or taurolidine). The primary outcomes were persistence and recurrence of the bacteraemia and Central Venous Access Device (CVAD) removal. Secondary outcomes included duration of antibiotic use, duration of hospitalization and side effects. Results: Data from eight HPN children experiencing 14 suspected CRI were analysed. Seven patients had proven CRIs by positive blood cultures. Four were treated with ELT and three with their standard flushing treatment. One CRI persisted in the control group. In one single patient, bacteraemia recurred three times within 24 weeks. This patient had been enrolled in both study arms. A CVAD removal was needed in one patient because of occlusion. Conclusions: This small study showed no additional efficacy of the use of ELT on cure rate or recurrences of CRIs compared to standard therapy in HPN treated children. There were also no differences in duration of hospitalization, the use of antibiotics or CVAD removal between both groups.
文摘目的评价枸橼酸盐溶液在成人血液透析导管封管中的效果。方法计算机检索NGC、Cochrane Library、Joanna Briggs Institute Library(JBI)、MEDLINE、EMbase、RNAO、PubMed、CBM、Web of Knowledge、CNKI及万方数据资源系统中关于经中心静脉导管血液透析患者应用枸橼酸盐和肝素钠封管的随机对照实验,同时筛检纳入文献的参考文献。2名研究者对文献进行质量评价并提取有效数据,采用RevMan5.0软件进行Meta分析。结果纳入11项研究(RCT),共1 016例患者。Meta分析结果显示,枸橼酸盐封管组导管相关性感染的发生率(P=0.03)、出血并发症的发生率(P<0.01)显著低于肝素钠封管组;但两者在溶栓治疗次数(P=0.96)、导管功能障碍所致拔管的发生率(P=0.95)、导管内血栓形成的发生率(P=0.94)及导管相关的住院率(P=0.34)方面比较,差异无统计学意义(均P>0.05)。结论采用枸橼酸盐溶液封管,可显著降低经静脉导管血液透析患者导管相关性感染的发生率、出血相关并发症的发生率。因此,推荐枸橼酸盐作为血液透析患者中心静脉导管的封管液。
文摘比较枸橼酸钠和肝素钠用于成人血液透析导管封管的效果。将68例使用中心静脉置管的血液透析患者随机分为实验组和对照组,每组各34例,透析结束后,分别以枸橼酸钠和肝素钠对实验组和对照组的患者进行封管,持续8周后,比较两组患者的PT、APTT、感染发生率、出血发生率、导管堵塞发生率以及导管功能良好率是否有差异。实验组和对照组封管后1 h和4 h PT,APTT时间与封管前相比都有升高,但对照组指标有显著的统计学差异（p〈0.05）,实验组则没有;对照组有8例患者出现出血状况,实验组有一例,同时对照组有7例患者在透析期间出现感染,实验组有2例,两组在封管后出血发生率和感染发生率均有显著性的统计学差异（p〈0.05）;而在导管堵塞发生率以及导管功能良好率方面没有显著的统计学差异（p〉0.05）。对于中心静脉置管的血液透析患者,枸橼酸钠较之肝素钠临床效果更好,并发症更少。
文摘[目的]系统评价采用乙醇封管与肝素封管预防长期静脉留置导管病人发生导管相关性感染的效果。[方法]检索PubMed、EMbase、Cochrane Library、Web of Science、中国生物医学文献数据库、中国期刊全文数据库及数字化全文数据库等资源,纳入对比乙醇与肝素封管预防导管相关性感染的随机对照试验(RCT)。采用Cochrane系统评价手册5.1.0版提供的偏倚风险评估工具对纳入研究进行质量评价,采用Stata12.0软件进行统计分析。[结果]共纳入5项RCT,共266例病人。Meta分析结果显示:与肝素封管相比,乙醇封管能有效预防导管相关性血流感染的发生[OR=0.25,95%CI(0.12,0.52),P=0.000 3)],且不增加血栓形成及不良反应的风险(P>0.05)。两组病人隧道感染、出口感染等指标差异无统计学意义(P>0.05)。[结论]乙醇封管相比肝素封管能有效降低长期静脉留置导管病人发生导管相关性血流感染的风险,是一种有效、安全的封管方式,且不增加血栓形成及不良反应的风险。
