Computational Neurosciences Outcome Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Neurocrit Care. 2020 Feb;32(1):262-271. doi: 10.1007/s12028-019-00786-5.
Intraventricular hemorrhage (IVH) is an independent poor prognostic factor in subarachnoid and intra-parenchymal hemorrhage. The use of intraventricular fibrinolytics (IVF) has long been debated, and its exact effects on outcomes are unknown. A systematic review and meta-analysis were performed in accordance with the PRISMA guidelines to assess the impact of IVF after non-traumatic IVH on mortality, functional outcome, intracranial bleeding, ventriculitis, time until clearance of third and fourth ventricles, obstruction of external ventricular drains (EVD), and shunt dependency. Nineteen studies were included in the meta-analysis, totaling 1020 patients. IVF was associated with lower mortality (relative risk [RR] 0.58; 95% confidence interval [CI] 0.47-0.72), fewer EVD obstructions (RR 0.41; 95% CI 0.22-0.74), and a shorter time until clearance of the ventricles (median difference [MD] - 4.05 days; 95% CI - 5.52 to - 2.57). There was no difference in good functional outcome, RR 1.41 (95% CI 0.98-2.03), or shunt dependency, RR 0.93 (95% CI 0.70-1.22). Correction for publication bias predicted an increased risk of intracranial bleeding, RR 1.67 (95% CI 1.01-2.74) and a lower risk of ventriculitis, RR 0.68 (95% CI 0.45-1.03) in IVH patients treated with IVF. IVF was associated with improved survival, faster clearance of blood from the ventricles and fewer drain obstructions, but further research is warranted to elucidate the effects on ventriculitis, long-term functional outcomes, and re-hemorrhage.
脑室内出血（IVH）是蛛网膜下腔和脑实质出血的独立不良预后因素。脑室溶栓（IVF）的应用一直存在争议，其对结局的确切影响尚不清楚。本研究按照 PRISMA 指南进行了系统评价和荟萃分析，以评估非创伤性 IVH 后 IVF 对死亡率、功能结局、颅内出血、脑室炎、第三和第四脑室清除时间、外部脑室引流管（EVD）阻塞以及分流依赖性的影响。共有 19 项研究纳入荟萃分析，共纳入 1020 例患者。IVF 与死亡率降低相关（相对风险 [RR] 0.58；95%置信区间 [CI] 0.47-0.72）、EVD 阻塞减少（RR 0.41；95% CI 0.22-0.74）和脑室清除时间缩短（中位数差值 [MD] -4.05 天；95% CI -5.52 至 -2.57）。良好的功能结局（RR 1.41；95% CI 0.98-2.03）或分流依赖性（RR 0.93；95% CI 0.70-1.22）无差异。发表偏倚校正预测 IVF 治疗的 IVH 患者颅内出血风险增加（RR 1.67；95% CI 1.01-2.74）和脑室炎风险降低（RR 0.68；95% CI 0.45-1.03）。IVF 与生存率提高、更快清除脑室血液和减少引流管阻塞相关，但需要进一步研究阐明对脑室炎、长期功能结局和再出血的影响。
