Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Neurochirurgie. 2022 Dec;68(6):e53-e59. doi: 10.1016/j.neuchi.2022.07.002. Epub 2022 Aug 5.
Intraventricular hemorrhage (IVH) is a severe form of stroke. Studies of existing treatment options are controversial. Therefore, we aimed to evaluate the safety and efficacy of extra ventricular drainage (EVD) combined with uPA administration for the treatment of IVH.
The clinical data of 157 IVH patients admitted to our department during 2019-2022 were retrospectively analyzed. Based on the Glasgow Outcome Score (GOS) after 30 days, patients were categorized into favorable outcome (GOS4-5) and poor outcome (GOS1-3), and factors with prognostic impact were screened by univariate and multifactorial analysis, followed by propensity score matching and screening of paired patients for comparative analysis between the uPA and non-uPA groups.
Patient age, uPA use, initial GCS score, and intracranial hematoma volume can all influence the patient's GOS. After propensity score-matched screening, 72 patients were finally included, 36 each in the uPA and non-uPA groups. Analysis revealed that at the follow-up after 30 days, 50.0% of patients with a GOS score of 4-5 were in the uPA group compared with 30.6% in the non-uPA group; however, they were not statistically significantly different. In contrast, the mean clearance of hematoma after four days was significantly higher in the uPA group than in the non-uPA group (P<0.05) and did not increase the incidence of postoperative complications (P>0.05).
uPA treatment may eliminate hematomas faster and reduce the rate of obstruction. However, its effectiveness in improving patient prognosis does not appear to be significant. Therefore, studies with larger samples may be needed to further validate its effectiveness.
脑室出血（IVH）是一种严重的中风形式。对现有治疗方案的研究存在争议。因此，我们旨在评估脑室外引流（EVD）联合 uPA 给药治疗 IVH 的安全性和疗效。
回顾性分析了 2019 年至 2022 年期间我科收治的 157 例 IVH 患者的临床资料。根据 30 天后的格拉斯哥预后评分（GOS），将患者分为预后良好（GOS4-5）和预后不良（GOS1-3），并通过单因素和多因素分析筛选有预后影响的因素，然后进行倾向评分匹配和配对患者筛选，对 uPA 组和非 uPA 组进行比较分析。
患者年龄、uPA 使用、初始 GCS 评分和颅内血肿体积均会影响患者的 GOS。经过倾向评分匹配筛选后，最终纳入 72 例患者，uPA 组和非 uPA 组各 36 例。分析显示，在 30 天后的随访中，uPA 组 GOS 评分为 4-5 的患者占 50.0%，而非 uPA 组占 30.6%，但差异无统计学意义。相反，uPA 组血肿清除 4 天后的平均血肿清除率明显高于非 uPA 组（P<0.05），且不增加术后并发症的发生率（P>0.05）。
uPA 治疗可能更快地消除血肿并降低梗阻发生率。然而，其改善患者预后的效果似乎并不显著。因此，可能需要更大样本的研究来进一步验证其有效性。
