Atenas Medical School, Department of Internal Medicine, Paracatu-MG, Brazil.
Turk Neurosurg. 2024;34(4):543-553. doi: 10.5137/1019-5149.JTN.45919-23.1.
To determine the effectiveness of extraventricular drainage (EVD) combined with fibrinolytics in reducing morbidity and mortality rates associated with intraventricular cerebral hemorrhage (IVH).
A literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO registration number: CRD42022332152). Articles were selected from various sources, including PubMed, Trip Database, LILACS, Cochrane Library, and ScienceDirect. Clinical trials focusing on IVH treatment using EVD and/or fibrinolytics were considered. The Risk of Bias in Non-randomized Studies of Interventions (ROB 2) tool was employed for bias assessment. A fixed-effects regression model was used following heterogeneity analysis. Treatment effectiveness was evaluated based on mortality outcomes.
A total of 531 patients from four studies were included. The use of fibrinolytics significantly decreased IVH mortality compared with a placebo. The odds ratio (OR) for recombinant tissue plasminogen activator (rtPA) or alteplase was 0.54 [0.36; 0.82]. For urokinase (UK), the OR was 0.21 [0.03; 1.54], rendering it statistically non-significant. The overall OR was 0.52 [0.35; 0.78], and the heterogeneity I2 was 0% (indicating low heterogeneity).
While EVD alone is a common approach for managing hydrocephalus, its effectiveness is limited by potential blockages and infections. Combining EVD with UK or rtPA demonstrated improved patient outcomes. rtPA stands out as a reliable and effective option, while limited data are available regarding UK's effectiveness in reducing IVH mortality.
评估脑室内出血（IVH）患者采用脑室外引流（EVD）联合溶栓治疗的有效性，降低相关发病率和死亡率。
检索 PubMed、Trip 数据库、LILACS、Cochrane 图书馆和 ScienceDirect 等数据库，按照 PRISMA 指南筛选关于 EVD 联合溶栓治疗 IVH 的随机对照研究，采用 Risk of Bias in Non-randomized Studies of Interventions（ROB 2）工具评价偏倚风险，根据异质性检验结果选择固定效应或随机效应模型进行 Meta 分析，计算死亡率的比值比（OR）及其 95%置信区间（CI）。
纳入 4 项研究共 531 例患者，与安慰剂组相比，溶栓治疗组患者 IVH 死亡率明显降低，重组组织型纤溶酶原激活剂（rtPA）或阿替普酶组 OR 为 0.54（0.36；0.82），尿激酶（UK）组 OR 为 0.21（0.03；1.54），差异无统计学意义，总体 OR 为 0.52（0.35；0.78），I ² 为 0%（提示低异质性）。
EVD 是治疗脑积水的常用方法，但存在潜在堵塞和感染的风险。EVD 联合 UK 或 rtPA 可改善患者预后，rtPA 是一种可靠且有效的治疗选择，而 UK 降低 IVH 死亡率的疗效证据有限。
