单纯脑室外引流和纤溶酶联合脑室外引流治疗脑室内出血的Meta分析  

Simple extraventricular drainage and fibrinolytic enzyme combined with extraventricular drainage for intraventricular hemorrhage: A meta-analysis

作　　者：汪乐生 王声播 文嘉宇 陈劲草[1] WANG Lesheng;WANG Shengbo;WEN Jiayu;CHEN Jincao(Dept,of Neurosurgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China)

机构地区：[1]武汉大学中南医院神经外科,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2021年第1期156-161,共6页Medical Journal of Wuhan University

基　　金：湖北省技术创新重大专项(编号:2018ACA139)。

摘　　要：目的:比较脑室外引流联合纤溶酶(EVD+FE)和单纯脑室外引流(EVD)治疗脑室内出血(IVH)的安全性和有效性。方法:通过计算机检索PubMed、Embase、Cochrane Library数据库,查找这两种治疗手段的临床研究,检索时间均为建库至2019年8月31日。同时手检纳入文献的参考文献,按预先制定的纳入和排除标准筛选出目标文献,并利用RevMan 5.3软件进行Meta分析。结果:最终共纳入10项研究。Meta分析的结果显示:①EVD+FE有较低的死亡率,差异有统计学意义[RR=0.59,95%CI(0.46,0.76),P<0.000 1];同时亚组中尿激酶联合脑室外引流[RR=0.43,95%CI(0.26,0.71),P=0.001]和阿替普酶联合脑室外引流[RR=0.65,95%CI(0.49,0.87),P=0.004],在随访期间死亡率均较低,差异均有统计学意义。②EVD+FE在功能改善方面与单纯EVD相比未见明显差异[RR=1.14,95%CI(0.95,1.37),P=0.16]。③EVD+FE在术后再出血方面与单纯EVD相比未见明显差异[RR=1.45,95%CI(0.73,2.89),P=0.29]。④EVD+FE与EVD有相同的术后脑室分流术发生率,差异无统计学意义[RR=1.05,95%CI(0.74,1.47),P=0.80]。⑤EVD+FE在颅内感染发生率方面与单纯EVD相比未见明显差异[RR=0.81,95%CI(0.19,3.38),P=0.77]。⑥EVD+FE有较低的不良事件发生率,差异有统计学意义[RR=0.82,95%CI(0.70,0.96),P=0.01]。结论:对于临床常用于治疗IVH的两种不同方式,与EVD相比,EVD+FE能明显降低术后死亡率,且不良事件的发生率明显降低,两种方式在功能改善、再出血、术后脑室分流术发生率、继发颅内感染方面没有统计学差异。Objective:To compare the safety and effectiveness of fibrinolytic enzyme combined with extraventricular drainage(EVD+FE) and simple extraventricular drainage(EVD) in the treatment of intraventricular hemorrhage(IVH).Methods:The PubMed,Embase,and Cochrane Library databases were searched by computer to find the clinical trials of the two treatments from establishment to August 31,2019.Meanwhile,screening all articles on the basis of pre-determined inclusion criteria and exclusion criteria,reviewers conducted the assessment and data extraction of targeted literatures.Meta-analysis was performed by using Revman 5.3 software.Results:A total of 10 studies involving 691 subjects were included.The results of meta-analysis showed that:(1) The mortality rate of EVD+FE group was significantly lower than that of simple EVD(RR=0.59,95%CI(0.46,0.76),P<0.000 1) with statistic differences;in the subgroup,the mortality of urokinase combined with extraventricular drainage(RR=0.43,95% CI(0.26,0.71),P=0.001) and alteplase combined with extraventricular drainage(RR=0.65,95% CI(0.49,0.87),P=0.004) was lower than that of simple EVD.(2) There was no significant difference between EVD+FE and EVD in functional improvement(RR=1.14,95% CI(0.95,1.37),P=0.16).(3) There was no significant difference between EVD+FE and EVD in postoperative rebleeding(RR=1.45,95%CI(0.73,2.89),P=0.29).(4)EVD+FE was equivalent to simple EVD in the incidence of postoperative ventricular shunt(RR=1.05,95% CI(0.74,1.47),P=0.80),without statistic differences.(5) There was no significant difference between EVD+FE and EVD in intracranial infection(RR=0.81,95% CI(0.19,3.38),P=0.77).(6) EVD+FE had a lower incidence of adverse events as compared with simple EVD(RR=0.82,95%CI(0.70,0.96),P=0.01) with statistic difference.Conclusion:For the two different methods commonly used in the treatment of IVH,compared with EVD,EVD+FE can significantly reduce the postoperative mortality and the incidence of adverse events.And no statistical significance was found between the two methos

关 键 词：脑室内出血 纤溶酶 脑室外引流 尿激酶 阿替普酶 

分 类 号：R651.1[医药卫生—外科学]