Efficacy and safety of plasminogen activator assist external ventricular drainage in cerebral hemorrhage: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

TONG Jingyi ¹ , CHEN Taixue ² , MA Lin ¹ ,  LI Qifu ¹

1. Department of Neurology, the First Affiliated Hospital of Hainan Medical College, Haikou, 570100, P.R.China;
2. Department of Neurosurgery, the First Affiliated Hospital of Hainan Medical College, Haikou, 570100, P.R.China;

Corresponding?author：

LI Qifu, Email: lee-chief@163.com

Keywords：

Hypertensive cerebral hemorrhage; External ventricular drainage; plasminogen activator; Urokinase; Alteplase; System review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.201905126

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objectives To systematically review the efficacy and safety of plasminogen activator assist external ventricular drainage in cerebral hemorrhage.Methods PubMed, EMbase, The Cochrane Library, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of plasminogen activator assist external ventricular drainage in cerebral hemorrhage from inception to March 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 23 RCTs involving 1 560 patients were included. The results of meta-analysis showed that, compared with the blank control or placebo, the addition of plasminogen activator urokinase after puncture and drainage could improve the clinical efficacy (RR=1.36, 95%CI 1.26 to 1.47, P<0.000 01), shorten removal time of hematoma (MD=?3.37, 95%CI ?3.89 to ?2.85, P<0.000 01), reduce postoperative re-bleeding rate (Peto OR=0.30, 95%CI 0.18 to 0.51, P<0.000 01), reduce the incidence of intracranial infection (Peto OR=0.47, 95%CI 0.25 to 0.87, P=0.02), and reduce mortality (Peto OR=0.45, 95%CI 0.27 to 0.76, P=0.003). The differences were statistically significant between two groups.Conclusions Current evidence shows that the combination with urokinase can improve curative effect of hypertension cerebral hemorrhage patients with external ventricular drainage. In reducing hemorrhage, intracranial infection and mortality, urokinase also has great curative effect. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Citation： TONG Jingyi, CHEN Taixue, MA Lin, LI Qifu. Efficacy and safety of plasminogen activator assist external ventricular drainage in cerebral hemorrhage: a systematic review. Chinese Journal of Evidence-Based Medicine, 2019, 19(9): 1078-1085. doi: 10.7507/1672-2531.201905126 Copy

1.	鄧平, 吳曉牧. 高血壓腦出血病理生理機制研究進展. 中華腦血管病雜志(電子版), 2010, 4(4): 267-278.
2.	何黎明, 劉保國, 王澤麟, 等. 方體定向雙軟通道并不同劑量尿激酶治療高血壓性腦出血療效觀察. 中國微侵襲神經外科雜志, 2017, 22(12): 540-543.
3.	張亞飛, 劉永建. 軟硬通道聯合穿刺術治療高血壓腦出血 30 例. 陜西醫學雜志, 2017, 46(1): 36-37.
4.	羅杰, 黃明火, 魏小川, 等. 軟-硬通道結合技術穿刺介入治療高血壓腦出血臨床分析. 臨床和實驗醫學雜志, 2017, 16(1): 68-71.
5.	羅德惠, 萬翔, 劉際明, 等. 如何實現從樣本量, 中位數, 極值或四分位數到均數與標準差的轉換. 中國循證醫學雜志, 2017, 17(11): 116-122.
6.	李顯鋒. 穿刺引流術中應用尿激酶治療老年高血壓腦出血的療效分析. 世界復合醫學, 2019, 5(2): 121-123.
7.	黃海常, 陸明雄, 韋以存, 等. 腦室引流與尿激酶腦室灌注持續引流治療原發性腦室內出血療效分析. 中國民族民間醫藥雜志, 2013, (2): 42.
8.	高紅欣. 軟通道穿刺引流術聯合尿激酶治療高血壓腦出血的臨床療效觀察. 中國療養醫學, 2018, 27(12): 1294-1295.
9.	梁曉銘, 亢紅妮. 穿刺引流術中應用尿激酶治療老年高血壓腦出血的臨床效果. 臨床醫學研究與實踐, 2017, 2(28): 67-68.
10.	林博. 側腦室外引流術聯合尿激酶溶解術治療腦室內出血的臨床療效. 中國社區醫師, 2017, 33(17): 45.
11.	楊春松. 尿激酶輔助腰大池引流治療腦室出血效果觀察. 中國鄉村醫藥, 2017, 24(19): 3-4.
12.	張志國. 微創聯合尿激酶溶解治療高血壓腦出血的效果觀察. 中國醫藥指南, 2016, 14(28): 159.
13.	湯明章, 陳莉. 鉆孔引流及尿激酶溶解術聯合治療高血壓性腦室出血的療效分析. 海峽藥學, 2016, 28(4): 208-209.
14.	徐開明, 郭強, 張耀華. 重組組織型纖溶酶原激活劑(rt-PA)聯合腦室外引流對重型腦室出血患者顱內壓升高的治療效果分析. 嶺南急診醫學雜志, 2016, 21(4): 333-334, 368.
15.	黃林洲. 微創雙管置入聯合尿激酶治療高血壓腦出血療效分析. 現代診斷與治療, 2015, 26(4): 909-910.
16.	武貴旭, 喬俊, 楊明林, 等. 雙側腦室外引流聯合腰大池持續引流治療腦室出血的療效觀察. 醫藥前沿, 2015, (34): 118-119.
17.	Naff N, Williams MA, Keyl PM, et al. Low-dose recombinant tissue-type plasminogen activator enhances clot resolution in brain hemorrhage: the intraventricular hemorrhage thrombolysis trial. Stroke, 2011, 42(11): 3009-3016.
18.	魏小年, 權天龍. 微創雙管置入聯合尿激酶治療高血壓腦出血的臨床價值. 中國實用神經疾病雜志, 2014, 17(18): 60-61.
19.	王文濤. 穿刺置管抽吸加尿激酶引流治療高血壓腦出血的效果分析. 中國衛生產業, 2013, 10(17): 140-141.
20.	桂心, 謝小紅. 微創穿刺輔以尿激酶治療高血壓性腦出血臨床分析. 中國生化藥物雜志, 2012, 33(2): 176-178.
21.	喻厚豐, 查曉華. 立體定向微創術聯合尿激酶纖溶療法治療高血壓腦出血的療效. 中國實用醫藥, 2011, 6(32): 162-163.
22.	King NK, Lai JL, Tan LB, et al. A randomized, placebo-controlled pilot study of patients with spontaneous intraventricular haemorrhage treated with intraventricular thrombolysis. J Clin Neurosci, 2012, 19(7): 961-964.
23.	Torres A, Plans G, Martino J, et al. Fibrinolytic therapy in spontaneous intraventricular haemorrhage: efficacy and safety of the treatment. Br J Neurosurg, 2008, 22(2): 269-274.
24.	錢傳云, 張瑋, 王云徽, 等. rt-PA 在高血壓腦出血微創置管溶栓引流治療中的作用. 中華急診醫學雜志, 2006, 15(8): 718-720.
25.	聶陸一. 超早期立體定向抽吸尿激酶溶解引流治療腦出血的臨床觀察. 臨床醫藥實踐, 2004, 13(7): 514-515.
26.	Naff NJ, Hanley DF, Keyl PM, et al. Intraventricular thrombolysis speeds blood clot resolution: results of a pilot, prospective, randomized, double-blind, controlled trial. Neurosurgery, 2004, 54(3): 577-583.
27.	周慶昆. 腦室外引流及加尿激酶灌注治療自發性腦室出血. 廣東醫學, 2000, 21(10): 879-880.
28.	Akdemir H, Sel?uklu A, Pa?ao?lu A. Treatment of severe intraventricular hemorrhage by intraventricular infusion of urokinase. Neurosurg Rev, 1995, 18(2): 95-100.
29.	陳小鋒, 溫中華, 周康勝, 等. 錐顱加尿激酶灌注治療高血壓腦出血 46 例. 中華神經醫學雜志, 2005, (5): 509-510.
30.	陳岷輝, 楊呈浩, 陳立珂, 等. 微創引流術治療高血壓腦出血的療效觀察. 醫學與哲學, 2016, 37(2B): 24-26.
31.	黃春剛, 張國棟, 李建華, 等. 高血壓腦出血微創術后超早期應用尿激酶的臨床療效分析. 神經損傷與功能重建, 2012, 7(6): 413-414, 463.

1. 鄧平, 吳曉牧. 高血壓腦出血病理生理機制研究進展. 中華腦血管病雜志(電子版), 2010, 4(4): 267-278.
2. 何黎明, 劉保國, 王澤麟, 等. 方體定向雙軟通道并不同劑量尿激酶治療高血壓性腦出血療效觀察. 中國微侵襲神經外科雜志, 2017, 22(12): 540-543.
3. 張亞飛, 劉永建. 軟硬通道聯合穿刺術治療高血壓腦出血 30 例. 陜西醫學雜志, 2017, 46(1): 36-37.
4. 羅杰, 黃明火, 魏小川, 等. 軟-硬通道結合技術穿刺介入治療高血壓腦出血臨床分析. 臨床和實驗醫學雜志, 2017, 16(1): 68-71.
5. 羅德惠, 萬翔, 劉際明, 等. 如何實現從樣本量, 中位數, 極值或四分位數到均數與標準差的轉換. 中國循證醫學雜志, 2017, 17(11): 116-122.
6. 李顯鋒. 穿刺引流術中應用尿激酶治療老年高血壓腦出血的療效分析. 世界復合醫學, 2019, 5(2): 121-123.
7. 黃海常, 陸明雄, 韋以存, 等. 腦室引流與尿激酶腦室灌注持續引流治療原發性腦室內出血療效分析. 中國民族民間醫藥雜志, 2013, (2): 42.
8. 高紅欣. 軟通道穿刺引流術聯合尿激酶治療高血壓腦出血的臨床療效觀察. 中國療養醫學, 2018, 27(12): 1294-1295.
9. 梁曉銘, 亢紅妮. 穿刺引流術中應用尿激酶治療老年高血壓腦出血的臨床效果. 臨床醫學研究與實踐, 2017, 2(28): 67-68.
10. 林博. 側腦室外引流術聯合尿激酶溶解術治療腦室內出血的臨床療效. 中國社區醫師, 2017, 33(17): 45.
11. 楊春松. 尿激酶輔助腰大池引流治療腦室出血效果觀察. 中國鄉村醫藥, 2017, 24(19): 3-4.
12. 張志國. 微創聯合尿激酶溶解治療高血壓腦出血的效果觀察. 中國醫藥指南, 2016, 14(28): 159.
13. 湯明章, 陳莉. 鉆孔引流及尿激酶溶解術聯合治療高血壓性腦室出血的療效分析. 海峽藥學, 2016, 28(4): 208-209.
14. 徐開明, 郭強, 張耀華. 重組組織型纖溶酶原激活劑(rt-PA)聯合腦室外引流對重型腦室出血患者顱內壓升高的治療效果分析. 嶺南急診醫學雜志, 2016, 21(4): 333-334, 368.
15. 黃林洲. 微創雙管置入聯合尿激酶治療高血壓腦出血療效分析. 現代診斷與治療, 2015, 26(4): 909-910.
16. 武貴旭, 喬俊, 楊明林, 等. 雙側腦室外引流聯合腰大池持續引流治療腦室出血的療效觀察. 醫藥前沿, 2015, (34): 118-119.
17. Naff N, Williams MA, Keyl PM, et al. Low-dose recombinant tissue-type plasminogen activator enhances clot resolution in brain hemorrhage: the intraventricular hemorrhage thrombolysis trial. Stroke, 2011, 42(11): 3009-3016.
18. 魏小年, 權天龍. 微創雙管置入聯合尿激酶治療高血壓腦出血的臨床價值. 中國實用神經疾病雜志, 2014, 17(18): 60-61.
19. 王文濤. 穿刺置管抽吸加尿激酶引流治療高血壓腦出血的效果分析. 中國衛生產業, 2013, 10(17): 140-141.
20. 桂心, 謝小紅. 微創穿刺輔以尿激酶治療高血壓性腦出血臨床分析. 中國生化藥物雜志, 2012, 33(2): 176-178.
21. 喻厚豐, 查曉華. 立體定向微創術聯合尿激酶纖溶療法治療高血壓腦出血的療效. 中國實用醫藥, 2011, 6(32): 162-163.
22. King NK, Lai JL, Tan LB, et al. A randomized, placebo-controlled pilot study of patients with spontaneous intraventricular haemorrhage treated with intraventricular thrombolysis. J Clin Neurosci, 2012, 19(7): 961-964.
23. Torres A, Plans G, Martino J, et al. Fibrinolytic therapy in spontaneous intraventricular haemorrhage: efficacy and safety of the treatment. Br J Neurosurg, 2008, 22(2): 269-274.
24. 錢傳云, 張瑋, 王云徽, 等. rt-PA 在高血壓腦出血微創置管溶栓引流治療中的作用. 中華急診醫學雜志, 2006, 15(8): 718-720.
25. 聶陸一. 超早期立體定向抽吸尿激酶溶解引流治療腦出血的臨床觀察. 臨床醫藥實踐, 2004, 13(7): 514-515.
26. Naff NJ, Hanley DF, Keyl PM, et al. Intraventricular thrombolysis speeds blood clot resolution: results of a pilot, prospective, randomized, double-blind, controlled trial. Neurosurgery, 2004, 54(3): 577-583.
27. 周慶昆. 腦室外引流及加尿激酶灌注治療自發性腦室出血. 廣東醫學, 2000, 21(10): 879-880.
28. Akdemir H, Sel?uklu A, Pa?ao?lu A. Treatment of severe intraventricular hemorrhage by intraventricular infusion of urokinase. Neurosurg Rev, 1995, 18(2): 95-100.
29. 陳小鋒, 溫中華, 周康勝, 等. 錐顱加尿激酶灌注治療高血壓腦出血 46 例. 中華神經醫學雜志, 2005, (5): 509-510.
30. 陳岷輝, 楊呈浩, 陳立珂, 等. 微創引流術治療高血壓腦出血的療效觀察. 醫學與哲學, 2016, 37(2B): 24-26.
31. 黃春剛, 張國棟, 李建華, 等. 高血壓腦出血微創術后超早期應用尿激酶的臨床療效分析. 神經損傷與功能重建, 2012, 7(6): 413-414, 463.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of plasminogen activator assist external ventricular drainage in cerebral hemorrhage: a systematic review

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content