| Background and objective:Intraventricular hemorrhage(IVH)is a common type of spontaneous intracerebral hemorrhage,and the patient's condition is very serious and the prognosis is poor.The previous studies showed that recombinant tissue type plasminogen activation agent(rt PA)combined with external ventricular drainage(EVD)can result in faster clearance of ventricular blood,lower contact time of blood with the ependymal lining,and possibly allows a faster resumption of cerebral spinal fluid homeostasis.A guideline for healthcare professionals from the American Heart Association/American Stroke Association(guidelines for the management of spontaneous intraventricular hemorrhage)suggested that "Although intraventricular administration of rtPA in IVH appears to have a fairly low complication rate,the efficacy and safety of this treatment are uncertain".The purpose of this study was to analyze the efficacy and safety of rt PA in intraventricular hemorrhage,and explore the influence factors of the efficacy and safety.Materials and methods:The literatures about the efficacy and safety of rtPA combined with EVD compared with EVD alone in the management of intraventricular hemorrhage were collected from PubMed,Embase,Cochrane Central Rigister of Controlled Trials.Two investigators used the words “intraventricular hemorrhage”,“intracerebral hemorrhage”,“external ventricular drainage”,“intraventricular fibrinolysis”,“recombinant tissue plasminogen activator” in the way of combination of free words and subject words.Articles were only considered if they were in English.The data were extracted from the original researches,and the quality of the original researches were evaluated.The experimental group is rtPA combined with EVD,the control group is EVD alone.Finally,The meta-analysis was conducted by Stata 12.0 software.In addition,subgroup analyses based on the dosage of rt PA,the region of cases,the types of research designs and the related pathogeny of ventricular hemorrhage were performed.Results: Finally ten studies were included.There were 437 patients in total including 229 patients who were treated with rtPA combined with EVD and 208 who were treated with EVD alone.There were significant advantages in the experimental group including the low mortality(OR=0.60;95%CI=0.36-0.99)and the better effect of postoperative recover(OR=1.66;95%CI=1.01-2.73);however,there was no significant difference in the incidence ventricular inflammation,the incidence of ventriculoperitoneal shun,and the incidence of recurrent hemorrhage.The subgroup analysis based on the dosage of rtPA found that when the dosage of rtPA is less than or equal to 4 mg the experimental group has a more obvious advantage in the rate of mortality(OR=0.40;95%CI=0.19-0.85).The subgroup analysis based on the region of cases found that when the region of cases are located inEurope the experimental group has a more obvious advantage in effect of postoperative recover(OR=2.08;95%CI=1.02-4.24)than patients who are located in North America.The subgroup analysis based on the related pathogeny of IVH found that when the related pathogeny of IVH is spontaneous intracerebral hemorrhage the experimental group has a more obvious advantage in effect of postoperative recover(OR=2.01;95%CI=1.09-3.72)than patients whose related pathogeny of IVH is aneurysm.For patients whose pathogeny of IVH is aneurysm,the subgroup analysis found that there was no significant difference in the mortality,the effect of postoperative recover,the incidence ventricular inflammation,the incidence of ventriculoperitoneal shunt and the incidence of recurrent hemorrhage.For patients whose pathogeny of IVH is spontaneous intracerebral hemorrhage,the experimental group has a more obvious advantage in effect of postoperative recover;and there was no significant difference in the mortality,the incidence ventricular inflammation,the incidence of ventriculoperitoneal shunt and the incidence of recurrent hemorrhage.Conclusion: Compared with EVD alone,the experimental group can significantly reduce the patient mortality and improve the effect of postoperative recover;however,there was no significant difference in the incidence of ventricular inflammation,the incidence of ventriculoperitoneal shunt,and the incidence of recurrent hemorrhage.Subgroup analysis showed: When the dosage of rt PA is lessthan or equal to 4mg the experimental group has more lower mortality than the control group.In European countries the experimental group have better effect of postoperative recover than the control group.For patients whose pathogeny of IVH is aneurysm,there was no significant difference in the mortality,the effect of postoperative recove,the incidence ventricular inflammation,the incidence of ventriculoperitoneal shunt and the incidence of recurrent hemorrhage.For patients whose pathogeny of IVH is spontaneous intracerebral hemorrhage,the experimental group has more better effect of postoperative recover than the control group,however,there was no significant difference in the mortality,the incidence ventricular inflammation,the incidence of ventriculoperitoneal shunt and the incidence of recurrent hemorrhage. |
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