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：

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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.	邓平, 吴晓牧. 高血压脑出血病理生理机制研究进展. 中华脑血管病杂志(电子版), 2010, 4(4): 267-278.
2.	何黎明, 刘保国, 王泽麟, 等. 方体定向双软通道并不同剂量尿激酶治疗高血压性脑出血疗效观察. 中国微侵袭神经外科杂志, 2017, 22(12): 540-543.
3.	张亚飞, 刘永建. 软硬通道联合穿刺术治疗高血压脑出血 30 例. 陕西医学杂志, 2017, 46(1): 36-37.
4.	罗杰, 黄明火, 魏小川, 等. 软-硬通道结合技术穿刺介入治疗高血压脑出血临床分析. 临床和实验医学杂志, 2017, 16(1): 68-71.
5.	罗德惠, 万翔, 刘际明, 等. 如何实现从样本量, 中位数, 极值或四分位数到均数与标准差的转换. 中国循证医学杂志, 2017, 17(11): 116-122.
6.	李显锋. 穿刺引流术中应用尿激酶治疗老年高血压脑出血的疗效分析. 世界复合医学, 2019, 5(2): 121-123.
7.	黄海常, 陆明雄, 韦以存, 等. 脑室引流与尿激酶脑室灌注持续引流治疗原发性脑室内出血疗效分析. 中国民族民间医药杂志, 2013, (2): 42.
8.	高红欣. 软通道穿刺引流术联合尿激酶治疗高血压脑出血的临床疗效观察. 中国疗养医学, 2018, 27(12): 1294-1295.
9.	梁晓铭, 亢红妮. 穿刺引流术中应用尿激酶治疗老年高血压脑出血的临床效果. 临床医学研究与实践, 2017, 2(28): 67-68.
10.	林博. 侧脑室外引流术联合尿激酶溶解术治疗脑室内出血的临床疗效. 中国社区医师, 2017, 33(17): 45.
11.	杨春松. 尿激酶辅助腰大池引流治疗脑室出血效果观察. 中国乡村医药, 2017, 24(19): 3-4.
12.	张志国. 微创联合尿激酶溶解治疗高血压脑出血的效果观察. 中国医药指南, 2016, 14(28): 159.
13.	汤明章, 陈莉. 钻孔引流及尿激酶溶解术联合治疗高血压性脑室出血的疗效分析. 海峡药学, 2016, 28(4): 208-209.
14.	徐开明, 郭强, 张耀华. 重组组织型纤溶酶原激活剂(rt-PA)联合脑室外引流对重型脑室出血患者颅内压升高的治疗效果分析. 岭南急诊医学杂志, 2016, 21(4): 333-334, 368.
15.	黄林洲. 微创双管置入联合尿激酶治疗高血压脑出血疗效分析. 现代诊断与治疗, 2015, 26(4): 909-910.
16.	武贵旭, 乔俊, 杨明林, 等. 双侧脑室外引流联合腰大池持续引流治疗脑室出血的疗效观察. 医药前沿, 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, 权天龙. 微创双管置入联合尿激酶治疗高血压脑出血的临床价值. 中国实用神经疾病杂志, 2014, 17(18): 60-61.
19.	王文涛. 穿刺置管抽吸加尿激酶引流治疗高血压脑出血的效果分析. 中国卫生产业, 2013, 10(17): 140-141.
20.	桂心, 谢小红. 微创穿刺辅以尿激酶治疗高血压性脑出血临床分析. 中国生化药物杂志, 2012, 33(2): 176-178.
21.	喻厚丰, 查晓华. 立体定向微创术联合尿激酶纤溶疗法治疗高血压脑出血的疗效. 中国实用医药, 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.	钱传云, 张玮, 王云徽, 等. rt-PA 在高血压脑出血微创置管溶栓引流治疗中的作用. 中华急诊医学杂志, 2006, 15(8): 718-720.
25.	聂陆一. 超早期立体定向抽吸尿激酶溶解引流治疗脑出血的临床观察. 临床医药实践, 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.	周庆昆. 脑室外引流及加尿激酶灌注治疗自发性脑室出血. 广东医学, 2000, 21(10): 879-880.
28.	Akdemir H, Selçuklu A, Paşaoğlu A. Treatment of severe intraventricular hemorrhage by intraventricular infusion of urokinase. Neurosurg Rev, 1995, 18(2): 95-100.
29.	陈小锋, 温中华, 周康胜, 等. 锥颅加尿激酶灌注治疗高血压脑出血 46 例. 中华神经医学杂志, 2005, (5): 509-510.
30.	陈岷辉, 杨呈浩, 陈立珂, 等. 微创引流术治疗高血压脑出血的疗效观察. 医学与哲学, 2016, 37(2B): 24-26.
31.	黄春刚, 张国栋, 李建华, 等. 高血压脑出血微创术后超早期应用尿激酶的临床疗效分析. 神经损伤与功能重建, 2012, 7(6): 413-414, 463.

1. 邓平, 吴晓牧. 高血压脑出血病理生理机制研究进展. 中华脑血管病杂志(电子版), 2010, 4(4): 267-278.
2. 何黎明, 刘保国, 王泽麟, 等. 方体定向双软通道并不同剂量尿激酶治疗高血压性脑出血疗效观察. 中国微侵袭神经外科杂志, 2017, 22(12): 540-543.
3. 张亚飞, 刘永建. 软硬通道联合穿刺术治疗高血压脑出血 30 例. 陕西医学杂志, 2017, 46(1): 36-37.
4. 罗杰, 黄明火, 魏小川, 等. 软-硬通道结合技术穿刺介入治疗高血压脑出血临床分析. 临床和实验医学杂志, 2017, 16(1): 68-71.
5. 罗德惠, 万翔, 刘际明, 等. 如何实现从样本量, 中位数, 极值或四分位数到均数与标准差的转换. 中国循证医学杂志, 2017, 17(11): 116-122.
6. 李显锋. 穿刺引流术中应用尿激酶治疗老年高血压脑出血的疗效分析. 世界复合医学, 2019, 5(2): 121-123.
7. 黄海常, 陆明雄, 韦以存, 等. 脑室引流与尿激酶脑室灌注持续引流治疗原发性脑室内出血疗效分析. 中国民族民间医药杂志, 2013, (2): 42.
8. 高红欣. 软通道穿刺引流术联合尿激酶治疗高血压脑出血的临床疗效观察. 中国疗养医学, 2018, 27(12): 1294-1295.
9. 梁晓铭, 亢红妮. 穿刺引流术中应用尿激酶治疗老年高血压脑出血的临床效果. 临床医学研究与实践, 2017, 2(28): 67-68.
10. 林博. 侧脑室外引流术联合尿激酶溶解术治疗脑室内出血的临床疗效. 中国社区医师, 2017, 33(17): 45.
11. 杨春松. 尿激酶辅助腰大池引流治疗脑室出血效果观察. 中国乡村医药, 2017, 24(19): 3-4.
12. 张志国. 微创联合尿激酶溶解治疗高血压脑出血的效果观察. 中国医药指南, 2016, 14(28): 159.
13. 汤明章, 陈莉. 钻孔引流及尿激酶溶解术联合治疗高血压性脑室出血的疗效分析. 海峡药学, 2016, 28(4): 208-209.
14. 徐开明, 郭强, 张耀华. 重组组织型纤溶酶原激活剂(rt-PA)联合脑室外引流对重型脑室出血患者颅内压升高的治疗效果分析. 岭南急诊医学杂志, 2016, 21(4): 333-334, 368.
15. 黄林洲. 微创双管置入联合尿激酶治疗高血压脑出血疗效分析. 现代诊断与治疗, 2015, 26(4): 909-910.
16. 武贵旭, 乔俊, 杨明林, 等. 双侧脑室外引流联合腰大池持续引流治疗脑室出血的疗效观察. 医药前沿, 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, 权天龙. 微创双管置入联合尿激酶治疗高血压脑出血的临床价值. 中国实用神经疾病杂志, 2014, 17(18): 60-61.
19. 王文涛. 穿刺置管抽吸加尿激酶引流治疗高血压脑出血的效果分析. 中国卫生产业, 2013, 10(17): 140-141.
20. 桂心, 谢小红. 微创穿刺辅以尿激酶治疗高血压性脑出血临床分析. 中国生化药物杂志, 2012, 33(2): 176-178.
21. 喻厚丰, 查晓华. 立体定向微创术联合尿激酶纤溶疗法治疗高血压脑出血的疗效. 中国实用医药, 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. 钱传云, 张玮, 王云徽, 等. rt-PA 在高血压脑出血微创置管溶栓引流治疗中的作用. 中华急诊医学杂志, 2006, 15(8): 718-720.
25. 聂陆一. 超早期立体定向抽吸尿激酶溶解引流治疗脑出血的临床观察. 临床医药实践, 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. 周庆昆. 脑室外引流及加尿激酶灌注治疗自发性脑室出血. 广东医学, 2000, 21(10): 879-880.
28. Akdemir H, Selçuklu A, Paşaoğlu A. Treatment of severe intraventricular hemorrhage by intraventricular infusion of urokinase. Neurosurg Rev, 1995, 18(2): 95-100.
29. 陈小锋, 温中华, 周康胜, 等. 锥颅加尿激酶灌注治疗高血压脑出血 46 例. 中华神经医学杂志, 2005, (5): 509-510.
30. 陈岷辉, 杨呈浩, 陈立珂, 等. 微创引流术治疗高血压脑出血的疗效观察. 医学与哲学, 2016, 37(2B): 24-26.
31. 黄春刚, 张国栋, 李建华, 等. 高血压脑出血微创术后超早期应用尿激酶的临床疗效分析. 神经损伤与功能重建, 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

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