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首页> 外文期刊>Journal of neurology >Treatment and outcome of severe intraventricular extension in patients with subarachnoid or intracerebral hemorrhage: a systematic review of the literature.
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Treatment and outcome of severe intraventricular extension in patients with subarachnoid or intracerebral hemorrhage: a systematic review of the literature.

机译：蛛网膜下腔或脑出血患者严重脑室内扩张的治疗和结果：系统评价文献。

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Severe intraventricular hemorrhage caused by extension from subarachnoid hemorrhage or intracerebral hemorrhage leads to hydrocephalus and often to poor outcome. We conducted a systematic review to compare conservative treatment, extraventricular drainage, and extraventricular drainage combined with fibrinolysis. We carried out a search in Medline of the literature between January 1966 and December 1998 and an additional hand-search from January 1990 to December 1998. Pharmaceutical companies were contacted to gather unpublished data. We reviewed the reference lists of all relevant articles. Two authors independently assessed eligibility of the studies and extracted data on characteristics of study design, patients, and treatment. Patients with primary intraventricular hemorrhage were excluded. Main outcome measures were death and poor outcome (defined as death or dependency) at the end of follow-up. No randomized clinical trial has yet been conducted so far, and we therefore reviewed only observational studies. The case fatality rate for conservative treatment (ten studies) was 78%. For extraventricular drainage (seven studies) it was 58% [relative risk versus conservative treatment (RR) 0.74; 95% confidence interval (CI) 0.55-0.99]. For extraventricular drainage with fibrinolytic agents (five studies) the case fatality rate was 6% (RR 0.08; 95% CI 0.02-0.24). The poor outcome rate for conservative treatment was 90%, that for extraventricular drainage 89% (RR 0.98; 95% CI 0.75-1.30) and that for extraventricular drainage with fibrinolytic agents 34% (RR 0.38; 95% CI 0.21-0.68). All RR values remained essentially the same after adjusting for age, sex, World Federation of Neurological Surgeons scale, study design, and year of publication for the studies that provided these data. Outcome is thus poor in patients with intraventricular extension of subarachnoid or intracerebral hemorrhage. This meta-analysis suggests that treatment with ventricular drainage combined with fibrinolytics may improve outcome for such patients, although this impression is derived only from an indirect comparison between observational studies. A randomized clinical trial is warranted.
机译：蛛网膜下腔出血或脑内出血引起的严重脑室内出血会导致脑积水，并常常导致不良的预后。我们进行了系统评价，比较了保守治疗，脑室引流和脑室引流结合纤维蛋白溶解的情况。我们在1966年1月至1998年12月期间对Medline文献进行了搜索，并在1990年1月至1998年12月进行了另一次人工搜索。与制药公司联系以收集未公开的数据。我们查看了所有相关文章的参考列表。两位作者独立评估了研究的资格，并提取了研究设计，患者和治疗特征的数据。原发性脑室内出血的患者被排除在外。主要结局指标为随访结束时的死亡和不良结局（定义为死亡或依赖）。到目前为止，尚未进行任何随机临床试验，因此，我们仅回顾了观察性研究。保守治疗的病死率（十项研究）为78％。对于室外引流（七项研究），其风险为58％[相对风险与保守治疗（RR）为0.74; 95％置信区间（CI）0.55-0.99]。对于使用纤维蛋白溶解剂进行室外引流（五项研究），病死率是6％（RR 0.08; 95％CI 0.02-0.24）。保守治疗的不良结局率为90％，脑室引流的不良率为89％（RR 0.98; 95％CI 0.75-1.30），纤维蛋白溶解剂脑室引流的不良率为34％（RR 0.38; 95％CI 0.21-0.68）。在调整了年龄，性别，世界神经外科医师联合会量表，研究设计和提供这些数据的研究的发表年之后，所有RR值基本上保持不变。因此，在蛛网膜下腔或脑出血的脑室内扩展患者中，结果较差。这项荟萃分析表明，使用心室引流结合纤溶酶治疗可改善此类患者的预后，尽管这种印象仅来自观察性研究之间的间接比较。有必要进行一项随机临床试验。

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