Cisternal and intraventricular irrigation in subarachnoid and intraventricular haemorrhage.

IF 2.6 1区 医学 Journal of Investigative Medicine Pub Date : 2024-05-23 DOI:10.1136/svn-2023-003062
Allice Nyborg Rosenkrans Lind, Mathias Green Krabbenhøft, Jan Brink Valentin, Mette Haldrup, Stig Dyrskog, Mads Rasmussen, Claus Ziegler Simonsen, Anders Rosendal Korshoej
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Abstract

Background: Subarachnoid haemorrhage (SAH) and intraventricular haemorrhage (IVH) are associated with poor patient outcomes. Intraventricular fibrinolysis is effective in clearing IVH and improving patient survival and neurological outcome. By similar rationale, cisternal irrigation has been proposed as a potential method to accelerate haematoma clearance in SAH. We aimed to provide a comprehensive review and meta-analysis evaluating the effect of intraventricular and cisternal irrigation on clinical outcomes in patients with SAH and IVH.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed preparing this systematic review and study selection was performed by multiple investigators. We extracted ORs from the individual studies and aggregated these using a random effects model. The quality of evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluations assessment and ROBINS-I or RoB-2.

Results: 24 articles were included. In SAH, we found that cisternal irrigation with fibrinolytic agents was associated with reduced mortality (OR: 0.68, 95% CI 0.46 to 1.00), higher probability of favourable functional outcome (OR: 1.80, 95% CI 1.30 to 2.51), and reduced risks of DCI (OR: 0.28, 95% CI 0.18 to 0.42) and cerebral vasospasm (OR: 0.28, 95% CI 0.18 to 0.42), compared with conventional therapy. Cisternal irrigation with vasodilatory agents was associated with lower mortality (OR: 0.32, 95% CI 0.13 to 0.79) and reduced risk of cerebral vasospasm (OR: 0.37, 95% CI 0.17 to 0.79). The evidence for irrigation therapy of IVH was sparse and insufficient to show any significant effect.

Conclusion: In this study, we found that cisternal irrigation could improve the prognosis in patients with SAH compared with conventional therapy. There is no evidence to support cisternal irrigation treatment of IVH.

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蛛网膜下腔和脑室内出血的椎管内和脑室内冲洗。
背景:蛛网膜下腔出血(SAH)和脑室内出血(IVH)与患者的不良预后有关。脑室内纤维蛋白溶解可有效清除 IVH,改善患者存活率和神经功能预后。基于类似的原理,有人提出了一种潜在的方法来加速腔内灌注清除 SAH 中的血肿。我们的目的是对SAH和IVH患者进行全面回顾和荟萃分析,评估脑室内灌注和椎管内灌注对临床预后的影响:本系统综述遵循《系统综述和荟萃分析首选报告项目》指南,并由多位研究者进行研究筛选。我们从单个研究中提取 ORs,并使用随机效应模型对其进行汇总。证据质量采用建议、评估、发展和评价分级法以及 ROBINS-I 或 RoB-2 进行评估。在 SAH 患者中,我们发现与传统疗法相比,使用纤溶药物进行膀胱灌注可降低死亡率(OR:0.68,95% CI 0.46 至 1.00),提高良好功能预后的概率(OR:1.80,95% CI 1.30 至 2.51),降低 DCI(OR:0.28,95% CI 0.18 至 0.42)和脑血管痉挛(OR:0.28,95% CI 0.18 至 0.42)的风险。使用血管扩张剂进行膀胱灌注与降低死亡率(OR:0.32,95% CI 0.13 至 0.79)和减少脑血管痉挛风险(OR:0.37,95% CI 0.17 至 0.79)相关。IVH灌注治疗的证据稀少,不足以显示任何显著效果:结论:本研究发现,与传统疗法相比,椎管内灌注可改善 SAH 患者的预后。结论:我们在这项研究中发现,与传统疗法相比,椎管内灌洗可改善 SAH 患者的预后,但没有证据支持椎管内灌洗治疗 IVH。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Investigative Medicine
Journal of Investigative Medicine MEDICINE, GENERAL & INTERNALMEDICINE, RESE-MEDICINE, RESEARCH & EXPERIMENTAL
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111
期刊介绍: Journal of Investigative Medicine (JIM) is the official publication of the American Federation for Medical Research. The journal is peer-reviewed and publishes high-quality original articles and reviews in the areas of basic, clinical, and translational medical research. JIM publishes on all topics and specialty areas that are critical to the conduct of the entire spectrum of biomedical research: from the translation of clinical observations at the bedside, to basic and animal research to clinical research and the implementation of innovative medical care.
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