Clinical Study Of Neurogenic Pulmonary Edema In Hypertensive Intracerebral Hemorrhage

Hypertensive intracerebral hemorrhage (HICH)is a common-seen and frequently encountered disease in neurosurgery. HICH, which has a rapid process and a high mortality, can threat to human life and affect the quality of life. Patients with hypertensive intracerebral hemorrhage often occur cerebral edema, gastrointestinal disorders, gastrointestinal bleeding, neurogenic pulmonary edema, or water and electrolyte disturbance, as a direct consequence of acute central nervous system injury. Among them, neurogenic pulmonary edema is one of the most common pulmonary complications after intracerebral hemorrhage.Neurogenic pulmonary edema (NPE) is usually defined as an acute pulmonary edema occurring shortly after a central neurologic insult. It often presents without pre-existing cardiovascular or pulmonary pathology-pathology that could explain the edema. Although several pathophysiological mechanisms have been proposed, the exact cascade leading to the development of neurogenic pulmonary edema remains unclear. Both the release of vasoactive substances and a rapid, transient, and severe sympathetic discharge are thought to participate in this process. Neurogenic pulmonary edema is a acute and rapidly developing disease which have a high mortalityrate. It significantly worsens the general health status of the patient. NPE can lead to an acute cardiopulmonary failure with consequent global hypoperfusion and hypoxia. These circumstances might cause severe secondary ischemic brain damage in patients with hypertensive intracerebral hemorrhage, their brain being especially vulnerable due to the primary damage caused by the initial bleeding. As a consequence, NPE must be regarded as a potentially life-threatening complication after HICH. Therefore, awareness of and knowledge about the occurrence of NPE in patients with HICH is of high interest.In this study, we wanted to assess clinical prognosis and risk factors,such as localization of the bleeding and the GCS rating of patients, for the development of NPE, evaluating a database on 324 patients with hypertensive intracerebral hemorrhage.Object:We sought to assess the related risk factors, clinical features and prognosis for the development of NPE after HICH, and provide a theoretical basis for clinical significanc of preventive treatment of high-risk patients and appropriate juncture for treatment.Methods:The database contained prospectively collected data from 324 patients, representing all patients with hypertensive intracerebral hemorrhage admitted to the Department of Neurosurgery, Second Hospital of Jilin University, within 1 days after ictus, between September 2007 to December 2009. All cases are divided into groups with and without pulmonary edema group, according to whether concurrent pulmonary edema (control group); (1) Predictive factors: Suspicious related factors, such as sex, age, vomiting, GCS score, bilateral pupillary asymmetry, localization of intracranial hemorrhage, ventricular extension, midline shift, and other clinical outcome of patients with NPE were compared with those of patients without NPE and evaluated by univariate analysis.(2) Prognosis:1) Recorded occurrence time of NPE and statistical and time of death with pulmonary edema; 2) Compare and analysis the mortality rate of HICH with two groups; 3) Further, the concurrent occur of other complications of HICH (gastrointestinal hemorrhage, lung infection, hernia) during the acute phase were evaluated retrospectively between with.or without NPE groups. All frequency data were analyzed by chi-square test, applied SPSS 13.0 statistical software for statistical analysis. P<0.05 as significant criterion.Result:It seems to be that GCS score (P＜0.05), midline shift (P＜0.05), bilateral pupillary asymmetry (P<0.05), localization of hypertensive intracranial hemorrhage (thalamic hemorrhage P＜0.05), breaking into the ventricle (P＜0.05) were significantly related to occurrence of NPE.. But the sex, age and record of vomiting unable to show a correlation (P>0.05).(1) In this study, neurogenic pulmonary edema often occurred 3 days or less after the hypertensive intracerebral hemorrhage, with the largest concentration in the first day after onset (29 cases, accounting for 64.44%). And the first day after the cerebral hemorrhage is also have the largest number of deaths with NPE (a total of 20 cases, accounting for 68.97%). The later occurs the NPE, the lower mortality rate.(2) In the 45 cases of hypertensive intracerebral hemorrhage with NPE,29 patients (64.44%) died. In another group without NPE,among all the 279 cases of hypertensive intracerebral hemorrhage,34 patients (12.19%) died. Compare the two groups, the mortality was significant difference (P<0.05). Showed poor prognosis with NPE.(3) The rate of NPE concurrent by other complications of HICH (gastrointestinal hemorrhage, pulmonary infection) is significantly higher than risk of pulmonary edema (control group), and the difference was significant.Conclusions(1) Neurogenic pulmonary edema is a commeon, rapidly developing and life-threatening complication of hypertensive cerebral hemorrhage.(2) This study shows that, in neurogenic pulmonary GCS score, bilateral pupillary asymmetry, midline shift, localization of hypertensive intracranial hemorrhage, broken into ventricles edema can be used as early predictors of clinical and maybe have some clinical reference value. But age, sex, and vomiting were unable to show correlations.(3) Hypertensive intracerebral hemorrhage with neurogenic pulmonary edema has significantly high mortality rate, and most patients with poor prognosi.(4) Neurogenic pulmonary edema, which has rapid progression and atypical symptoms, is difficult to treat and the associated mortality is high. Therefore, severe forms require early and adequate intervention for a favorable outcome. And treatment should include the fact of central nervous system injury and pulmonary edema.