The Influence Of Blood Gas Analysis On Clinical Treatment And Prognosis In Patients With Hypertensive Intracerebral Hemorrhage

Hypertension is a major worldwide public health problem. The World Health Organization predicts that by 2020, non-communicable diseases will account for 79% of the cause of death in china, and cardiovascular and cerebrovascular diseases will be the first. According to the Statistics Cente of Ministry of Health, the crowd surveillance data show that the mortality of urban residents in cerebrovascular disease has risen to the first or second place. Cerebral hemorrhage, as a hypertensive cardio-cerebral vascular diseases, generally refers to primary cerebral hemorrhage, the majority of which are caused by high blood pressure and cerebral arteriosclerosis, is a serious threat to human life and health. In the developed countries, cerebral hemorrhage account for about 5% ~ 10% of all the strokes, in China and Asia area,it account for 15% to 30%,in some areas it may be higher, the mortality rate within 30 days is 30% ~ 52%, 10% of patients are able to live independently arter a month, but only 20% have the ability to take care of themselves after 6 months.In recent years,as the development of imaging technology and the neurological surgery, the mortality rate has decreased significantly, but the overall incidence is in the trends of increasing, morbidity remains high, the patients'quality of life is declining,which impose a heavy burden on families and society, and has drawn a lot of attention from the international medical community.Hypertensive cerebral hemorrhage due to acute increased intracranial pressure can cause damage to the nervous system, leading to respiratory dysfunction and various types of ventilation abnormalities or respiratory failure, associated with acid-base balance disorders. Coma is common in patients with severe hypertensive intracerebral hemorrhage, which often cause direct ventilation obstacles due to glossocoma and aspiration,leading to hypoxemia, often accompanied by increased PaCO2, this case is easy to be corrected clinically because of the timely discovery. Only hypoxemia in patients with no increase in PaCO2 is caused by pulmonary gas exchange impairment ,the most common case is hyperventilation which may further lead to respiratory alkalosis. Hypoxemia accompanied by low PaCO2 and respiratory alkalosis is the most common and indicates the worst prognosis in patients with hypertensive cerebral hemorrhage. The Mechanism of hyperventilation is in two aspects: First, brain lactate, pyruvate increase due to cerebral ischemia and hypoxia,lactic acid enter into the cerebrospinal fluid from the ventricle and induce pH decrease,bloody cerebrospinal fluid metabolites in blood cells can also cause pH decrease, consequently stimulate the medullary respiratory chemoreceptors to increase ventilation. Second, neural mechanisms, known as the central nervous hyperventilation ,is mainly due to the dysfunction of paramedian pontine reticular formation, with an autopsy confirming that paramedian pontine reticular formation has severe pathological changes. Hyperventilation leads to excessive CO2 emissions, PaCO2 decreased,blood vessels of brain constricted, cerebral blood flow reduced, thereby aggravates brain disfunction. In hyperventilation, the Bohr Effect caused by pH increase significantly lower brain tissue oxygen partial pressure, which is the main reason for brain damage. PaCO2 decreased and cerebrovascular contraction due to hyperventilation can cause severe hypoxia, cerebral hypoxia increases cerebral edema and a vicious circle come into being, if respiratory alkalosis appears ,it may further aggravated hypoxia. In summary, hypoxemia associated with increased PaCO2 is often due to airway obstruction and is common in patients with hypertensive cerebral hemorrhage, timely intubation or tracheostomy is effective corrective measures in clinical practice. Hypoxemia, low PaCO2 and respiratory alkalosis three reinforce each other and increase the brain damage, is an important factor to cause the patients to death, and therefore closely monitoring changes in blood gas and acid-base has great significance to judge patients'condition and prognosis in the treatment course of patients with hypertensive cerebral hemorrhage.Blood gas analysis has become a critically important part of patients monitoring, it could well reflect the body's respiratory and metabolic function, objectively assess patients'oxygenation, ventilation and acid-base balance, reflect the patients'functional status of lungs, kidneys and other internal organs. It is an important indicator of changes in the monitoring of critically ill patients, which plays an important role for diagnosis, treatment and prognosis of the critical disease. The experiment gives clinical analysis to the results of oxygen saturation and blood gas analysis from the 80 patients with hypertensive cerebral hemorrhage during January 2008 ~ October 2009 in the second hospital of Jilin University, to explore its mechanism, clinical significance and impact on prognosis.Objective: To study the influence of blood gas analysis on the clinical treatment and prognosis of patients with hypertensive cerebral hemorrhage, and to explore the mechanisms of blood gas changes in hypertensive cerebral hemorrhage, in order to improve the treatment level of hypertensive cerebral hemorrhage.Method: 80 patients with hypertensive intracerebral hemorrhage were analyzed in the experimental group.Gathering the patients'general information, recording the monitoring results of arterial blood gas analysis and pulse oximetry, recording the therapeutic measures such as tracheotomy, mechanical ventilation and the results of blood gas analysis before and after the treatment .Evaluating the prognosis of patients (at discharge) with GOS score sheet,analyzing the relationship between blood gas analysis and the therapeutic measures ,and the relationship between blood gas analysis and the patients'prognosis with statistical methods. The results were analyzed by SPSS(version 17.0). Measurement data and numeration data were compared with t test andχ2 test respectively,and p <0.05 was considered to be statistically significant.Results: For patients with hypertensive intracerebral hemorrhage, hypoxemia (Pa02 <60 mmHg group) affect the prognosis of patients, the difference was significant compared with the normal oxygen partial pressure group(p <0.05); acid-base imbalance (pH <7.35 / pH > 7.45 group) affect the prognosis of patients, the difference was statistically significant compared with the normal pH group.(p<0.05); tracheostomy sooner or later affect the prognosis of patients, the difference was statistically significant between the two groups within and after 24 hours tracheotomy implemented.(p <0.05); pH, PaO2, PaCO2 significantly improved in patients after tracheotomy, the difference was significant compared with which before tracheotomy.(p <0.05); PaO2, SpO2 improved after mechanical ventilation treatment, the difference was statistically significant compared with which before mechanical ventilation.( p <0.05); respiratory alkalosis is a main type of acid-base imbalances in patients with hypertensive intracerebral hemorrhage .Conclusions: 1. Hypoxemia and acid-base imbalance have close relationship with the prognosis of patients with hypertensive intracerebral hemorrhage. 2. Tracheotomy can improve patients'blood gas condition and affect the prognosis. 3. Mechanical ventilation can improve patients'blood gas condition and affect the prognosis. 4. Blood gas analysis can effectively monitor changes in patients'condition, direct clinical treatment and affect the patients'prognosis.