Changes Of Cerebral Oxygen And Glucose Metabolism In Acute Hypertensive Cerebral Hemorrhagic Patients And Its Significance

Objective To study early changes of cerebral oxygen and glucose metabolism, its relationship withprognosis and its clinical significance in hypertensive cerebral hemorrhagic patients with Glasgow coma score (GCS) of5-8.Methods From January1,2011to June30,2012, blood was collectedfor blood gas analysis and blood glucose test from jugular vein and radial arteryin a total of43hypertensive cerebral hemorrhagic patients (Male27cases, female16cases, male and female ratio is1.7:1; age49～81(mean66.2±15.3)) with GCS score5-8, including:28cases of basal ganglia hemorrhage,6cases of cerebellar hemorrhage,4cases of lobar hemorrhage,5cases of pontine hemorrhage;25cases of supratentorial hematoma volume were no less than30ml in,10cases of infratentorial hematoma volume were no less than10ml; Craniotomy and evacuation of hematoma and decompressive craniectomy in11cases, the rest all for conservative treatmentlnclusion criteria:all patients meet the diagnostic criteria of hypertensive cerebral hemorrhage revised by the4th National Academic Conference on cerebro vascular disease in1995confirmed by brain CT; within24hours of onset; Glasgow coma score (GCS)5-8; a history of hypertension. Exclusion criteria:cerebral hemorrhagecaused bytraumatic intracranial hematoma; spontaneous subarachnoid hemorrhage; arteriovenous malformation and Moyamoya disease; intracranial tumor apoplexy; the disturbance of blood coagulation derived cerebral bleeding; cerebral hemorrhagic infarction. The internal jugular vein catheter was intubated retrogradely and the radial artery was puncturedfor indwelling catheter placement, and every6-8h or when great changes in physical signs have taken place, blood samples were collected for monitoring the blood gas and blood sugar for consecutive3days. The blood of patients was particularly extracted for analysis24h after onset Then the internal jugular venous oxygen saturation (SjvO2), cerebral oxygen utilization rate (CEO2), cerebral arteriovenous oxygen difference (AVDO2) and blood glucose difference (V-AGlu), lactic acid (V-ALac), the absolute value of carbon dioxide pressure difference between jugular vein and artery (V-APCO2) were calculated.According to the short-term prognosis,the patients were divided into the death group and the survival group. Then the difference of the two sets of the above indices and its relationship with prognosis wereinvestigated. Then a prospective study was conducted in23patients from July,2012to January,2013and the short term prognosis was predicted by the above indices. The statistical analysis was performed with SPSS16.0software (SPSS, USA) and a P<0.05was considered significant. Numerical values were given as means±SD unless stated otherwise. For statistical analyses, normality was assessed before choosing the relevant comparative test and nonparametric tests was used in cases in which the normality test failed.Results Compared with the death group, the CEO2, AVDO2, V-AGlu, V-ALac in the survival group decreased significantly (P<0.05), while V-APCO2and SjvO2increased significantly (P<0.05). In the subsequent prospective study, the accuracy rate of condition (SjvO2<52%5AVDO2>83%) was78.3%for prognosis prediction.Significance:The cerebral oxygen and glucose metabolism was obviously abnormal in hypertensive cerebral hemorrhagic patients with GCS score of5-8among the death group, and especially the anaerobic metabolism was apparently increased.It was also found that the risk threshold (SjvO2<52%,AVDO2>83%) was in close relationship with patients’death expectation.