Clinical Observation And Analysis Of Cerebral Hemorrhage Complicated With Hypernatremia Treated By CRRT

Objective: Through CRRT therapy and conservative medical treatment of intracerebral hemorrhage with hypernatremia in patients with clinical observation and comparison,analysis of CRRT therapy on the treatment of the disease and prognostic advantages.Methods: All cases were hospitalized in the Department of Critical Care,People's Hospital of Wuqiao County from January 2016 to December 2017.All patients were diagnosed as having cerebral hemorrhage by head CT examination and hypernatremia occurred one to seven days after admission.In addition,serum sodium was greater than or equal to 150 mmol/l for 2 consecutive patients within 24 hours.A total of 60 patients were randomly allocated to a conservative medical treatment group and a CRRT treatment group,30 in each group.Including 37 males and 23 females,aged 39 to 79 years old.Of the 60 patients,22 were basal ganglia hemorrhage,23 were thalamic hemorrhages,10 were lobar hemorrhages,3were cerebellar hemorrhages,and 2 were brain stem hemorrhages.CRRT therapy,which is continuous renal replacement therapy,includes all continuous blood purification techniques that slowly remove solutes,and is being used in acute renal failure and other electrolyte disorders.In both groups,serum sodium ion concentration,urea nitrogen(BUN),and creatinine(Scr)levels were monitored and the patient's vital signs monitored on an automatic biochemistry analyzer.The clinical efficacy and prognosis of the two groups were compared.Result: Of the 30 patients in the CRRT treatment group,24 were cured(serum sodium concentration decreased to normal levels and patient consciousness was restored),accounting for 80%,and 5 cases were improved(serum sodium concentration dropped to normal level,but accompanied by disturbance of consciousness).It accounted for 16.67%,1 death,and mortality rate was 3.33%.Of the 30 patients in the conservative medical treatment group,15 cases cured 50%,6 cases improved 20%,9 cases died,and the mortality rate was 33.33%.2.The mortality rate in the conservative medical treatment group was significantly higher than that in the CRRT treatment group(P <0.01).Serum sodium ion concentration decreased after treatment with conservative medical therapy or CRRT in both groups.However,after treatment,serum sodium concentration in the CRRT treatment group was 143.5±3.2 mmol/l,which was lower than that in conventional medical treatment group.±±5.2 mmol/l decreased significantly(P<0.05).CRRTtreated group had a significantly lower BUN of 8.7±2.8 mmol/l than BUN 17.6±4.5 mmol/l(P<0.05).CRRT-treated group had Scr 107.7±30.7 umol/l was significantly decreased(P <0.05)compared with the routine medical treatment group Scr238.8±84.6umol/l.There was no significant difference in heart rate and mean arterial pressure between the CRRT treatment group and the conservative medical treatment group before treatment(P >0.05).The CRRT treatment group can control the blood sodium drop by about 1 mmol/L per hour,but it does not exceed 15 mmol/L throughout the day,making the sodium slowly and steadily decrease.About 2 to 3 days,blood sodium fell to the normal range.However,the rate of sodium decline in the conservative medical treatment group was uncontrollable and the treatment effect was poor.For patients with hypernatremia within 3 days,both groups achieved better results with a cure rate of 100%.For patients with hypernatremia after 3 days to 1 week,the cure rate in the CRRT group was 75%,the improvement rate was 20.83%,and the mortality rate was 4.17%.The cure rate of the conservative medical treatment group was 34.78%,the improvement rate was 26.09%,and the mortality rate was 39.13%.It can be seen that CRRT treatment group was significantly better than conservative medical treatment group.Conclusion: Hypernatremia is one of the common serious clinical complications in patients with cerebral hemorrhage.The clinical treatment is not timely or improper treatment may make the disease worse,and even lead to death.When patients with intracerebral hemorrhage have severe hypernatremia,it is often difficult to achieve ideal results using conventional medical treatment.CRRT is safe and effective in correcting electrolyte disturbances in hypertensive patients with cerebral hemorrhage.In the treatment of non-renal diseases,it can be used to treat severe electrolyte and acid-base metabolic disorders,lower blood sodium levels,and improve Patients' renal function and prognosis.