Severe coma due to cerebral hemorrhage

Cerebral hemorrhage is a relatively common disease at present. It will bring considerable pressure to the patient's body, and most patients with cerebral hemorrhage will fall into a coma, and may even produce a lot of high-pressure gas, and there will be complications. Severe cerebral hemorrhage will damage the brain nerves, so the patient will be poisoned and comatose. In this regard, we must pay attention to the recovery of cerebral hemorrhage, understand the onset of cerebral hemorrhage, and understand some changes after severe coma.

The treatment and prognosis of patients in coma due to hypertensive cerebral hemorrhage have always been a concern. After the onset of the disease, patients generally have to undergo treatment for high intracranial pressure, lung infection, gastrointestinal bleeding, renal failure, aphasia, hemiplegia of limbs, etc. Especially in comatose patients, the above clinical manifestations are particularly prominent due to the large amount of intracranial hemorrhage and the cause of the bleeding site, which makes the treatment chaotic. This study believes that the entire course of disease evolution of patients with coma due to hypertensive cerebral hemorrhage under medical intervention shows three stages: acute intracranial hypertension stage, complication stage, and recovery stage.

Stage 1: Acute intracranial hypertension (1.5-2.5 weeks). After cerebral hemorrhage occurs, brain damage occurs first, manifested as morphological changes caused by direct compression of the hematoma, followed by biochemical changes caused by cerebral edema and cerebral ischemia. Clinically, it manifests as high intracranial pressure and neurological dysfunction.

Especially for severe patients, although the hematoma pressure is relieved after surgery, the incidence of cerebral edema and severe intracranial hypertension is still very high. Another data shows that in patients with hypertensive cerebral hemorrhage, cerebral edema occurs around the hematoma 6 to 7 hours after the hemorrhage, and the edema reaches a peak in 3 to 7 days. Therefore, the first stage of treatment for hypertensive cerebral hemorrhage is: treatment of acute high intracranial pressure. The authors used drug dehydration and intracranial pressure reduction treatment for hospitalized patients. For patients with large amounts of bleeding, hematoma removal and drug reduction were used.

Among the 323 patients in this group who were in a mild to deep coma and had a bleeding volume of more than 30 ml, 301 (93.2%) had relief of high intracranial pressure after 1.5 to 2.5 weeks of intracranial pressure-reducing treatment, as confirmed by cranial CT, lumbar puncture, and decompression window tension. 22 patients died of high intracranial pressure and brain herniation due to rebleeding.

Increased intracranial pressure after cerebral hemorrhage is the main cause of death in the acute phase. Lowering intracranial pressure not only has the benefit of saving patients' lives in the short term, but recent studies have also shown that it can improve long-term prognosis. Therefore, this stage is the key to treatment.

Stage 2: Complication stage (starts 3 to 9 days after onset and improves in 2 to 2.5 weeks). Critically ill patients with hypertensive cerebral hemorrhage are very susceptible to infection, with an incidence as high as 37.3%, with lung infection being the most common. The onset time is early, usually appearing about 3 days after surgery, and even more serious clinical manifestations can occur 1 day after surgery. It lasts for a long time and is mostly a recurrent infection.

Phase 3: Recovery phase. In this study, among 323 patients with hypertensive cerebral hemorrhage, 250 (77.4%) survived the period of high intracranial pressure and complications and entered the recovery period 21 days after onset under medical intervention. Treatment measures include acupuncture, massage therapy, hyperbaric oxygen, active or passive functional exercise, psychotherapy, Chinese herbal medicine treatment, etc. Recovery treatment should begin as early as possible. Some people believe that the first three months are the best time for recovery treatment as neurological function recovers fastest. If there are signs of recovery of neurological function after more than 3 months, active treatment should be given.

The entire course of disease for patients in coma due to hypertensive cerebral hemorrhage presents three stages of changes, but each stage is not independent and they blend with each other in time. This group of studies found that the incidence of complications is highest during the period of high intracranial pressure, especially when cerebral edema reaches its peak (3 to 7 days). This is related to the high intracranial pressure that causes hypothalamic autonomic nervous system dysfunction, which eventually leads to heart, lung, kidney, and gastrointestinal dysfunction.

High intracranial pressure directly leads to the occurrence of complications. As the high intracranial pressure is relieved and the hypothalamic function is restored, the complications will improve accordingly. Therefore, in treatment, emphasis is placed on controlling high intracranial pressure as quickly as possible to avoid organic damage to the hypothalamus and other brain tissues, which is beneficial to reducing complications and mortality.

The recovery period does not simply end with the first period. It runs through the period of high intracranial pressure and the period of complications. The only difference is that the recovery period is a treatment period focused on rehabilitation. .