Pathomorphological changes of lungs and functional biochemical parameters of respiratory function in patients with intracerebral hemorrhages

Abstract

Pulmonary complications and closely related with them systemic functional-biochemical abnormalities are the most common complications of cerebral stroke. The purpose of the work was to research functional-biochemical parameters of respiratory function and to find it’s association with morphological changes in the lungs because of intracerebral hemorrhage.

37 sectional observations in patients who die of intracerebral hemorrhage were analized. It was conducted analysis of morphological transformations and retrospective analysis of functional-biochemical findings of respiratory functions, in order to detect changes of systemic hemodynamics, oxygen balance and ion-osmotic one and acid-alkaline status.

The results of the study. The changes of blood gas composition and acid-alkaline status are registered in the lungs in the background of microcirculation disturbance from the first hours of development of intracerebral hemorrhage. During the first days of the onset of disease the partial oxygen pressure in arterial blood (РаО2) decreased 50,88% in comparison with the calculated normative findings. Partial pressure of carbon dioxide (РаСО₂) in the arterial blood rosed by 52,17%. Without conducting artificial lung ventilation PO₂ in venous blood decreased by 45,9%, and PCO₂ increased by 40%. I has been marked a decrease in the oxygen capacity of the blood, due to the reduction of hemoglobin content in the blood to 103,7 minus 2 g/l and the concomitant decline in hematocrit up to 0,24-0,3.

Deficit of the foundations has averaged from -6 to -10 mmol/l. These changes have led to a impression of the respiratory and metabolic acidosis, with a significant increase in the concentration of hydrogen ions. In the first day after the development of the disease with a rapid growing marks of swelling of the brain with concomitant dislocation of the brain stem, blood pH was 7,28 minus 0,02.

It has been histologically determined interstitial edema, that eventually spread to the intraalveolar sector. Swelling had segmental character without hemorrhagic component. Thickness of the intraalveolar septums in the fist day gradually increased by 25 - 34%. The average cross-sectional area of the microvessels increased by 2.25 times comparison with measurements. The changes in the large diameter of arterioles 200-250 microns were revealed vasoconstriction.

In 1-3 days of phenomena of stasis, sludge and aggregation of blood form elements have been identified both in vessels of microcirculation and small arterioles with diameter 30-40 mkm, erythrocytes in most capillaries acquired the blurred outline and pale colouring. In arterioles were detected fibrin clods, that has gained widespread nature in the 4-6 days of the disease.

In the 1-3 day and in subsequent periods (4-6 days) rose dystrophic and focal necrotic shifts of the bronchi epithelium with partial desquamation and filling gaps of the bronchioles. In these periods the part of the alveoli was emphysema expanded filled with fibrin net and accumulation of the fibroblasts, gemosiderophages, every where was been provided vary degree of severity of neutrophilic infiltration.

In case of compound cerebral haemorrhage have been determined signs of respiratory distress syndrome with multiple blood microclots in the microcircular vessels, laminar  atelectasis, increasing phenomena interstitial-alveolar edema with the presence a large number of erythrocytes in the alveoli, desquamatinal hurt alveolocytes, macrophages and fibrin in the form of «hyaline membranes».

The purulent loci of inflammation have been found at 1-3 days, the first signs of which there were in peribronhial  tissue. On the 4-6 day the phenomena of  fibrinous -purulent inflammation became more general character, in some with the formation of microabscesses. On 7-9 day and subsequent periods at the background of decrease swollen changes in the interstitial tissue appeared accumulation of the fibroblasts and sclerotic changes have been found in the lungs everywhere were marked small portions of fibrino-atelectasis.

Conclusion. Studies have shown that intracerebral hemorrhage from the first hours lead to increasing violations of functional-biochemical indices of respiratory functions with the deepening of the respiratory and metabolic acidosis based on disorders of the pulmonary microcirculation, edema, degenerative and inflammatory changes.