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Gastrointestinal hemorrhage with cerebral watershed infarction in 9 cases

The occurrence of cerebral watershed infarction. In all patients, decompensated liver cirrhosis, 7 cases of acute cerebral watershed infarction of its causes, on the one hand and the occurrence of upper gastrointestinal bleeding cirrhosis related to their higher probability the other hand, several factors with the following : ① patients with cirrhosis hemodynamic compensation is insufficient, then gradually speed up heart rate, myocardial oxygen consumption increases, arteries and veins to reduce the oxygen pressure, pH is low, then the loop body has a certain reserve of energy decrease and become brittle recycled. So again when the adverse factors affecting cycle, as indicated in gastrointestinal bleeding, can lead to effective hypovolemia, caused the redistribution of body fluids,[link widoczny dla zalogowanych], will be quickly and seriously affect the hemodynamics of systemic circulation _】]. ② plasma endothelin in patients with advanced cirrhosis of the liver of a 1 (endothelin-1, ET-1) levels may be a compensatory increase _l2]. Meanwhile, the effective reduction of blood volume can also stimulate the secretion of ET-1 and ET-1 is an endogenous substance so far known to have the strongest role in the vasoconstrictor agent, closing agent when combined with vascular smooth muscle cell surface to specific receptors,[link widoczny dla zalogowanych], through G protein dependent pathway, causing the sarcoplasmic reticulum Ca + release and extracellular Ca ions into the cell, leading to intracellular Ca ion concentration increases, leaving the vascular smooth muscle contraction. Resulting in cerebral vasospasm, stenosis. Severe gastrointestinal bleeding in clinical emergency, such as hypotension not corrected in time, prone to cardiovascular complications, seriously affecting the quality of life of patients. Especially when the nervous system atypical symptoms,[link widoczny dla zalogowanych], the clinic is often misdiagnosed as hepatic encephalopathy. In addition, elderly patients during intravenous infusion in the treatment of hemostatic, easily lead to platelet aggregation, induced thrombosis. Therefore, in the treatment of gastrointestinal bleeding in patients, close observation of their vital signs, it should also closely observe the patient's condition for the emergence of new neurological symptoms and signs,[link widoczny dla zalogowanych], should prompt the brain CT or MRI examination line and found the cerebrovascular complications, prompt treatment and improve prognosis. Intravenous hemostatic agents should also be used with caution to avoid cardiovascular complications. 【
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