Abstract: Objective To explore the effect of three different surgical methods in the treatment of hypertensive cerebral hemorrhage(HICH) and the risk factors of postoperative rebleeding.
Methods The clinical data of 126 patients with hich from May 2017 to August 2019 were analyzed retrospectively.All the patients were divided into three groups according to the operation mode:the traditional craniotomy group(group A) 30 cases,the small bone window craniotomy group(group B) 46 cases,the minimally invasive hematoma drainage group(Group C) 50 cases.The operation time,hospitalization time,bleeding volume and short-term effect were compared among the groups,and the risk factors of postoperative rebleeding were analyzed.
Results The operation time,hospitalization time and bleeding volume of patients in group B and group C were lower than those in group A;the excellent and good rate of patients in the three groups was not statistically significant(P>0.05).By univariate unconditional logistic analysis,systolic blood pressure,bleeding volume,coagulation dysfunction,analgesics and sedatives,GCS score,bleeding site,operation mode and other indicators were correlated with the occurrence of postoperative rebleeding in hich(P<0.05).The results of multivariate unconditional logistic analysis showed that systolic blood pressure > 160mmhg,bleeding volume ≥ 60ml,coagulation dysfunction,no use of analgesics and sedatives,GCS score < 8,bleeding site in basal ganglia,different operation methods and other indicators were independent risk factors for bleeding after hich(P<0.05).
Conclusion Compared with the traditional craniotomy,small bone window hematoma removal and minimally invasive puncture hematoma drainage have the advantages of short operation time,less bleeding,short hospitalization time and low postoperative rebleeding rate;There are many factors of postoperative rebleeding in patients with hypertensive cerebral hemorrhage.High systolic pressure,large amount of bleeding,coagulation dysfunction and GCS score are the risk factors of postoperative rebleeding.

Key words: traditional craniotomy, hematoma drainage, small bone window craniotomy, hypertensive cerebral hemorrhage, curative effect, postoperative hemorrhage, risk factors