Brainstem hemorrhage is an acute neurological condition with a poor prognosis and high mortality rate. We have recently successfully treated 18 cases of brainstem hemorrhage. We would like to present the following for the benefit of our colleagues. Data and methods Clinical data: From 2002.1 to 2004.7, 148 cases of cerebral hemorrhage were admitted to our department, including 18 cases of brainstem hemorrhage, accounting for 12.62% of cerebral hemorrhage. Among them, 10 cases were male and 8 cases were female, age 40-65 years old, average 52.4 years old. Onset of disease: all were of dynamic onset. There was a history of hypertension in 16 cases, myocardial infarction in 1 case, and diabetes mellitus in 2 cases, and no previous history of cerebral hemorrhage or cerebral infarction. All cases were clearly diagnosed by CT examination, and the bleeding volume was between 1 ml and 10 ml. Among them, there were 6 cases of simple pontocerebral hemorrhage, 8 cases involving the midbrain and 4 cases involving the medulla oblongata. There were 6 cases of rupture into the cricoid pool or the 4th ventricle. The treatment method: immediately admitted to CCU with oxygen, cardiac monitoring, 15° decubitus position, cryoprotection of the head, retention of catheter, opening of intravenous access (indwelling needle); namely, dehydration and hypotension, application of cerebroprotective agents; tracheotomy was performed in all cases with heavy snoring and respiratory distress; one hemostatic agent (6-amino acid or hemostatic aromatic acid) was used in appropriate amount for 3-4 days after admission for those without hypercoagulable tendency; nasal feeding was placed after 48 hours. The nasal cannula was placed after 48 hours to ensure the supply of calories and the administration of drugs; subhypnotic therapy was used for those who were dry or developed hyperthermia. The results of treatment were 14 cases of tracheotomy and 12 cases of ventilator-assisted breathing. The longest hospitalization was 50 days, the shortest was less than 1 day, and the average was 20.4 days; 12 cases were discharged with different degrees of sequelae (diplopia, peripheral facial palsy, mild paralysis of one limb, etc.), 2 cases were discharged with atresia; 2 cases were discharged with less than one week of economic constraints after active treatment; 2 cases died within 12 hours after admission (both refused tracheotomy), and the bleeding volume was greater than 5 ml. The success rate was 77.8% (including those who finally gave up treatment on their own although they were successfully treated). Typical case: Zhang, male, 55 years old. When he got out of bed at 5:30 a.m., he suddenly felt dizziness and weakness in his right limb, and called 120 for treatment. He was taken to CCU at 6:30 a.m. He had a history of hypertension for 4 years and denied any history of diabetes mellitus, heart attack or angina pectoris. Physical examination on admission: T 37.2℃, P 120 beats/min, BP 192/120 mmHg, waking state, restlessness, snoring like sleep. Both pupils were like pinpoint, the left eye fissure was smaller than the opposite side, the left nasolabial sulcus was slightly shallow, the right limb was hypermobile, the right foot was lightly abducted, and both pathological signs were positive. Laboratory tests: routine blood WBC 9.4×109/L, neutral 77%, lymphatic 23%; electrolytes and renal function were not abnormal; CCG: “old inferior wall myocardial infarction”. Diagnosis: brainstem hemorrhage. The patient was sedated, lowered cranial pressure (mannitol plus glycerol fructose), and lowered blood pressure. 2 h later, the patient became respiratory depressed, and the oxygen saturation (SpO2) dropped from 98% to 82%, which improved after tracheotomy, and the pulse and blood pressure returned to normal. 10 h later, the patient’s body temperature rose to 38.5°C, and subhypnotic therapy was implemented. Mechanical respiration was implemented until spontaneous breathing resumed and SpO2 was maintained at 98% or more. Nasal feeding, daily electrolyte and renal function monitoring were performed to maintain water and electrolyte balance. High doses of vitamin C and cerebroprotective agents such as cerebrosides were applied. On the 6th day of hospitalization, he was given 2 sticks of chandan with 5% GS 250ml qd. On the 8th day, he stopped the use of hibernation and recovered consciousness, and on the 15th day, he was able to speak after extubation. The patient was discharged on day 25 with diplopia, left peripheral facial palsy and right limb muscle strength of 5-. The patient was discharged on day 25 with diplopia, left peripheral facial palsy, and right limb muscle strength of 5-. Initially, the patient’s functional posture position and passive movement and later limb and speech function training were carried out throughout. The experience of this group with high treatment success rate mainly lies in the following: ① dispelling concerns and actively performing tracheotomy; ② actively adopting hibernation therapy and head cryoprotection to reduce brain cell metabolism, not using wake-up promoters prematurely, and minimizing the patient’s functional brain load; ③ actively and orderly lowering cranial pressure treatment: crystal dehydration agent and colloidal dehydration agent (human albumin) combined; ④ early application of antioxidant and other brain protection agents in large quantities (5) timely administration of blood-activating and stasis-transforming Chinese herbal preparations; (6) nutrition to maintain water-electrolyte and acid-base balance; (7) focused care; (8) establishment and operation of a comprehensive treatment system for cerebrovascular diseases (implementation of the stroke unit concept and multidisciplinary collaboration). Brainstem hemorrhage with medullary paralysis and head shaking with loud snoring is not conducive to brain protection and is bound to aggravate the disease. In the past, tracheotomy was performed cautiously because of the intensity of nursing work and the risk of surgery. It is a bold reward to consider brainstem hemorrhage with loud snoring as an indication for tracheotomy; subcold temperature therapy, which can reduce tissue oxygen consumption and metabolism, improve tolerance to hypoxia, reduce cerebral edema, and protect the blood-brain barrier [1]. Early application of subhypothermia therapy can also prevent or reduce reactive hyperthermia after brain injury and prolong the duration of action of dehydrating agents. It can also stop bleeding in those who continue to bleed [2]; avoiding premature use of brain cell excitation-activating drugs in the critical acute phase is the best protection for brain cells; cranial pressure-lowering therapy, especially in elderly patients, mannitol dosage should be cautious and preferably supplemented with glycerol fructose. The application of human albumin is not only an excellent immune enhancing and nutritional support drug, but also a good drug to increase the colloid osmotic pressure in the body to reduce intracranial pressure; the application of brain cell protective agents, including calcium ion antagonists, free radical scavengers, excitatory amino acid NMDA receptor antagonists, etc., is beneficial to the rescue and treatment of brain stem hemorrhage; in recent years, the treatment of the acute phase of cerebral hemorrhage by activating blood circulation and resolving blood stasis has received attention [3]. According to the theories of traditional Chinese medicine, “the blood that leaves the meridian is stasis”, “if stasis blood does not go, new blood will not be born”, “treating the wind first treats blood, and the wind will be extinguished when the blood moves”, and combined with clinical objective In addition to the clinical objective “blood stasis evidence” and the self-stopping nature of cerebral hemorrhage. The early use of blood-activating and stasis-removing drugs has good therapeutic effect on hypertensive cerebral hemorrhage and is safe and effective [4]. Early application of antibiotics and anti-ulcer drugs is necessary to prevent infection and peptic ulcer; nutrition and maintenance of water and electrolyte balance are important aspects that should not be neglected; introduction of the concept of “stroke unit”, multidisciplinary collaboration, comprehensive standardized overall care and rehabilitation training are the guarantee of successful treatment of brainstem hemorrhage. References 1. Huang Ruxun, Liang Xiuling, Liu Chorin, eds. Clinical neurology [M]. First edition: People’s Health Publishing House. 1996. 172-1732. Qin Deying, Li Xianfeng . Adjunctive treatment of cerebral hemorrhage with subfreezing [J]. Zhong Yuan Medical Journal.2003,30(7):24-253. Wang W . Overview of recent studies on the treatment of cerebral hemorrhage in the acute phase by activating blood circulation and resolving blood stasis[J] . Modern Journal of Integrated Chinese and Western Medicine.2002,11(7):672-6744.Huang Y . Observation on the efficacy of early use of blood-activating and stasis-transforming drugs in the treatment of hypertensive cerebral hemorrhage[J] . Chinese Journal of Integrative Medicine and Emergency Medicine. 2000,7(5):279-281 Note: This article was published in the first issue of Chinese Journal of Neurology in 2005.