Effect of rebleeding after hypertensive cerebral hemorrhage on postoperative survival

  The danger of hypertensive cerebral hemorrhage is enormous, and its lethality reaches 30%-70%. The presence of intracerebral hematoma worsens the patient’s condition, not only by the volumetric effect of the hematoma and the pressure on the surrounding brain tissue that produces cerebral edema, but also by the stimulation of the edema by harmful substances from the hematoma that aggravate the edema. Hematoma removal can improve patient survival by eliminating the volumetric effect while also eliminating the effects of active substances from hematoma decomposition. However, patients are at risk of rebleeding again. In our 134 cases, 29 cases of postoperative rebleeding, 21 cases died, with a mortality rate of 72%; while only 12 of the remaining 105 cases without hematoma recurrence died, with a mortality rate of only 11.4%. Thus, it is important to reduce postoperative rebleeding to improve the postoperative survival rate. The most important factor for the occurrence of rebleeding is the impact of intraoperative and postoperative blood pressure fluctuations on the vessels at the bleeding site. The hematoma after rebleeding is often larger than the primary hematoma, and the damage caused by the compression of the surrounding brain tissue is more severe.  If the recurrent hematoma is removed, the surgery aggravates the trauma to the brain tissue and the damage from reperfusion is further aggravated, resulting in irreversible damage to the surrounding brain tissue and increased mortality of the patient. We adopt continuous pumping to give different drugs and doses according to different patients, while monitoring blood pressure at all times to keep it stable and keep it within the required range, postoperative rebleeding is reduced and mortality is decreased, so keeping blood pressure stable is an important method to prevent rebleeding and reduce surgical mortality.