Objective To study the effect of microbone window approach on the occurrence of pneumonia after surgery in patients with hypertensive cerebral hemorrhage. Methods Fifty-four patients with hypertensive cerebral hemorrhage treated surgically in our hospital from July 2010 to July 2013 were selected and divided into 33 cases in the traditional bone flap opening group and 21 cases in the microbone window approach group according to the surgical approach. The general surgical conditions, the incidence of postoperative pneumonia and the cellular immunity levels of patients at different time points before and after surgery were compared between the two groups. Results There were statistically significant differences in the size of the bone window, operative time, and intraoperative bleeding between the two groups (P < 0.05). The incidence of postoperative pneumonia was higher in the conventional flap-opening group than in the micro-opening group, and the difference was statistically significant (P < 0.05); the leukocyte count and C-reactive protein levels in the blood of patients in both groups increased on the third day after surgery compared with those before surgery, and the difference was statistically significant (P < 0.05); compared with the conventional flap-opening group, the leukocyte count and C-reactive protein levels were lower in the micro-opening group on the third day after surgery, and the difference was statistically significant (P < 0.05). The differences were statistically significant (P < 0.05). Conclusion The cellular immunity of patients with hypertensive cerebral hemorrhage in the microbony window approach was less affected by the surgery, and their postoperative incidence of pneumonia was lower than that of conventional bone flap craniotomy. Hypertensive cerebral hemorrhage is a serious cerebrovascular disease with the highest death and disability rates among all types of stroke and a serious risk to human health [1]. In patients with significant hematoma and significant impairment of consciousness, early surgical removal of the hematoma can effectively improve the prognosis and reduce neurological deficits. Bone flap craniotomy is the conventional procedure routinely used, and with the rise of minimally invasive techniques, the use of microbone window access is beginning to be explored in patients with hypertensive cerebral hemorrhage. Pneumonia is one of the common and serious complications in the early postoperative period after cerebral hemorrhage, and severe pneumonia is difficult to control and may even endanger the patient's life. As patients with postoperative cerebral hemorrhage have a low immune function, they are prone to prolonged infection, which not only affects the prognosis and increases the postoperative risk, but also prolongs the hospital stay and brings a great economic burden to the patient's family. For this reason, we compare the effects of bone flap craniotomy and microbone window access on the postoperative cellular immunity level of patients with hypertensive cerebral hemorrhage and compare the incidence of pulmonary infection in patients after the two procedures, in order to provide a reference for clinical work. 1. Data and methods 1.1 General data Fifty-four patients with hypertensive cerebral hemorrhage treated surgically in our hospital from July 2010 to July 2013 were selected and divided into 33 cases in the traditional bone flap craniotomy group and 21 cases in the micro-osseous window access group according to the surgical method. There was no significant difference between the two groups in terms of age, gender, history of hypertension, blood pressure level and previous medical history, and degree of preoperative impaired consciousness (P>0.05). 1.2 Inclusion criteria (1) All patients met the diagnosis of hypertension; (2) All were confirmed by CT scan for cerebral hemorrhage and excluded brain herniation. (3) immune diseases, serious heart, kidney and other chronic disease comorbidities were excluded;, (4) preoperative lung and other parts of the body infections were excluded and postoperative lung infections were confirmed; (5) cerebrovascular malformation, intracranial aneurysm, traumatic brain injury or bleeding caused by brain tumor were excluded. 1.3 Surgical approach All patients were operated under general anesthesia with tracheal intubation. Microbone window approach for hematoma removal: According to the CT examination results, a longitudinal straight incision of about 125 px long was made in the closest cortical area avoiding the functional area of the brain, and the mastoid retractor was used to retract. After cranial drilling, the bone window was enlarged to about 2.5-75px, and the dura was cut in a cross shape to puncture the hematoma site, and the correct puncture site was confirmed if there was dark red blood flow. The cerebral cortex is then incised in the direction of the puncture about 0.125px and bluntly separated to the hematoma cavity. The hematoma was completely removed under direct microscopic view. When removing the hematoma, care should be taken to adjust the negative pressure to avoid inadvertent aspiration of brain tissue, and the attached thin layer of hematoma around the hematoma wall can be removed without forcible removal. After careful hemostasis and examination for active bleeding, the dura was rinsed with saline and sutured, and a silicone drainage tube with measurement and control was left in the hematoma cavity. Conventional bone flap craniotomy for hematoma removal: Combine with CT examination check. According to the site and size of the hematoma, a cortical approach with a bone flap of about 6-8 cm was chosen from the nearest hematoma without blood vessels and important functional areas. the blood accumulated in the hematoma cavity was removed under direct vision by incising the cortex and carefully stopping the bleeding, suturing the dura and resetting the bone flap, and a drainage tube was routinely placed in the hematoma cavity. All patients were routinely tested for blood pressure, body temperature, respiration, pulse rate and oxygen saturation after surgery, sedated, given oxygen and kept the airway unobstructed, observed the drainage, and care was given to regular turning and patting the back, and occasional aspiration to prevent lung infection. 1.4 Observation indexes (1) The operating time, the presence of rebleeding, the amount of surgical bleeding, the amount of hematoma removal, etc. of the two different surgical methods. (2) Observe the incidence of postoperative pulmonary infections in patients. (3) The leukocyte and C-reactive protein levels of patients in both groups before and on the 3rd day after surgery. 1.5 Statistical analysis SPSS17.0 statistical software was applied to analyze and process the data statistically. Among them, the measurement data were expressed as (mean ± standard deviation) using t-test; the count data used chi-square test. P < 0.05 was set as the difference was statistically significant. 2.Results 2.1 Comparison of general surgical conditions between the two groups There was a statistically significant difference in the size of the bone window, operative time, and intraoperative bleeding between the two groups (P < 0.05). No significant difference was seen between the two groups when comparing the risk of postoperative rebleeding and hematoma clearance rate (p>0.05). 2.2 Comparison of the incidence of pneumonia between the two groups The incidence of postoperative pulmonary infection was 39.4% (13/33) in the conventional bone flap opening group, which was significantly higher than that of 14.3% (3/21) in the microbone window access group, and the difference was statistically significant (X2=3.880,p=0.049). 2.3 Comparison of leukocyte count and C-reactive protein level before and 3 days after surgery In both groups, the leukocyte count and C-reactive protein level increased on the third day after surgery compared with those before surgery, and the difference was statistically significant (P < 0.05); compared with the traditional bone flap opening group, the leukocyte count and C-reactive protein level were lower on the third day after surgery in the micro-osseous approach group, and the difference was statistically significant (P < 0.05). Currently, the common surgical procedures for hypertensive cerebral hemorrhage include traditional bone flap craniotomy hematoma removal, stereotactic hematoma aspiration and microbone window approach hematoma removal [2]. Zhang Teng [3] et al. observed 28 patients with microbone window access and 28 patients with traditional bone flap craniotomy and found that the microbone window craniotomy group had the advantages of shorter operative time, less bleeding, shorter mean hospital stay ((P < 0.01) and prognosis with no significant differences (P > 0.05) between the two groups in terms of preoperative general condition, state of consciousness, hematoma site and hematoma volume, and operative timing, etc. The prognosis was also better than that of the traditional craniotomy group (P < 0.05). In this study, there was a statistically significant difference in the size of the bone window, operative time, and intraoperative bleeding between the two groups (p < 0.05); no significant difference was found in the risk of postoperative rebleeding and hematoma clearance rate between the two groups (p > 0.05), which was consistent with the literature. Microbone window access hematoma removal can not only overcome the shortcomings of stereotactic puncture hematoma aspiration that cannot be seen directly, poor decompression effect and incomplete hemostasis, but also reduce the surgical trauma condition and mortality, ensure satisfactory postoperative decompression, minimize the impact of surgery on patients and improve their survival quality. Pneumonia is the most common early complication in patients with hypertensive cerebral hemorrhage, and effective prevention of postoperative pneumonia in patients with hypertensive cerebral hemorrhage is of positive significance to reduce postoperative risk and ensure patient prognosis [4]. In this study, the incidence of postoperative pulmonary infection was 39.4% (13/33) in the conventional bone flap opening group, which was significantly higher than that of 14.3% (3/21) in the microbone window access group, and the difference was statistically significant (P=0.049). Blood tests on postoperative day 3 in both groups revealed an increase in leukocyte count and C-reactive protein levels compared with preoperative levels, with statistically significant differences compared with preoperative levels (P < 0.05); compared with the traditional bone flap craniotomy group, patients in the microbone window access group had lower leukocyte and C-reactive protein levels on postoperative day 3, with statistically significant differences (P < 0.05). both C-reactive protein and leukocyte count were good predictors of Both C-reactive protein and leukocyte count are good predictors of inflammation, and the study concluded that the microbone window access group could better prevent the occurrence of infection compared with the traditional bone flap opening group. A study by Wanchun Yin et al [5] also confirmed that the microbone window approach had a milder effect on the cellular immunity of patients compared to the traditional approach. The main reasons for the occurrence of pulmonary infections in patients with hypertensive cerebral hemorrhage are (1) the effect of the respiratory tract. First, the stress response of the body after cerebral hemorrhage overactivates the sympathetic-adrenal system, and the body produces large amounts of catecholamines causing systemic vasoconstriction and pulmonary stasis causing impaired oxygen diffusion [6]. Secondly, the bleeding site may compress the respiratory center, causing central respiratory dysfunction. Finally, the patient is mostly in a comatose state, and physiological reflexes such as swallowing and coughing are weakened or absent, and respiratory secretions cannot be eliminated in a timely and effective manner, which is highly likely to be complicated by pulmonary infection [7]. The increased intracranial pressure caused by intracranial hemorrhage often causes patients to vomit violently, and it is very easy to have misaspiration. (2) Decreased immunity of the organism. Patients usually have low cardiopulmonary function, poor organism tolerance, stress and neuromodulation disorders of surgery, combined with coma or prolonged bed rest after bleeding, all of which suppress the immune function of the organism [8].