Multi-Factors Analysis And Treatment Strategies On Recurrent Hemorrhage After Operation Of Hypertensive Intracerebral Hemorrhage

Hypertensive intracerebral hemorrhage (HICH) locates in the brain or under the meninges, owing to the cerebrovascular pathological change which is caused by hypertension and arteriosclerosis. HICH has been as an independent classification of diseases from non-traumatic intracerebral hemorrhage, and there is a certain regularity in its pathogeny, the pathogenesis, the clinical process and the outcome. The death rate of conservative treatment is 70% to 85%, while surgical treatment may reduce the death rate to 28%-30%. But the recurrent hemorrhage after operation of HICH is one of its complications, once the treatment is not prompt, there will be serious consequences.[Purpose and Methods]: This paper retrospectively analyzes the clinical data of 163 cases of hypertensive intracerebral hemorrhage patients. It comprehensively expatiates the causes, the risk factors, the clinical manifestations, the early diagnosis, the treatment and the prognosis of the recurrent hemorrhage after operation of HICH. It also discusses the prevention and the cure methods, in order to deepen the surgeons'understanding of the recurrent hemorrhage after operation of HICH, so that it effectively increases the survival rate and improves the quality of life of hypertensive cerebral hemorrhage patients.[Results]: The recurrent hemorrhage after operation of HICH patients accounts for nearly 10% of HICH patients. It is mainly caused by the senility, the high blood pressure before and after operation, the big postoperative blood pressure fluctuation, the excessive preoperative cerebral hemorrhage, the premature or excessive application of mannitol, the intraoperative skills and so on.[Conclusion]: (1) The preoperative and postoperative hypertension status is the main reason for the recurrent hemorrhage after operation, at same time the big postoperative blood pressure fluctuation is the important inducement. (2) Most HICH patients are the elderly. Their blood vessel elasticity and the cruor mechanism maybe poor, consequently the hematoma cavity in which the cruor has not been cure and the surgical cuts may easily lead to the recurrent cerebral hemorrhage. (3) Recurrent cerebral hemorrhage is likely to happen because the hematoma is large in primary hemorrhage and the change gradient of the encephalic pressure is big after purging the postoperative hematoma. (4) Recurrent cerebral hemorrhage owes to the premature or excessive application of mannitol. (5) Recurrent cerebral hemorrhage is due to the unreliable intraoperative hemostasis and the blood pressure is low when the surgeons subjectively consider themselves to stanch completely for the patients. (6) The typical clinical manifestations show the various awareness changes, going with other symptoms such as: the disparate pupils, headache, nausea, vomiting and meningeal irritation. (7) The preferred way of diagnosis is CT. (8) The way of treatment can choose surgical treatment or conservative treatment according to the illness of the patients. (9) The key of the recurrent hemorrhage after operation of HICH lies in prevention, at the same time whether the diagnosis is timely and the treatment of recurrent cerebral hemorrhage are also directly related to the patient's prognosis.