Reasons and preventive strategies for postoperative early rehaemorrhagia after neuroendoscopic treatment for hy-pertensive cerebral hemorrhage

XU Xiao-bing; LIN Fa-mu; LI Zi-jian; LUO Shi; PENG Yong-dong; CHEN Jian-min

Abstract：Objective To investigate the causes and preventive management of postoperative early rehaemorrhagia ( during the first 24 hours after operation ) after neuroendoscopic treatment for hypertensive cerebral hemorrhage .Methods The five known contributing factors for postoperative rehaemorrhagia such as age , alcoholism , antiplatelet or anticoagu-lant therapy , intraoperative hemostasis , fluctuation of postoperative blood pressure were analyzed retrospectively on 69 pa-tients with hypertensive putamen hemorrhage who underwent neuroendoscopic evacuation .Head CT scans were performed at 6 h and 24 h after operation in all patients .A CT scan was also performed immediately whenever the patients′conditions were getting worse after surgery .Sixty-nine patients were divided into the rehaemorrhagia group and the non -rehaemor-rhagia group.Results Intraoperative removal of more than 90%of hematomas was achieved in all of the 69 patients.Nine patients developed rehaemorrhagia within the first 24 hours after operation .The postoperative rehaemorrhagia rate was 13.0%.Ultra-early surgery was done in 77.8%of the rehaemorrhagia group while only in 23.3%of the non-rehaem-orrhagia group (P=0.003).Postoperative fluctuation of blood pressure occurred in 66.7% of patients in the rehaemor-rhagia group, whereas it only occurred in 13.3%of patients in the non -rehaemorrhagia group (P=0.001).Unreliable intraoperative hemostasis occurred in 55.6%of patients in the rehaemorrhagia group , whereas it only occurred in 11.7%of the non-rehaemorrhagia group (P=0.003).GCS scores before admission in 88.7%of patients in the rehaemorrhagia group were between 11 to 13, whereas only 43.3%in the non-rehaemorrhagia group had a GCS score between 11 to 13 (P=0.033).Conclusions Although many factors may be associated with postoperative rehaemorrhagia after neuroendo-scopic treatment for hypertensive cerebral hemorrhage , ultra-early surgery, unreliable intraoperative hemostasis and poor control of postoperative blood pressure may be the closely related factors .Therefore , proper timing of surgery , reliable in-traoperative hemostasis and strict postoperative management of blood pressure are the most important strategies to prevent postoperative rehaemorrhagia .