To investigate the effect and clinical application value of propofol combined with midazolam on neurological function in patients with acute cerebral hemorrhage undergoing hematoma evacuation.

A total of 100 patients undergoing surgery for acute cerebral hemorrhage admitted to Shenmu Municipal Hospital from January 2022 to December 2024 were enrolled as research subjects, including 56 males and 44 females, aged 42~70 years [(52.44±6.02) years]. The patients were divided into a control group (n=50) and an observation group (n=50) by the random number table method. The control group received anesthesia with propofol alone, while the observation group received anesthesia combined with propofol and midazolam. Differences between the two groups were compared in vital signs [mean arterial pressure (MAP), heart rate (HR)], oxidative stress indicators [malondialdehyde (MDA), cortisol (Cor), norepinephrine (NE)], nerve injury factors [neuron-specific enolase (NSE), S100β protein (S100β)], National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS) score, anesthetic efficacy and safety indicators. Safety indicators contained anesthesia induction time, extubation time, post anesthesia care unit (PACU) stay time, incidence of intraoperative hypotension, dosage of vasoactive drugs, length of intensive care unit (ICU) stay, incidence of postoperative delirium and pulmonary infection.

There was a significant group × time interaction effect for HR and MAP (P<0.05). Simple effect analysis showed no intergroup differences in baseline vital signs (P>0.05). From T₂ to T₄ after operation, HR and MAP in the observation group were significantly lower. Vital signs remained stable throughout the observation period in the observation group, whereas obvious elevations in these indicators were observed in the early postoperative stage in the control group. The levels of MDA, Cor and NE at 48 h after operation were increased compared with preoperative levels in both groups; these indicators at 48 h postoperatively in the observation group were lower than those in the control group at the same time point (P<0.05). Meanwhile, the levels of NSE and S100β at 48 h after operation in the observation group were also significantly lower than those in the control group (P<0.05). Repeated-measures analysis of variance revealed statistically significant intergroup differences in NIHSS scores and mRS scores (both P<0.05). Pairwise comparisons after Bonferroni correction demonstrated that NIHSS and mRS scores at 1 month and 6 months postoperatively were lower than preoperative values in both groups, and scores at 6 months postoperatively were further decreased compared with those at 1 month postoperatively (P<0.05). The NIHSS and mRS scores of the observation group at 1 month and 6 months after surgery were lower than those of the control group at the corresponding time points (P<0.05). In addition, the observation group had shorter extubation time and PACU stay time, along with a lower incidence of intraoperative hypotension and less consumption of vasoactive drugs (P<0.05).

Anesthesia with propofol combined with midazolam in acute cerebral hemorrhage surgery can effectively stabilize patients' vital signs, alleviate oxidative stress response, improve anesthetic efficacy, and facilitate the recovery of neurological function, demonstrating substantial clinical benefits.