Abstract: Objective To analyze related factors of difficult extubation after external ventricular drainage in patients with ventricular hemorrhage. Methods A total of 206 patients with intraventricular hemorrhage undergoing ventricular puncture and external drainage were selected, and 142 of 206 patients were divided into normal extubation group(n=78)and difficult extubation group(n=64)according to conditions of tubes removal at 7 days after operation. The heart rate, diastolic blood pressure, systolic blood pressure, mean arterial pressure, intracranial pressure changes, average postoperative extubation time, postoperative average hospital stay, and occurrence of complications of two groups were compared; the influencing factors of difficult extubation after external ventricular drainage in treating intraventricular hemorrhage were analyzed, and multivariate Logistic regression analysis was used to find out the risk factors of difficult extubation. The rest of 64 patients with intraventricular hemorrhage caused by cerebral hemorrhage undergoing ventricular puncture and external drainage were selected as intervention group, and those in the difficult extubation group were as controls. The intervention group implemented intervention measures for risk factors, and the difficult extubation group implemented no intervention measures. The average hospital stay, average postoperative time of extubation, Glasgow Coma Scale(GCS)score, Glasgow Outcome Scale(GOS)score, and complication rate were compared between the intervention group and the difficult extubation group. Results The revised - Graeb score, heart rate, diastolic blood pressure, systolic blood pressure, mean arterial pressure, and intracranial pressure in the normal extubation group were significantly lower,while the GCS score was significantly higher than that in the difficult extubation group(P<0.05). Logistic regression analysis showed that the increase in intracranial pressure, cerebrospinal fluid circulation disorder, the presence of hematoma by CT examination, and poor drainage were independent risk factors of difficult extubation for intraventricular hemorrhage undergoing ventricular puncture and external drainage(P<0.05). The average postoperative hospital stay and the average postoperative extubation time of the intervention group were shorter than those of the difficult extubation group, and the GCS and GOS scores were higher than those of the difficult extubation group, the differences were statistically significant(P<0.05); the incidence of complications in the intervention group was lower than that in the difficult extubation group, but the difference was not statistically significant(P>0.05). Conclusion Elevated intracranial pressure, cerebrospinal fluid circulation disorder, poor drainage and the presence of hematoma by CT examination are independent risk factors for difficult extubation after extraventricular drainage in treating ventricular hemorrhage. Targeted clinical preventive treatment can effectively shorten drainage time and hospitalization time, reduce the incidence rates of complications such as intracranial infection, hydrocephalus, and re-bleeding, and improve the prognosis.