〔Abstract〕 Objective To investigate the ECG changes before and after operation and clinical prognosis in patients with hypertensive intracerebral hemorrhage. Methods 186 patients with HICH treated by surgery were retrospectively chosen in the period from January 2017 to December 2019 in Chaoyang District People's Hospital of Shantou. The ECG examination results before and after operation were analyzed, and the ECG abnormal rate, hematoma clearance and mortality before and after operation were compared. Results The ECG changes before operation of the selected patients included 174 cases of sinus tachycardia, 112 cases of ST segment descent with T wave depression / inversion, 78 cases of left ventricular hypertrophy, 22 cases of atrial premature contraction, 30 cases of ventricular premature contraction, 24 cases of sinus bradycardia, 24 cases of QT interval prolongation, 22 cases of left anterior branch block, 16 cases of supraventricular tachycardia, 14 cases of atrial fibrillation and 12 cases of complete right bundle branch block; Postoperative ECG changes included 102 cases of sinus tachycardia, 84 cases of ST segment descent with T wave depression / inversion, 76 cases of left ventricular hypertrophy, 22 cases of left anterior branch block, 16 cases of ventricular premature contraction, 12 cases of atrial premature contraction, 12 cases of complete right bundle branch block, 8 cases of sinus bradycardia, 6 cases of QT interval prolongation, 4 cases of atrial fibrillation and 4 cases of supraventricular tachycardia. The abnormal rate of ECG after operation of different operation methods was significantly lower than that before operation, and the difference was statistically significant (P < 0.05). The hematoma clearance of patients undergoing large bone flap craniotomy 24 hours after operation was significantly higher than mall bone window craniotomy and minimally invasive puncture hematoma clearance, the difference was statistically significant (P < 0.05). The mortality of different groups was 5.12% (4/78) in small bone window craniotomy group, 3.85% (2/52) in minimally invasive puncture hematoma removal group, 23.53% (8/34) in large bone flap craniotomy group and 18.18% (4/22) in ventricular puncture drainage group. The mortality of patients undergoing large bone flap craniotomy was significantly higher than small bone window craniotomy, minimally invasive puncture hematoma removal and ventricular puncture drainage the difference was statistically significant (P < 0.05). Conclusion The abnormal rate of ECG in patients with HICH was high and the abnormal ECG was significantly improved after effective removal of hematoma.