宮外孕手術(shù)的麻醉

Theanesthesiaofectopicpregnancy宮外孕手術(shù)麻醉林瑩宮外孕手術(shù)的麻醉第1頁Ectopicpregnancyisthemostcommonemmergencysurgery.Theanesthesiadependsonthedegreeofbloodloss.宮外孕手術(shù)為常見急診手術(shù)，麻醉處理主要取決于失血程度。

宮外孕手術(shù)的麻醉第2頁Beforetheoperation,weshouldestimatethebloodlossandthewholebodyconditionofthepatientquickly.Andprepareforbloodtransfusiontorescurehemorrhagicshock.

麻醉前要對(duì)病人失血量和全身狀態(tài)做出快速判斷，并做好大量輸血準(zhǔn)備，方便搶救出血性休克。宮外孕手術(shù)的麻醉第3頁Howtoestimatethebloodloss?

Earlyshockbloodloss400-600mlMildshockbloodloss800-1200mlModerateshockbloodloss1200-1600mlSevereshockbloodlossml

休克前期失血量約為400-600ml輕度休克失血量約為800-1200ml中度休克失血量約為1200-1600ml重度休克失血量約為ml宮外孕手術(shù)的麻醉第4頁Forearlyandmildshock,wecanchoosesmalldoseepiduralanesthesiaonthebaseofsufficientfluidinfusion.

休克前期或輕度休克應(yīng)在輸血輸液基礎(chǔ)上，選取小劑量硬膜外阻滯宮外孕手術(shù)的麻醉第5頁Formoderateandsevereshock,wecanchooselocalanesthesiaorgeneralanesthesiaifitdidn’tbeimprovedaftercomprehensivecure.

中度或重度休克，經(jīng)綜合治療無好轉(zhuǎn)者，應(yīng)酌情選取局麻或全麻宮外孕手術(shù)的麻醉第6頁Forsevereshock,wecouldfirststanchthebleedingafterlocalinfiltrationanesthesia.Whentheshockisimproved,thenusecomplexanesthesia,forexamplediazepamandketamine.

嚴(yán)重休克，可先在局部浸潤(rùn)麻醉下進(jìn)腹止血，經(jīng)補(bǔ)充血容量待休克好轉(zhuǎn)后再給予地西泮、氯胺酮等復(fù)合麻醉宮外孕手術(shù)的麻醉第7頁

Ifwechoosetracheacannulaanesthesia,we’dbetterusethedrugwhichrestrainsthecardiovascularsystemless,forexampleetomidate、ketamine、anectine.

選取氣管內(nèi)全麻，宜選取對(duì)心血管抑制較輕依靠咪酯、氯胺酮、琥珀膽堿復(fù)合麻醉宮外孕手術(shù)的麻醉第8頁

Whenmodivating,preventanaboleandaspiration誘導(dǎo)時(shí)，嚴(yán)防嘔吐誤吸Duringtheoperation,supplywholeblood、dextranandequilibriumliquidaccordingtothebloodloss,thencorrectmetabolicacidosisandmaintainrenalfunction麻醉中，依據(jù)失血量補(bǔ)充全血、代血漿和平衡液，并糾正代謝性酸中毒，維護(hù)腎功效

Aftertheoperation,preventinfectionandthelesionofh