宫外孕手术的麻醉

Theanesthesiaofectopicpregnancy宫外孕手术麻醉林莹宫外孕手术的麻醉第1页Ectopicpregnancyisthemostcommonemmergencysurgery.Theanesthesiadependsonthedegreeofbloodloss.宫外孕手术为常见急诊手术，麻醉处理主要取决于失血程度。

宫外孕手术的麻醉第2页Beforetheoperation,weshouldestimatethebloodlossandthewholebodyconditionofthepatientquickly.Andprepareforbloodtransfusiontorescurehemorrhagicshock.

麻醉前要对病人失血量和全身状态做出快速判断，并做好大量输血准备，方便抢救出血性休克。宫外孕手术的麻醉第3页Howtoestimatethebloodloss?

Earlyshockbloodloss400-600mlMildshockbloodloss800-1200mlModerateshockbloodloss1200-1600mlSevereshockbloodlossml

休克前期失血量约为400-600ml轻度休克失血量约为800-1200ml中度休克失血量约为1200-1600ml重度休克失血量约为ml宫外孕手术的麻醉第4页Forearlyandmildshock,wecanchoosesmalldoseepiduralanesthesiaonthebaseofsufficientfluidinfusion.

休克前期或轻度休克应在输血输液基础上，选取小剂量硬膜外阻滞宫外孕手术的麻醉第5页Formoderateandsevereshock,wecanchooselocalanesthesiaorgeneralanesthesiaifitdidn’tbeimprovedaftercomprehensivecure.

中度或重度休克，经综合治疗无好转者，应酌情选取局麻或全麻宫外孕手术的麻醉第6页Forsevereshock,wecouldfirststanchthebleedingafterlocalinfiltrationanesthesia.Whentheshockisimproved,thenusecomplexanesthesia,forexamplediazepamandketamine.

严重休克，可先在局部浸润麻醉下进腹止血，经补充血容量待休克好转后再给予地西泮、氯胺酮等复合麻醉宫外孕手术的麻醉第7页

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

选取气管内全麻，宜选取对心血管抑制较轻依靠咪酯、氯胺酮、琥珀胆碱复合麻醉宫外孕手术的麻醉第8页

Whenmodivating,preventanaboleandaspiration诱导时，严防呕吐误吸Duringtheoperation,supplywholeblood、dextranandequilibriumliquidaccordingtothebloodloss,thencorrectmetabolicacidosisandmaintainrenalfunction麻醉中，依据失血量补充全血、代血浆和平衡液，并纠正代谢性酸中毒，维护肾功效

Aftertheoperation,preventinfectionandthelesionofh