异位妊娠破裂出血性休克42例急诊救治分析

目的总结异位妊娠破裂出血性休克患者急诊手术的救治经验。方法回顾分析42例异位妊娠破裂出血性休克，的治疗经过，总结最佳治疗措施与流程。结果42例患者年龄（31．6±4．8）岁，停经（49．4±6．2）d，均因下腹痛入院．有休克症状，腹腔穿刺均抽出不凝血，术前血色素平均（6．7±3．2）g/dl。36例经“绿色通道”直送手术室。开放两路以上静脉输液通道（其中一路中心静脉）行液体复苏，同时快诱导气管插管静吸复合全身麻醉下进行开腹（34例）或腹腔镜下手术（8例），腹腔出血（1123±436）ml，异体输血前均给予自体血液清洗回输（768±247）ml。手术切除患侧输卵管、宫角或剥取胚囊保留附件，所有患者术后均顺利恢复。结论“绿色通道”快速入院直送手术室，中心静脉穿刺置管后迅速液体复苏，快诱导插管全麻下手术，配合自体血液清洗回输可提高抢救成功率。

Emergency treatment of hemorrhagic shock caused by rupture of ectopic pregnancy: analysis of 42 cases

Objective To summarize the experience in emergency treatment of hemorrhagic shock caused by rupture of eetopie pregnancy. Methods The clinical data of 42 patients, aged （31.6±4.8）, were analyzed retrospectively. Results All the 42 patients showed the symptom of hypogastralgia, anemia, and shock （49.4±6.2） days after menolipsis. Thirty-six of them were taken to the operating room via the ＂green channel＂. More than 2 intravenous infusion channels were opened, including a channel of central vein for fluid resuscitation. Tracheal Intubation with combined epidural with intravenous anesthesia was conducted rapidly. 34 patients underwent laparotomy and 8 patients underwent laparoscopic operation. The amount of intra-abdominal hemorrhage was （1123 ±436） ml. Autogenous transfusion of （768 ±247） ml of blood was conducted before heterogeneous transfusion. The fallopian tube and uterine horn of the affected side were reseeted or the embryonic sac was striped with the appendix reserved. All patients recovered. Conclusion ＂Green channel＂, intubation by central vein puncture, rapid fluid resuscitation, operation under general anesthesia, and autogenous blood transfusion help improve the success of emergency treatment of hemorrhagic shock caused by rupture of eetopic pregnancy.