86例异位妊娠破裂手术麻醉处理

目的通过对86例异位妊娠破裂手术的麻醉处理总结，探讨此类手术最佳的麻醉选择及管理方法。方法病人进入手术室前尽可能输乳酸林格溶液500～1500mL。A组（81例）：持续硬脊膜外阻滞，试验量为1．5％利多卡因0～5mL，5min后如无全脊麻征象，根据可能的出血量及循环稳定情况酌情分次给予1．0％。1．5％利多卡因＋0．5％～0．75％罗哌卡因5．0～10mL；B组（5例）：局麻＋静吸复合全麻，麻醉诱导采用咪唑安定0．02～0．03mg/kg、依托咪酯0．1～0．2mg/kg、阿曲库胺0．8～1．0mg/kg、芬太尼1．0～2．0μg／kg，术中以低浓度异氟醚、少量芬太尼、充足的维库溴铵维持麻醉。分别记录A组给予试验量后5min（T1）和给予全量后5min（T2）的血压、心率数值；B组诱导完毕（T1）及插管结束（T2）时的血压、心率数值；A组硬外阻滞不全加静脉辅助药者例数；两组血压下降20％以上者的例数；各组输血的例数。结果A组T1时间点血压下降幅度较B组同一时间点明显加大，心率上升亦较明显；硬膜外阻滞不全加静脉辅助药者42例；A组血压下降20％以上者15例（占32％），需辅助呼吸者12例；B组血压下降20％以上者1例（占20％）；A组输血11例，B组输血3例（自体输血2例）。结论异位妊娠破裂手术选用硬膜外阻滞生命体征变化较明显，对重度休克病人局麻＋静吸复合全麻相对更安全。

Anesthesia Management of Ruptured Ectopic Pregnancy Operation

Objective To discuss the best selection of anesthesia and management after summarizing 86 cases of rupture ectopic pregnancy operation.Methods 86 cases of such patient were divided into group A (81 cases) and group B(5 cases).The group A was given continuous epidural anesthesia with lidocaine and ripivacaine,the group B was given local,venous and inhaling combined anesthesia with midazolam,etomidate and fentanyl.The HR and Bp at 5 min before and after epidural anesthesia in group A inducing and extubation in group B were recorded.Results The HR and Bp in group A had obviously change than those in group B with more blood transfusion.Conclusion There might be obviously changes in vital signs when epidural anesthesia performed in rupture ectopic pregnancy.The severe shock patients should be treated with general anesthesia with safe.