宫内早孕合并输卵管妊娠腹腔镜手术麻醉管理及妊娠结局(附48例报告)

Anesthesia Management and Outcomes of Laparoscopic Surgery for Early Pregnant Women with Tubal Pregnancy: a Report of 48 Cases

目的 总结宫内早孕合并输卵管妊娠腹腔镜手术的麻醉方法和术巾管理。方法回顺我院生殖医学巾心2010年1月～2014年7月宫内单活胎早孕合并输卵管妊娠48例资料，均存气管内插管全凭静脉麻醉下接受腹腔镜手术。记录患者的一般情况、围术期情况、妊娠期合并症、妊娠结局及新生儿情况。结果同术期均平稳渡过。孕妇结局：7例（14．6％）自然流产，继续妊娠41例。继续妊娠者中，39例（95．1％）足月分娩，2例（4．9％）早产；8例（19．5％）发生孕期合并症；34例（82．9％）行剖宫产；41例胎儿均活产，出生体重（3429．2±499．4）g，2例（4．9％）为低体重新生儿，新生儿无窒息，均未见新生儿畸形。结论全凭静脉麻醉适用于宫内早孕合并输卵管妊娠患者的腹腔镜手术。全面了解妊娠期生理特征及麻醉用药的药学特征，使用最低有效剂量的麻醉剂，维持母体的氧合、灌注及内环境平衡能保证胎儿的最佳预后。

Objective To summarize the anesthesia management in laparoscopic surgery for early pregnant women with tubal pregnancy. Methods Forty-eight women diagnosed as early intrauterine pregnancy combined with tubal pregnancy from January 2010 to July 2014 were enrolled in this retrospective study. All the patients received laparoseopic surgery under endotraeheal intubation and total intravenous anesthesia. Their general conditions, per[operative conditions, pregnant complications, pregnant outeomes and newborns status were recorded. Results All the patients were operated successfully and recovered uneventfully. Among the 48 patients, spontaneous abortion occurred in 7 patients （ 14.6% ）. Among the remaining41 patients who continued on their gestation, 39 cases （95.1%） had full term deliveries, 2 cases （4.9%） terminated pregnancy with premature birth, 8 cases （19.5%） got different complications related to pregnancy, and 34 cases （82.9%） received cesarean sections. All the newborns survived, with an average weight of 3429.2±499.4 g. There were 2 cases （4.9%） of low birth weight. No asphyxia or congenital malformation was seen in all the newborns. Conclusions Total intravenous anesthesia can be applied to laparoscopic surgery smoothly for early pregnant women with tubal pregnancy. When surgery is indicated during pregnancy, maintenance of marternal oxygenation, perfusion and homeostasis with the minimum effective anesthetic dose will assure the best outcomes for the fetus.