异位妊娠破裂手术的麻醉探讨

Clinic Study About Anesthetic Management of Ectopic Pregnancy Operation

目的 探讨异位妊娠破裂手术的麻醉处理。方法 病人入室前常规输乳酸林格溶液 5 0 0～ 15 0 0ml,391例行持续硬脊膜外阻滞 ,局麻药用 1%～ 1.5 %利多卡因或 0 .375 %～ 0 .5 %罗哌卡因 ;4 5例行气管插管全麻 ,采用芬太尼、咪唑安定、维库溴铵诱导气管插管 ,术中芬太尼、维库溴铵、异氟醚维持麻醉。结果 硬膜外麻醉组 391例中血压下降 192例 ,占 4 9 1% (192 / 391) ,另外导管脱出 2例 ,麻药毒性反应 4例 ,阻滞不全加静脉辅助药者 7例。气管插管全麻组 4 5例中血压下降 17例 ,占 37 8% (17/ 4 5 ) ,血压升高者 5例 ,插管困难 2例 ,术毕拔气管导管时发生呕吐误吸 1例。两组血压下降率无差异 (P >0 .0 5 )。结论 异位妊娠破裂手术选用硬膜外阻滞或气管内插管全麻各有利弊 。

Objective To investigate the anesthetic management of ectopic pregnancy operation Methods Patients have inputed 500～1 500 ml Ringer lactate solution before operation, 391 patients received epidural anesthesia, using 1%～1.5% lidocaine or 0.375%～0.5% ropivacine; 45 patients received general anesthesia with endotracheal intubation, induced with fentanvl, midazolam and vecuronium and maintained with fentanvl, vecuronium and isoflurane Results In patients who received epidural anesthesia, blood pressure descent occured on 192 patients, about forty nine point one percent, epidural tube lost on 2 patients, 4 patients occurred toxic response, and 7 patients needed intravenous drugs for block absence In patients who received general anesthesia, blood pressure descend on 17 patients and increased on 5 paients, 2 patients were difficult in endotracheal intubation, and one patient occurred vomiting and reflu when extubation There was no significant differences on blood pressure descent in two groups( P >0.05) Conclusion Either epidural anesthesia, or general anesthesia has its virtue and shortcoming for ectopic pregnancy operation Synthetic consideration is the key