异位妊娠的急诊处理

Emergency treatment of ectopic pregnancy.

目的 探讨异位妊娠急诊处理方法及优劣。方法 异位妊娠 12 5 7例 ,分别采用手术和非手术治疗 ,回顾性分析各组的临床特征、主要诊断手段、并发症等 ,并探讨非手术治疗失败的原因。结果 后穹隆穿刺和B超诊断阳性率分别为92 .4 %和 6 1.1% ,血β HCG升高者89.0 %。休克或休克代偿期患者占 5 4 .9% ,腹腔内积血量 (5 4 5± 86 )ml。手术组β HCG恢复正常及住院时间明显短于非手术组 ;非手术治疗成功组与失败后再转手术组相比 ,前者β HCG、出血速度值均显著低于后者。结论 后穹隆穿刺是诊断和决定治疗方式的重要手段 ,有休克或休克代偿期者只能采取手术治疗 ;无休克患者 ,出血速度值是重要的预测非手术治疗能否成功的指标 ,β

Objective To study the emergency treatments of ectopic pregnancy and their advantage and disadvantage.Methods 1257 cases of ectopic pregnancy receiving treatments of operation and non operation were retrospectively analyzed on the clinical characters, diagnosis, complication and so on. The causes for non operation failure were explored.Results The positive diagnostic rate of puncture of Douglas and ultrasound examination was 92.4% and 61.1% respectively. 89.0% patients had an increase of β HCG. The patients in the stage of shock or shock compensation accounted for 54.9% . The mean volume of abdominal blood loss was (545±86)ml. The hospital stay and β HCG recovery time in the operation group were shorter than in the non operation group. The β HCG and the value of bleeding speed in the successful group by non operation was significantly lower than in unsuccessful group.Conclusion Puncture of Douglas was an important method for diagnosis of ectopic pregnancy and deciding treatments. The patients with shock or preshock due to bleeding must undergo surgical operation. In the paitents without shock, bleeding speed value is a key indicator for the prognosis of non operation. The patients with a lower β HCG have a higher successful rate of non operation.