宫外孕手术的麻醉.ppt

可编辑 可编辑 The anesthesia of ectopic pregnancy宫外孕手术的麻醉 林莹 Ectopic pregnancy is the most common emmergency surgery. The anesthesia depends on the degree of blood loss. 宫外孕手术为常见的急诊手术，麻醉处理主要取决于失血程度。 Before the operation,we should estimate the blood loss and the whole body condition of the patient quickly. And prepare for blood transfusion to rescure hemorrhagic shock. 麻醉前要对病人的失血量和全身状态做出迅速判断，并做好大量输血准备，以便抢救出血性休克。 How to estimate the blood loss? Early shock blood loss 400-600ml Mild shock blood loss 800-1200ml Moderate shock blood loss 1200-1600ml Severe shock blood loss 2000ml 休克前期 失血量约为400-600ml 轻度休克 失血量约为800-1200ml 中度休克 失血量约为1200-1600ml 重度休克 失血量约为2000ml For early and mild shock ,we can choose small dose epidural anesthesia on the base of sufficient fluid infusion . 休克前期或轻度休克应在输血输液基础上，选用小剂量硬膜外阻滞 For moderate and severe shock ,we can choose local anesthesia or general anesthesia if it didn’t be improved after comprehensive cure. 中度或重度休克，经综合治疗无好转者，应酌情选用局麻或全麻 THANK YOU SUCCESS * * 可编辑 For severe shock ,we could first stanch the bleeding after local infiltration anesthesia. When the shock is improved ,then use complex anesthesia, for example diazepam and ketamine. 严重休克，可先在局部浸润麻醉下进腹止血，经补充血容量待休克好转后再给予地西泮、氯胺酮等复合麻醉 If we choose trachea cannula anesthesia ,we’d better use the drug which restrains the cardiovascular system less, for example etomidate、 ketamine 、anectine. 选用气管内全麻，宜选用对心血管抑制较轻的依托咪酯、氯胺酮、琥珀胆碱复合麻醉 When modivating ,prevent anabole and aspiration诱导时，严防呕吐误吸 During the operation ,supply whole blood、dextran and equilibrium liquid according to the blood loss ,then correct metabolic acidosis and maintain re