宫外孕手术的麻醉.ppt

Theanesthesiaofectopicpregnancy宫外孕手术的麻醉 林莹 Ectopicpregnancyisthemostcommonemmergencysurgery Theanesthesiadependsonthedegreeofbloodloss 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 Beforetheoperation weshouldestimatethebloodlossandthewholebodyconditionofthepatientquickly Andprepareforbloodtransfusiontorescurehemorrhagicshock 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 Howtoestimatethebloodloss Earlyshockbloodloss400 600mlMildshockbloodloss800 1200mlModerateshockbloodloss1200 1600mlSevereshockbloodloss2000ml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 Forearlyandmildshock wecanchoosesmalldoseepiduralanesthesiaonthebaseofsufficientfluidinfusion 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 Formoderateandsevereshock wecanchooselocalanesthesiaorgeneralanesthesiaifitdidn tbeimprovedaftercomprehensivecure 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 Forsevereshock wecouldfirststanchthebleedingafterlocalinfiltrationanesthesia Whentheshockisimproved thenusecomplexanesthesia forexamplediazepamandketamine 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 Ifwechoosetracheacannulaanesthesia we dbetterusethedrugwhichrestrainsthecardiovascularsystemless forexampleetomidate 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 Whenmodivating preventanaboleandaspiration诱导时 严防呕吐误吸Duringtheoperation supplywholeblood dextranandequilibriumliquidaccordingtothebloodloss thencorrectmetabolicacidosisandmaintainrenalfunction麻醉中 根据失血量补充全血 代血浆和平衡液 并纠正代谢性酸中毒 维护肾功能Aftertheoperation preventinfect