李洪书+华海红+赵雅玲

【摘要】 目的 探討腹腔镜手术治疗异位妊娠出血性休克患者的可行性以及感染发生及预防情况。方法 68例异位妊娠伴出血性休克患者， 随机分为实验组与对照组， 每组34例。所有患者在入院后均给予补充血容量、吸氧、保暖以及纠正休克的治疗， 在此基础上对照组采用开腹手术， 实验组采用腹腔镜手术， 比较两组手术相关指标以及术后感染发生情况。结果 两组患者术中最低血压、手术时间比较差异无统计学意义（P>0.05）；实验组患者术中出血量、输血量显著低于对照组， 差异具有统计学意义（P<0.05）。两组发热例数、发热持续时间比较差异无统计学意义（P>0.05）；实验组胃肠功能恢复时间、下床活动时间和住院时间均显著短于对照组， 差异具有统计学意义（P<0.05）。随访1个月， 两组切口均为甲级愈合， 实验组术后无感染发生， 对照组有4例发生院内感染（11.76%）， 经对症抗感染处理已好转， 两组感染发生情况比较， 差异具有统计学意义（P<0.05）。结论 在抗休克治疗的同时， 采取腹腔镜手术， 对异位妊娠出血性休克患者术后恢复以及减少感染发生方面具有显著效果， 适合推广。

【关键词】 腹腔镜手术；异位妊娠；出血性休克；感染

DOI：10.14163/j.cnki.11-5547/r.2017.01.025

Feasibility and infection prevention of laparoscopic surgery in the treatment of ectopic gestation hemorrhagic shock patients LI Hong-shu， HUA Hai-hong， ZHAO Ya-ling. Department of Obstetrics and Gynecology， Dongguan City Changan Hospital， Dongguan 523843， China

【Abstract】 Objective To investigate feasibility and infection prevention of laparoscopic surgery in the treatment of ectopic gestation hemorrhagic shock patients. Methods A total of 68 patients with ectopic gestation hemorrhagic shock were randomly divided into experimental group and control group， with 34 cases in each group. All patients received blood capacity supplement， oxygen inhalation， warm keeping and shock correction for treatment after admission. On this basis， the control group received laparotomy， and the experimental group received laparoscopic surgery. Comparison was made on operation related indexes and postoperative infection between the two groups. Results There was no statistically significant difference of minimum intraoperative blood pressure and operation time between the two groups （P>0.05）. The experimental group had lower intraoperative bleeding volume and blood transfusion volume than the control group， and their difference had statistical significance （P<0.05）. There was no statistically significant significance of fever cases and duration between the two groups （P>0.05）. The experimental group had obviously shorter gastrointestinal function recovery time， off-bed activity time and hospital stay time than the control group， and the difference had statistical significance （P<0.05）. After 1 month of follow-up， both groups had grade A healing wound. The experimental group had no case with postoperative infection， while there were 4 cases with nosocomial infection in the control group （11.76%）， which were improved by anti-infection treatment. The difference of infection between the two groups had statistical significance （P<0.05）. Conclusion Implement of laparoscopic surgery along with anti-shock treatment provides excellent effect for postoperative recovery and infection decrease in ectopic gestation hemorrhagic shock patients， and this method is suitable for promotion.

【Key words】 Laparoscopic surgery； Ectopic gestation； Hemorrhagic shock； Infection

异位妊娠指的是受精卵着床位置在子宫体腔以外的位置， 主要发生部位包括卵巢、子宫颈、腹腔以及输卵管等[1-5]。对于异位妊娠患者， 妊娠一旦破裂， 将发生大出血， 患者很容易发生失血性休克， 对其生命造成严重的威胁[6]， 临床上传统多采用开腹手术治疗， 近年来随着腹腔镜技术的不断推广， 临床上逐渐开始采用该技术进行治疗， 因此为了探讨两种方法的差异性， 本研究对本院收治的68例患者进行分组对照研究， 报告如下。

1 资料与方法

1. 1 一般资料 选择2015年1月～2016年5月本院妇产科收治的68例异位妊娠伴出血性休克患者， 随机分为实验组与对照组， 每组34例。实验组年龄25～40岁， 平均年龄（35.9±4.7）岁， 平均停经时间（39.7±7.5）d， 平均阴道流血时间（11.4±3.1）d， 其中输卵管峡部妊娠13例、输卵管壶腹部妊娠8例、输卵管伞部妊娠8例、卵巢妊娠5例；对……