2026 年第 2 期 第 21 卷

高原地区异位妊娠的临床特点分析

Clinical characteristics of ectopic pregnancy in plateau area

作者：赵静1尼玛卓嘎1李琳2

英文作者：Zhao Jing1 Nimazhuoga1 Li Lin2

单位：1西藏自治区拉萨市人民医院妇产科，拉萨850000；2首都医科大学附属北京妇产医院北京妇幼保健院妇科微创中心，北京100006

英文单位：1Department of Obstetrics and Gynecology Lhasa People′s Hospital Tibet Autonomous Region Lhasa 850000 China; 2Gynecological Minimally Invasive Center Beijing Obstetrics and Gynecology Hospital Capital Medical University Beijing Maternal and Child Health Care Hospital Beijing 100006 China

关键词：异位妊娠；高原地区；失血性休克

英文关键词：Ectopicpregnancy;Plateauarea;Hemorrhagicshock

• 摘要：

• 目的 探讨高原地区异位妊娠的临床特点。方法 回顾性选取2021年12月至2024年12月西藏自治区拉萨市人民医院妇科共收治的异位妊娠患者283例，其中输卵管妊娠192例，宫角妊娠7例，子宫瘢痕妊娠11例，卵巢妊娠5例，未明确具体位置68例。对患者临床资料进行回顾性分析。结果 283例患者年龄（31±6）岁，其中藏族患者219例（77.4%），来自于海拔≥4 000 m地区患者66例（23.3%），121例（42.8%）患者有流产史、101例（35.7%）患者有盆腔手术史，27例（9.5%）患者有异位妊娠病史，26例（9.2%）患者放置宫内节育环。283例患者中共203例行腹腔镜或开腹手术治疗，其中发生破裂失血性休克症状患者43例（21.2%），纳入合并休克组，其中藏族患者35例（81.4%），来自于海拔≥4 000 m地区患者11例（25.6%），余160例纳入未合并休克组。2组患者年龄、孕次、产次、流产次数及异位妊娠史、盆腔手术史、海拔≥4 000 m、藏族比例比较差异均无统计学意义（均P＞0.05）。合并休克组术中积血量、出血量、总积液量均大于未合并休克组，术前和术后血红蛋白、红细胞计数、血细胞比容均低于未合并休克组（均P＜0.05）。异位妊娠破裂失血性休克患者的出血量为2 100（1 550，2 550）ml，部分患者术前血红蛋白值仍在正常范围内。结论 高原地区异位妊娠合并失血性休克的发生情况与民族、生活地区海拔高度、流产次数、异位妊娠病史或盆腔手术史均无关，合并休克组术中积血量、出血量、总积液量均较大，术前和术后

  血红蛋白、红细胞计数、血细胞比容均较低。因高原地区缺氧患者血红蛋白代偿性升高，所以高原地区异位妊娠患者的血红蛋白值往往不能体现病情严重程度，需注重动态监测变化，结合其他检查手段尽早做出决策。

• Objective To investigate the clinical characteristics of ectopic pregnancy in plateau area. Methods A total of 283 patients with ectopic pregnancy admitted to Department of Gynecology, Lhasa People′s Hospital, Tibet Autonomous Region from December 2021 to December 2024 were retrospectively selected, including 192 cases of tubal pregnancy, 7 cases of cornual pregnancy, 11 cases of uterine scar pregnancy, 5 cases of ovarian pregnancy, and 68 cases of unspecified location. The clinical data of the patients were retrospectively analyzed. Results The average age of 283 patients was (31±6) years old, of which 219 patients (77.4%) were Tibetan, 66 patients (23.3%) were from areas with altitude ≥4 000 m, 121 patients (42.8%) had a history of abortion, 101 patients (35.7%) had a history of pelvic surgery, 27 patients (9.5%) had a history of ectopic pregnancy, and 26 patients (9.2%) with intrauterine device placement. A total of 203 cases of 283 patients were treated with laparoscopic or open surgery, including 43 cases (21.2%) with rupture and hemorrhagic shock symptoms, which were included in the combined shock group, including 35 cases (81.4%) of Tibetan patients, 11 cases (25.6%) from altitude ≥ 4 000 m, and the remaining 160 cases were included in the non combined shock group. There were no significant differences in age, pregnancy, parity, number of miscarriages, history of ectopic pregnancy, history of pelvic surgery, altitude ≥ 4 000 m, and proportion of Tibetans between the two groups (all P＞0.05). The intraoperative blood volume, blood loss, and total effusion volume in the combined shock group were greater than those in the non combined shock group, and the preoperative and postoperative hemoglobin, red blood cell count, and hematocrit were lower than those in the non combined shock group (all P＜0.05). The bleeding volume of patients with ectopic pregnancy rupture hemorrhagic shock was 2 100(1 550, 2 550) ml, and the preoperative hemoglobin value of some patients was still within the normal range. Conclusion The occurrence of ectopic pregnancy complicated with hemorrhagic shock at high altitude has nothing to do with nationality, altitude of living area, number of miscarriages, ectopic pregnancy history or pelvic surgery history. The intraoperative blood volume, blood loss, and total effusion volume of the combined shock group  were larger, and the preoperative and postoperative hemoglobin, red blood cell count, and hematocrit were lower. Due to the compensatory increase of hemoglobin in patients with hypoxia in plateau area, the hemoglobin value of patients with ectopic pregnancy in plateau area often cannot reflect the severity of the disease. It is necessary to pay attention to dynamic monitoring changes and make decisions as soon as possible combined with other examination methods.