耳穴辅助全麻妇科手术围手术期机体调整作用研究
|
摘要
目的：
1.文献研究：采用文献计量及评价方法,对近年来国内针灸方法辅助静脉全麻手术的相关文献进行检索、整理、分析,评价针灸辅助静脉全麻手术的镇痛及对心血管系统的影响,以指导科研、临床研究。
2.临床研究：(1)通过耳穴贴压疗法辅助气管插管全麻手术的研究,观察气管插管全麻手术的病人麻醉用药量；(2)运用简便有效的耳穴贴压疗法,于围手术期给予持续治疗,观察其辅助镇痛效果；(3)观察耳穴贴压对术后机体恢复的干预效果,研究该法对麻醉和手术损伤及术后并发症的作用；(4)探讨该法是否能通过神经递质、炎症反应、抗氧化应激反应促进机体适应麻醉及手术,以期能扩大耳穴贴压疗法的应用范围；(5)基于研究结果,总结出一套简便有效的耳穴贴压辅助气管插管全麻的操作方法。
方法：
1.文献研究：以“针灸”OR“针刺”AND“静脉全麻”OR“全凭静脉麻醉”AND“随机”为检索策略,电子检索中国生物医学文献数据库、中国知网、维普数据库、万方数据库,其中中国知网包括中国期刊文献数据库、重要会议全文数据库、硕博学位论文数据库；不能获取的全文,则辅以手工检索广州中医药大学图书馆过刊资料库。根据纳入、排除标准选择适宜文献,进行Meta分析。
2.临床研究：
(1)分组方法：采用SPSS18.0随机序列生成模块将受试者分为3组：(1)耳贴安慰对照组(对照组),40例；(2)耳穴贴压组(耳穴1组),40例；(3)耳穴前后对贴组(耳穴2组),40例。
(2)实验步骤：
①全部病例入院抽血检验(血常规、β-EP、TNF-α、MDA)。
②同时给与中医分型。可分为气滞血瘀、气虚血瘀、湿瘀阻络三型。
③术前一日观察患者耳廓,用拇指和食指牵拉耳廓,在充足的自然光线下进行视诊,由内向外,从上而下,观察其是否有皮肤破损、脱屑。再利用耳穴探测器,选取双侧子宫、心、肺、胃、脾、肝、神门、皮质下、内分泌、交感等穴位,再在穴区内探查最敏感点。
耳穴1组：常规75%酒精双耳消毒,贴压磁珠。采用磁疗贴藉其机械压迫和磁场效应刺激耳穴。以拇指、食指对压耳穴,按压穴位力度逐渐加大,一松一紧,使之产生痛、麻、胀、热的感觉,以局部发红、患者自觉发热可耐受为度。术中操作者每30分钟按压1次,每次按压频率为60次／分,每个穴位按压30秒,用力均匀。术后按压耳穴,每日按压5次,3日后去除耳穴贴。并嘱患者应防止胶布潮湿和污染,如有患者易胶布过敏,则换用抗过敏胶布。
耳穴2组：在耳穴1组的贴压部位的耳背面对贴,其他操作和耳穴1组一样。
对照组：在探查到的耳穴敏感点敷贴同样外观和数量的无磁珠胶布,并不行任何刺激,其他操作同上。
④术前准备：所有患者术前30分钟均常规注射苯巴比妥钠(鲁米那)0.1克、阿托品0.5毫克。入室后抽取静脉血3毫升静置。
⑤开通静脉后常规连接多功能监测仪(Marquette EA-GLE3000)、并连接脑电意识深度监测仪(德国Narcotrend-comPact),以监测患者术中麻醉镇静深度、血压、心电图、手指脉氧饱和度、呼末二氧化碳等参数。手术行气管插管全麻,呼吸机(德国德尔格Fabius GS),诱导用药：异丙酚,舒芬太尼,顺式阿曲库胺；维持用药：异丙酚,根据手术需要追加舒芬太尼。维持患者的心率、血压、波动在±15%水平,脑电Narcotrend值为40-60。术中静脉输注乳酸钠林格注射液输液速度统一为8ml·kg-1·h-1,如失血较多,按失血量补充晶体：胶体为1：1的液体。术毕待病人清醒后拔除气管导管,送返病房。
⑥手术操作：三组患者均进行腹腔镜手术。麻醉后常规消毒腹部及外阴、阴道,放置导尿管和根据手术需要放置举宫器(无性生活史者则不放置举宫器)。患者平卧位,进行人工气腹,于肚脐穿刺气腹针进入腹腔,连接自动CO2气腹机,l～2L/min流速进行CO2充气,当充气1L后,调整患者体位至头低臀高位(倾斜约15-25。),继续充气,使腹腔内压力达12mmHg,拔去气腹针,放置腹腔镜,接好CO2气腹机,术中维持腹腔内压在12mmHg,打开冷光源,见盆腔视野。再根据不同的手术需求选择不同的位置进行第2、3点穿刺,进行腹腔的探查和肿物的切除。手术结束时用0.9%氯化钠注射液冲洗盆腔,检查无出血,无内脏损伤,放尽腹腔内CO2,取出腹腔镜及各穿刺点的套管针鞘,缝合穿刺口。
⑦记录患者手术过程各时点(包括：入室时、麻醉诱导时、插管时、气腹时、术毕)心率、平均动脉压；
⑧术中输注丙泊酚、舒芬太尼,根据心率、血压、脑电指数等调节至适宜麻醉深度。使心率和血压维持在基础值的15%左右,脑电指数控制在40-60。
⑨术毕时,抽取静脉血3毫升,送患者返回病房。
(3)观察指标
①一般临床资料记录：姓名、体重、年龄、中医分型及舌脉、ASA分级、疾病诊断和手术方式等。
②焦虑评分记录：于手术前一天及术后第三天时由患者自行评价状态-特质焦虑问卷(STAI)见附录,以评价耳穴贴压对患者神志、情绪状况的调整作用。
③血流动力学记录：入室时、麻醉诱导时、插管时、气腹时、术毕时各个时点的心率(HR)、平均动脉压(MAP),以评价耳穴贴压对机体血流动力学的调整作用。
④镇痛评分记录：术中记录患者使用的丙泊酚、舒芬太尼用量,术后24小时记录患者疼痛视觉模拟评分(VAS评分),记录术后第三天静息状态下疼痛发生情况,以评价耳穴辅助镇痛的作用。
⑤胃肠功能恢复观察：记录患者术前和术后24小时音每分钟肠鸣次数、术后首次排气及首次排便时间,以评价耳穴贴压对机体消化系统功能恢复的调整作用。
⑥术后第三天复查生化指标,以评价耳穴贴压对生理变化的调整功能。
⑦应用酶联免疫吸附法(Elisa)测肿瘤坏死因子(TNF—a)、β内啡肽(β-EP)；硫代巴比妥酸(TBA)法测定丙二醛(MDA)含量。以探明耳穴贴压镇痛及氧化应激等相关作用机制。
结果：
1.文献研究：本评价共纳入11项RCT,共710例受试者。大多是小样本试验,而且方法学质量不高,有4项研究仅提及随机字样,没有详细交代随机方法,11项研究均为提及实施随机化隐藏,因此可能造成选择性偏倚。仅1项试验提及“单盲法”。经Meta分析后,显示针灸辅助静脉麻醉与单纯静脉麻醉比较对气管插管即刻的血流动力学的影响优势明确,其他各时点优势尚不能确定,提示针灸对机体应激时有保护作用。对麻醉药物使用量的影响优势确定,提示针灸对机体辅助镇静镇痛作用,减少麻醉药品的使用量。
2.临床研究
(1)三组患者的年龄、体重、手术方式、ASA分级、中医证型等方面的比较,组间差异无统计学意义(P>0.05),提示组间具有可比性。(2)三组病例麻醉镇静深度指数比较差异无统计学意义(P>0.05)。(3)术中三组麻醉药用量的比较,异丙酚的使用剂量差异无统计学意义(P>0.05),舒芬太尼的用量三组间差异有统计学意义(P<0.05),与对照组比较耳穴1组和耳穴2组分别减少了15.50%和22.73%。(4)三组患者各时间点的心率、平均动脉压的组间比较差异均无统计学意义(P>0.05),说明各心率、动脉压在术中各时间点略有变化,但无显著影响。5.三组病例状态-特质焦虑问卷(STAI)评分,耳穴1组、耳穴2组分数低于对照组的特质问卷(T-AI)评分,组间差异无统计学意义(P>0.05)；三组病例术前S-AI评分差异无统计学意义(P>0.05),术后三组分数均降低,组内与术前自身比较差异有统计学意义(P<0.01),三组间比较差异有统计学意义(P<0.05),术后耳穴1、2组评分均低于对照组,且差异有统计学意义(P<0.05),而术后耳穴1组与耳穴2组比较差异无统计学意义(P>0.05)。各组各证型比较差异均无统计学意义(P>0.05)。(6)手术后第一天疼痛VAS评分与对照组的比较,耳穴1、2组的差异有统计学意义(P<0.05),而耳穴1组与耳穴2组的比较差异无统计学意义(P>0.05),手术后第三天疼痛发生情况比较,三组间差异有统计学意义(P<0.05),各组各证型比较差异无统计学意义(P>0.05)。(7)与对照组比较,耳穴1、2组肠鸣音术前差异无统计学意义(P>0.05),各组的组内比较术后与术前的差异有统计学意义(P<0.01),三组之间术后24小时的比较差异均有统计学意义(P<0.01)；与对照组比较,耳穴1、2组术后排气、排便时间均有所提前,差异有统计学意义(P<0.05),说明耳穴可以促进肠道的蠕动,帮助机体及早的恢复消化功能。各组各证型比较,差异无统计学意义(P>0.05),说明耳穴对各证型都可以使用,无特异性。(8)与对照组比较,耳穴1、2组白细胞差异虽均无统计学意义(P>0.05),但是术后较术前均有升高,且对照组幅度最大,其次是耳穴1组,耳穴2组最少,说明耳穴对手术后炎症的发生有抑制趋势。(9)与对照组比较,中性粒细胞绝对值、中性粒细胞百分比耳穴1组差异无统计学意义(P>0.05),耳穴2组差异有统计学意义(P<0.05)。(10)淋巴粒细胞绝对值、单核粒细胞绝对值、血红蛋白、钠离子、钾离子、血糖浓度三组之间差异都没有统计学意义(P>0.05)。(11)同对照组比较,耳穴1、2组的β-内啡肽含量手术前差异有统计学意义(P<0.05),手术后三组间差异没有统计学意义(P>0.05)。术前、术后各证型比较,β-EP含量差异无统计学意义(P>0.05)。说明耳穴可以使β内啡肽水平升高,从而发挥镇痛的作用。(12)三组间术后肿瘤坏死因子含量比较,差异无统计学意义(P>0.05)。(13)三组间术后丙二醛含量比较,组间差异有统计学意义(P<0.05)。说明耳穴可以抗氧化应激,抵抗细胞的损伤。
结论：
本研究表明,耳穴贴压辅助妇科腹腔镜手术镇痛作用及围手术期对机体功能的调整作用是肯定的。在手术前期可以缓解患者紧张、焦虑、恐惧的情绪,通过调整体内β内啡肽、肿瘤坏死因子及丙二醛来启动抗痛系统,抵制氧化应激反应,维持机体的稳定,并降低术中麻醉药品的使用。于手术后缓解术口疼痛,促进患者肠蠕动,提前首次排气、排便时间,调整术后胃肠功能,帮助机体快速恢复。
Objective:
1. Literature search:Using quantitative and evaluation methods, acupuncture methods in recent years domestic auxiliary intravenous anesthesia related literature searched, organized, analyzed, evaluate acupuncture auxiliary intravenous anesthesia and analgesic effects on the cardiovascular system to guide the research, clinical study.
2. Clinical research
(1)Through auricular paste the pressure therapy assisted intubation general anesthesia research, observation of general anesthesia surgery anesthesia dosage;(2) The use of simple and effective auricular acupressure therapy, in the treatment of perioperative give continuous, auxiliary analgesic effect was observed;(3) Observe the auricular acupressure body recovery after the intervention, to study the method of anesthesia and surgical trauma and postoPerative complications;(4) Explore whether the act through the neurotransmitter, inflammation reaction, anti-oxidative stress promote the body to adapt to anesthesia and surgery, in order to expand the auricular acupressure range of applications;(5) Based on the research results, summed up a simple and effective auricular point sticking and pressing assisted intubation anesthesia method of operation.
Methods:
1. Literature search:With "acupuncture" OR "acupuncture" AND "intravenous anesthesia" OR "TIVA" AND "random" as the search strategy, electronic retrieval CBM, CNKI, VIP, Wanfang database, which includes Chinese HowNet journal literature databases, full-text database of important meetings, title of dissertation database; Can not obtain the full text, and then supplemented by hand searching of Guangzhou University of Chinese Medicine library archive database. According to inclusion and exclusion criteria select the appropriate literature, meta-analysis.
2. Clinical research
(1)Grouping method:the SPSS18.0random sequence generation module the subjects were divided into three groups:①the auricular comfort control group (control group),40cases;②auricular acupressure group (ear group),40cases;③ear before and after the patch group(auricular group2),40.
(2) Experimental Procedure:
①All patients admitted to hospital blood tests (blood, beta-EP, TNF-alpha, MDA).
②At the same time give Chinese dialectical type. Can be divided into qi depression to blood stasis, qi deficiency to blood stasis, the wet stasis network type.
③The day before surgery observed in patients with ear, with the thumb and forefinger and pulling the pinna, visual examination in plenty of natural light from the inside out, from the top down, to observe whether there are breaks in the skin, desquamation. Ear detector, select on both sides of the door of God, subcortical, endocrine, ear, lung, spleen, uterus and pelvic auricular probe in the hole area the most sensitive point.
Auricular GrouP1:75%alcohol routine disinfection ears, taping and pressing bead. Using magnetic stickers by mechanical pressure and magnetic field effects to stimulate the auricular. Ear pressure to the thumb, index finger, the patient is asked to press the point intensity from light to heavy, a loose-tight, thus producing the feeling of acid, hemp, swelling, pain, heat, local redness, fever, the patient can tolerate the limit. The surgery operation every30minutes, press1, press ear every time a frequency of60beats/min,30seconds per hole, firmly and evenly. Postoperative pressing auricular, press5times a day (wake up in the morning, three meals a day after meals and before going to bed),3days after the removal of auricular. Be taken to prevent tape wet and pollution, for those who are allergic to tape-for-allergy tape.
Auricular two groups:the in the Auricular paste of pressure parts of the ear face stickers and other operations with the ear of a group.
Control group:the selected auricular area applicator with the same appearance, the number of non-bead tape will not be any stimulus, other operations above.
④Preoperative preparation:all patients30minutes before regular injection of phenobarbital sodium (luminal)0.1grams,0.5mg atropine. Extraction of3ml venous blood was allowed to stand after the burglary.
⑤Routine after the opening of the vein connected to the multi-function monitor (Marquette EA-GLE3000), and connect the EEG depth of awareness the monitor (the Germany of Narcotrend-compact) to monitor patients undergoing sedation depth, blood pressure, electrocardiogram, finger pulse oxygen saturation, the etC02and other parameters. Surgery tracheal intubation, ventilator (Drager Fabius GS, Germany), induced by drugs:Propofol, sufentanil, cisatracurium; Maintenance medication: propofol, according to need surgery to requires sufentanil. Maintain the patient's heart rate, blood pressure, fluctuations in the level of±15%, EEG Narcotrend value of40-60. Intraoperative intravenous infusion of sodium lactate Ringer's injection infusion rate unified8ml·kg-1H-1, such as blood loss, the supplementary crystal blood loss:liquid colloid1:1. surgery to be patient awake extubation, returned to the ward.
⑥Surgical procedure:three groups of patients underwent laparoscoPic surgery. Anesthesia after routine disinfection of the abdomen and vulva, vagina, placed catheter and uterine manipulator (asexual life cycle is not Placed the uterine manipulator). Patient supine position, pneumoPeritoneum, in navel piercing veress needle into the peritoneal cavity, connected automatic CO2pneumoperitoneum,1～2L/min flow rate of CO2inflatable, inflatable1L, adjust the patient's position to the first low-hiphigh (approximately15to25°tilt), continue inflatable, intra-abdominal pressure of12mmHg, unplug the veress needle, place the laparoscopic connected CO2pneumoperitoneum, surgery to maintain intra-abdominal pressure12mmHg, open the cold light source, see pelvic vision. And then select the type of the position of the point2,3 puncture according to the type of surgery demand for intraperitoneal the profiler and tumor resection. The end of the surgery, with0.9%sodium chloride injection flush pelvic check no bleeding, no visceral injury, put the best intra-abdominal CO2, remove the laparoscopic trocar sheath and the puncture site, suture the puncture.
⑦Record surgical procedures in patients at each time point (include:burglary, the induction of anesthesia, intubation, pneumoperitoneum, surgery over) heart rate, mean arterial pressure;
⑧Intraoperative infusion of propofol, fentanyl, based on the heart rate, blood pressure, EEG index adjusted to a suitable depth of anesthesia.heart rate and.blood pressure was maintained at about15%of the underlying value, the EEG index control at40-60.
⑨When surgery over to draw3ml venous blood, send the Patient to return to the ward,
(3)Obvervational index
①The general clinical data records:name, age, weight, TCM syndromes and syndromes performance, ASA classification, diagnosis, surgical approach.
②The State-Trait Anxiety Inventory (STAI) were the day before surgery, the third postoPerative day, see the appendix to evaluate auricular acupressure role in the adjustment of the emotional state of body consciousness.
③Recorded before anesthesia, induction of anesthesia, surgical incision, the separation of the tumor, surgery, after the first day of each period, heart rate (HR), mean arterial pressure (MAP) to evaluate the auricular acuPressure role in the adjustment of the body's heart and lung function.
④VAS Record:Record patients with intraoperative propofol, sufentanil dosage were recorded24hours after the pain visual analog scale (VAS score), recording the third postoperative day resting occurrence of pain, to evaluate the ear auxiliary analgesic effect.
⑤Recovery of gastrointestinal function observed:Record preoperative and postoperative24hours the number of bowel sounds per minute, and the first bowel movement after the first time the exhaust to evaluate auricular functional recovery of the body to adjust the role of the digestive system.
⑥Third postoperative day review of biochemical indicators to evaluate physiological changes auricular adjustment function.
⑦By enzyme-linked immunosorbent assay (ELISA) detection of tumor necrosis factor (TNF-a), beta-endorPhin (beta-EP); thiobarbituric acid (TBA) malondialdehyde (MDA) content. To proven auricular point sticking and pressing analgesia, oxidative stress mechanism.
Results:
1. Literature search:The evaluation included a total of11RCT,710subjects. Mostly small trials, and methodological quality is not high, there are four randomized study refers only to the refers to "single-blind". The Meta analysis, display and simple acupuncture auxiliary intravenous anesthesia intravenous anesthesia endotracheal intubation compares the hemodynamic effects of advantages, other advantages can not be determined at each time point, suggesting that acupuncture on the body has a protective effect during stress. Use of narcotic drugs to determine the impact of superiority, suggesting that acupuncture on the body assisted sedation analgesia, reducing the use of narcotic drugs.
2. Clinical research
(1)The comparison of the three groups the patient's age, weight, ASA classification, surgical approach, TCM-difference between the groups was not statistically significant (P>0.05), comparable between the groups.(2)Three groups of cases the depth of sedation index difference was not statistically significant (P>0.05).(3) Patients in the three groups comparison of the amount of anesthetic propofol dose difference was not statistically significant (P>0.05), sufentanil differences among the three groups was statistically significant (P<0.05), and compared with the control group, group1and to respectively reduced by15.50%and22.73%. In each group various syndromes sufentinal dose comparative difference was not statistically significance (P>0.05).(4)Patients at each time Point of the heart rate, mean arterial pressure between groups difference was not statistically significant (P>0.05), heart rate and arterial blood pressure in surgery at each time point a slight change, but had no significant effect.(5) Three groups of patients status-trait anxiety inventory (STAI)score, group1and2scores than the control group, two groups of traits questionnaire (T-AI) score, no statistically significant difference between the groups (P>0.05); Three groups of patients preoperative S-AI score difference was not statistically significant (P>0.05), after three group scores were lower itself with the preoperative group difference was statistically significant (P<0.01), the difference between the three groups was statistically significant (P<0.05), postoperative ear scores were lower than the control guoup,2group and the difference was statistically significant (P<0.05), while group1and2difference was ststistically significant (P>0.05).Compare various syndromes in each group showed no significant difference (P>0.05).(6)Compared with the control group, auricular group1and2after the first day of pain VAS score difference was statistically significant (P<0.05), but VAS score difference between two trail groups was not statistically significant (P>0.05).Occurrence of pain on the third day after surgery compared with three statistically significant difference between the group (P<0.05). Compare various syndromes in each group showed no significant difference (P>0.05)7)Compared with the control group the auricular group1and group2bowel sounds preoperative difference was not statistically significant (P>0.05), but after the first day differences were statistically significant (P<0.05), were compared with the control group, ear1,2flatus, defecation time in advance, the difference was statistically significant (P<0.05), indicating that the auricular points therapy can promote intestinal peristalsis, helping the body as soon as possible to restore the digestive function. The syndrome in each group, the difference was not statistically significant (P>0.05), described auricular points therapy for various syndromes can be sused, without specificity.(8)Compared with control group, group1and2were no statistically significant difference in leukocyte (P>0.05), but were increased after surgery than before surgery, and extent of the control group is biggest, followed by group1, group2at least, explain the occurrence of auricular point therapy postoperative inflammation inhibitory trend.(9) ComPared with the control group, the absolute neutrophil count, neutrophil percentage auricular group1difference was not statistically significant (P>0.05), group2difference was statistically significant (P<0.05),(10)LymPhoid myeloid absolute value, the absolute value of the mononuclear granulocytes, hemoglobin, sodium, potassium, glucose concentrations among the three groups showed no significant difference (P>0.05).(11)Compared with the control group, ear1,2group the beta endorphins preoperative difference was statistically significant among the three groups after surgery, the difference was not statistically significant (P>0.05). Auriclar point therapy can make beta endorphin levels, which play the role of pain.(12)Among the three groups of tumor necrosis factor levels, the difference was not statistically significant (P>0.05).(13) Between the three grouPs of malondialdehyde content, the difference between the groups was statistically significant (P<0.05). Auriclar points therapy against oxidative stress, resistance to cell damage.
Conclusion:
This study shows that auricular magnetic auxiliary analgesia in laparoscopic surgery and perioperative role in the adjustment of body functions is sure. Pre-surgery can alleviate Patient stress, fear, anxiety, anti-pain system to start by adjusting the beta endorphins in the body, tumor necrosis factor and MDA, resist oxidative stress, to maintain the stability of the body, and reduce intraoPerative anesthesia Drug use. Promote patients with bowel movements, for the first time in advance exhaust, defecation, adjust gastrointestinal function, helps the body fast recovery after surgery.
1.文献研究：采用文献计量及评价方法,对近年来国内针灸方法辅助静脉全麻手术的相关文献进行检索、整理、分析,评价针灸辅助静脉全麻手术的镇痛及对心血管系统的影响,以指导科研、临床研究。
2.临床研究：(1)通过耳穴贴压疗法辅助气管插管全麻手术的研究,观察气管插管全麻手术的病人麻醉用药量；(2)运用简便有效的耳穴贴压疗法,于围手术期给予持续治疗,观察其辅助镇痛效果；(3)观察耳穴贴压对术后机体恢复的干预效果,研究该法对麻醉和手术损伤及术后并发症的作用；(4)探讨该法是否能通过神经递质、炎症反应、抗氧化应激反应促进机体适应麻醉及手术,以期能扩大耳穴贴压疗法的应用范围；(5)基于研究结果,总结出一套简便有效的耳穴贴压辅助气管插管全麻的操作方法。
方法：
1.文献研究：以“针灸”OR“针刺”AND“静脉全麻”OR“全凭静脉麻醉”AND“随机”为检索策略,电子检索中国生物医学文献数据库、中国知网、维普数据库、万方数据库,其中中国知网包括中国期刊文献数据库、重要会议全文数据库、硕博学位论文数据库；不能获取的全文,则辅以手工检索广州中医药大学图书馆过刊资料库。根据纳入、排除标准选择适宜文献,进行Meta分析。
2.临床研究：
(1)分组方法：采用SPSS18.0随机序列生成模块将受试者分为3组：(1)耳贴安慰对照组(对照组),40例；(2)耳穴贴压组(耳穴1组),40例；(3)耳穴前后对贴组(耳穴2组),40例。
(2)实验步骤：
①全部病例入院抽血检验(血常规、β-EP、TNF-α、MDA)。
②同时给与中医分型。可分为气滞血瘀、气虚血瘀、湿瘀阻络三型。
③术前一日观察患者耳廓,用拇指和食指牵拉耳廓,在充足的自然光线下进行视诊,由内向外,从上而下,观察其是否有皮肤破损、脱屑。再利用耳穴探测器,选取双侧子宫、心、肺、胃、脾、肝、神门、皮质下、内分泌、交感等穴位,再在穴区内探查最敏感点。
耳穴1组：常规75%酒精双耳消毒,贴压磁珠。采用磁疗贴藉其机械压迫和磁场效应刺激耳穴。以拇指、食指对压耳穴,按压穴位力度逐渐加大,一松一紧,使之产生痛、麻、胀、热的感觉,以局部发红、患者自觉发热可耐受为度。术中操作者每30分钟按压1次,每次按压频率为60次／分,每个穴位按压30秒,用力均匀。术后按压耳穴,每日按压5次,3日后去除耳穴贴。并嘱患者应防止胶布潮湿和污染,如有患者易胶布过敏,则换用抗过敏胶布。
耳穴2组：在耳穴1组的贴压部位的耳背面对贴,其他操作和耳穴1组一样。
对照组：在探查到的耳穴敏感点敷贴同样外观和数量的无磁珠胶布,并不行任何刺激,其他操作同上。
④术前准备：所有患者术前30分钟均常规注射苯巴比妥钠(鲁米那)0.1克、阿托品0.5毫克。入室后抽取静脉血3毫升静置。
⑤开通静脉后常规连接多功能监测仪(Marquette EA-GLE3000)、并连接脑电意识深度监测仪(德国Narcotrend-comPact),以监测患者术中麻醉镇静深度、血压、心电图、手指脉氧饱和度、呼末二氧化碳等参数。手术行气管插管全麻,呼吸机(德国德尔格Fabius GS),诱导用药：异丙酚,舒芬太尼,顺式阿曲库胺；维持用药：异丙酚,根据手术需要追加舒芬太尼。维持患者的心率、血压、波动在±15%水平,脑电Narcotrend值为40-60。术中静脉输注乳酸钠林格注射液输液速度统一为8ml·kg-1·h-1,如失血较多,按失血量补充晶体：胶体为1：1的液体。术毕待病人清醒后拔除气管导管,送返病房。
⑥手术操作：三组患者均进行腹腔镜手术。麻醉后常规消毒腹部及外阴、阴道,放置导尿管和根据手术需要放置举宫器(无性生活史者则不放置举宫器)。患者平卧位,进行人工气腹,于肚脐穿刺气腹针进入腹腔,连接自动CO2气腹机,l～2L/min流速进行CO2充气,当充气1L后,调整患者体位至头低臀高位(倾斜约15-25。),继续充气,使腹腔内压力达12mmHg,拔去气腹针,放置腹腔镜,接好CO2气腹机,术中维持腹腔内压在12mmHg,打开冷光源,见盆腔视野。再根据不同的手术需求选择不同的位置进行第2、3点穿刺,进行腹腔的探查和肿物的切除。手术结束时用0.9%氯化钠注射液冲洗盆腔,检查无出血,无内脏损伤,放尽腹腔内CO2,取出腹腔镜及各穿刺点的套管针鞘,缝合穿刺口。
⑦记录患者手术过程各时点(包括：入室时、麻醉诱导时、插管时、气腹时、术毕)心率、平均动脉压；
⑧术中输注丙泊酚、舒芬太尼,根据心率、血压、脑电指数等调节至适宜麻醉深度。使心率和血压维持在基础值的15%左右,脑电指数控制在40-60。
⑨术毕时,抽取静脉血3毫升,送患者返回病房。
(3)观察指标
①一般临床资料记录：姓名、体重、年龄、中医分型及舌脉、ASA分级、疾病诊断和手术方式等。
②焦虑评分记录：于手术前一天及术后第三天时由患者自行评价状态-特质焦虑问卷(STAI)见附录,以评价耳穴贴压对患者神志、情绪状况的调整作用。
③血流动力学记录：入室时、麻醉诱导时、插管时、气腹时、术毕时各个时点的心率(HR)、平均动脉压(MAP),以评价耳穴贴压对机体血流动力学的调整作用。
④镇痛评分记录：术中记录患者使用的丙泊酚、舒芬太尼用量,术后24小时记录患者疼痛视觉模拟评分(VAS评分),记录术后第三天静息状态下疼痛发生情况,以评价耳穴辅助镇痛的作用。
⑤胃肠功能恢复观察：记录患者术前和术后24小时音每分钟肠鸣次数、术后首次排气及首次排便时间,以评价耳穴贴压对机体消化系统功能恢复的调整作用。
⑥术后第三天复查生化指标,以评价耳穴贴压对生理变化的调整功能。
⑦应用酶联免疫吸附法(Elisa)测肿瘤坏死因子(TNF—a)、β内啡肽(β-EP)；硫代巴比妥酸(TBA)法测定丙二醛(MDA)含量。以探明耳穴贴压镇痛及氧化应激等相关作用机制。
结果：
1.文献研究：本评价共纳入11项RCT,共710例受试者。大多是小样本试验,而且方法学质量不高,有4项研究仅提及随机字样,没有详细交代随机方法,11项研究均为提及实施随机化隐藏,因此可能造成选择性偏倚。仅1项试验提及“单盲法”。经Meta分析后,显示针灸辅助静脉麻醉与单纯静脉麻醉比较对气管插管即刻的血流动力学的影响优势明确,其他各时点优势尚不能确定,提示针灸对机体应激时有保护作用。对麻醉药物使用量的影响优势确定,提示针灸对机体辅助镇静镇痛作用,减少麻醉药品的使用量。
2.临床研究
(1)三组患者的年龄、体重、手术方式、ASA分级、中医证型等方面的比较,组间差异无统计学意义(P>0.05),提示组间具有可比性。(2)三组病例麻醉镇静深度指数比较差异无统计学意义(P>0.05)。(3)术中三组麻醉药用量的比较,异丙酚的使用剂量差异无统计学意义(P>0.05),舒芬太尼的用量三组间差异有统计学意义(P<0.05),与对照组比较耳穴1组和耳穴2组分别减少了15.50%和22.73%。(4)三组患者各时间点的心率、平均动脉压的组间比较差异均无统计学意义(P>0.05),说明各心率、动脉压在术中各时间点略有变化,但无显著影响。5.三组病例状态-特质焦虑问卷(STAI)评分,耳穴1组、耳穴2组分数低于对照组的特质问卷(T-AI)评分,组间差异无统计学意义(P>0.05)；三组病例术前S-AI评分差异无统计学意义(P>0.05),术后三组分数均降低,组内与术前自身比较差异有统计学意义(P<0.01),三组间比较差异有统计学意义(P<0.05),术后耳穴1、2组评分均低于对照组,且差异有统计学意义(P<0.05),而术后耳穴1组与耳穴2组比较差异无统计学意义(P>0.05)。各组各证型比较差异均无统计学意义(P>0.05)。(6)手术后第一天疼痛VAS评分与对照组的比较,耳穴1、2组的差异有统计学意义(P<0.05),而耳穴1组与耳穴2组的比较差异无统计学意义(P>0.05),手术后第三天疼痛发生情况比较,三组间差异有统计学意义(P<0.05),各组各证型比较差异无统计学意义(P>0.05)。(7)与对照组比较,耳穴1、2组肠鸣音术前差异无统计学意义(P>0.05),各组的组内比较术后与术前的差异有统计学意义(P<0.01),三组之间术后24小时的比较差异均有统计学意义(P<0.01)；与对照组比较,耳穴1、2组术后排气、排便时间均有所提前,差异有统计学意义(P<0.05),说明耳穴可以促进肠道的蠕动,帮助机体及早的恢复消化功能。各组各证型比较,差异无统计学意义(P>0.05),说明耳穴对各证型都可以使用,无特异性。(8)与对照组比较,耳穴1、2组白细胞差异虽均无统计学意义(P>0.05),但是术后较术前均有升高,且对照组幅度最大,其次是耳穴1组,耳穴2组最少,说明耳穴对手术后炎症的发生有抑制趋势。(9)与对照组比较,中性粒细胞绝对值、中性粒细胞百分比耳穴1组差异无统计学意义(P>0.05),耳穴2组差异有统计学意义(P<0.05)。(10)淋巴粒细胞绝对值、单核粒细胞绝对值、血红蛋白、钠离子、钾离子、血糖浓度三组之间差异都没有统计学意义(P>0.05)。(11)同对照组比较,耳穴1、2组的β-内啡肽含量手术前差异有统计学意义(P<0.05),手术后三组间差异没有统计学意义(P>0.05)。术前、术后各证型比较,β-EP含量差异无统计学意义(P>0.05)。说明耳穴可以使β内啡肽水平升高,从而发挥镇痛的作用。(12)三组间术后肿瘤坏死因子含量比较,差异无统计学意义(P>0.05)。(13)三组间术后丙二醛含量比较,组间差异有统计学意义(P<0.05)。说明耳穴可以抗氧化应激,抵抗细胞的损伤。
结论：
本研究表明,耳穴贴压辅助妇科腹腔镜手术镇痛作用及围手术期对机体功能的调整作用是肯定的。在手术前期可以缓解患者紧张、焦虑、恐惧的情绪,通过调整体内β内啡肽、肿瘤坏死因子及丙二醛来启动抗痛系统,抵制氧化应激反应,维持机体的稳定,并降低术中麻醉药品的使用。于手术后缓解术口疼痛,促进患者肠蠕动,提前首次排气、排便时间,调整术后胃肠功能,帮助机体快速恢复。
Objective:
1. Literature search:Using quantitative and evaluation methods, acupuncture methods in recent years domestic auxiliary intravenous anesthesia related literature searched, organized, analyzed, evaluate acupuncture auxiliary intravenous anesthesia and analgesic effects on the cardiovascular system to guide the research, clinical study.
2. Clinical research
(1)Through auricular paste the pressure therapy assisted intubation general anesthesia research, observation of general anesthesia surgery anesthesia dosage;(2) The use of simple and effective auricular acupressure therapy, in the treatment of perioperative give continuous, auxiliary analgesic effect was observed;(3) Observe the auricular acupressure body recovery after the intervention, to study the method of anesthesia and surgical trauma and postoPerative complications;(4) Explore whether the act through the neurotransmitter, inflammation reaction, anti-oxidative stress promote the body to adapt to anesthesia and surgery, in order to expand the auricular acupressure range of applications;(5) Based on the research results, summed up a simple and effective auricular point sticking and pressing assisted intubation anesthesia method of operation.
Methods:
1. Literature search:With "acupuncture" OR "acupuncture" AND "intravenous anesthesia" OR "TIVA" AND "random" as the search strategy, electronic retrieval CBM, CNKI, VIP, Wanfang database, which includes Chinese HowNet journal literature databases, full-text database of important meetings, title of dissertation database; Can not obtain the full text, and then supplemented by hand searching of Guangzhou University of Chinese Medicine library archive database. According to inclusion and exclusion criteria select the appropriate literature, meta-analysis.
2. Clinical research
(1)Grouping method:the SPSS18.0random sequence generation module the subjects were divided into three groups:①the auricular comfort control group (control group),40cases;②auricular acupressure group (ear group),40cases;③ear before and after the patch group(auricular group2),40.
(2) Experimental Procedure:
①All patients admitted to hospital blood tests (blood, beta-EP, TNF-alpha, MDA).
②At the same time give Chinese dialectical type. Can be divided into qi depression to blood stasis, qi deficiency to blood stasis, the wet stasis network type.
③The day before surgery observed in patients with ear, with the thumb and forefinger and pulling the pinna, visual examination in plenty of natural light from the inside out, from the top down, to observe whether there are breaks in the skin, desquamation. Ear detector, select on both sides of the door of God, subcortical, endocrine, ear, lung, spleen, uterus and pelvic auricular probe in the hole area the most sensitive point.
Auricular GrouP1:75%alcohol routine disinfection ears, taping and pressing bead. Using magnetic stickers by mechanical pressure and magnetic field effects to stimulate the auricular. Ear pressure to the thumb, index finger, the patient is asked to press the point intensity from light to heavy, a loose-tight, thus producing the feeling of acid, hemp, swelling, pain, heat, local redness, fever, the patient can tolerate the limit. The surgery operation every30minutes, press1, press ear every time a frequency of60beats/min,30seconds per hole, firmly and evenly. Postoperative pressing auricular, press5times a day (wake up in the morning, three meals a day after meals and before going to bed),3days after the removal of auricular. Be taken to prevent tape wet and pollution, for those who are allergic to tape-for-allergy tape.
Auricular two groups:the in the Auricular paste of pressure parts of the ear face stickers and other operations with the ear of a group.
Control group:the selected auricular area applicator with the same appearance, the number of non-bead tape will not be any stimulus, other operations above.
④Preoperative preparation:all patients30minutes before regular injection of phenobarbital sodium (luminal)0.1grams,0.5mg atropine. Extraction of3ml venous blood was allowed to stand after the burglary.
⑤Routine after the opening of the vein connected to the multi-function monitor (Marquette EA-GLE3000), and connect the EEG depth of awareness the monitor (the Germany of Narcotrend-compact) to monitor patients undergoing sedation depth, blood pressure, electrocardiogram, finger pulse oxygen saturation, the etC02and other parameters. Surgery tracheal intubation, ventilator (Drager Fabius GS, Germany), induced by drugs:Propofol, sufentanil, cisatracurium; Maintenance medication: propofol, according to need surgery to requires sufentanil. Maintain the patient's heart rate, blood pressure, fluctuations in the level of±15%, EEG Narcotrend value of40-60. Intraoperative intravenous infusion of sodium lactate Ringer's injection infusion rate unified8ml·kg-1H-1, such as blood loss, the supplementary crystal blood loss:liquid colloid1:1. surgery to be patient awake extubation, returned to the ward.
⑥Surgical procedure:three groups of patients underwent laparoscoPic surgery. Anesthesia after routine disinfection of the abdomen and vulva, vagina, placed catheter and uterine manipulator (asexual life cycle is not Placed the uterine manipulator). Patient supine position, pneumoPeritoneum, in navel piercing veress needle into the peritoneal cavity, connected automatic CO2pneumoperitoneum,1～2L/min flow rate of CO2inflatable, inflatable1L, adjust the patient's position to the first low-hiphigh (approximately15to25°tilt), continue inflatable, intra-abdominal pressure of12mmHg, unplug the veress needle, place the laparoscopic connected CO2pneumoperitoneum, surgery to maintain intra-abdominal pressure12mmHg, open the cold light source, see pelvic vision. And then select the type of the position of the point2,3 puncture according to the type of surgery demand for intraperitoneal the profiler and tumor resection. The end of the surgery, with0.9%sodium chloride injection flush pelvic check no bleeding, no visceral injury, put the best intra-abdominal CO2, remove the laparoscopic trocar sheath and the puncture site, suture the puncture.
⑦Record surgical procedures in patients at each time point (include:burglary, the induction of anesthesia, intubation, pneumoperitoneum, surgery over) heart rate, mean arterial pressure;
⑧Intraoperative infusion of propofol, fentanyl, based on the heart rate, blood pressure, EEG index adjusted to a suitable depth of anesthesia.heart rate and.blood pressure was maintained at about15%of the underlying value, the EEG index control at40-60.
⑨When surgery over to draw3ml venous blood, send the Patient to return to the ward,
(3)Obvervational index
①The general clinical data records:name, age, weight, TCM syndromes and syndromes performance, ASA classification, diagnosis, surgical approach.
②The State-Trait Anxiety Inventory (STAI) were the day before surgery, the third postoPerative day, see the appendix to evaluate auricular acupressure role in the adjustment of the emotional state of body consciousness.
③Recorded before anesthesia, induction of anesthesia, surgical incision, the separation of the tumor, surgery, after the first day of each period, heart rate (HR), mean arterial pressure (MAP) to evaluate the auricular acuPressure role in the adjustment of the body's heart and lung function.
④VAS Record:Record patients with intraoperative propofol, sufentanil dosage were recorded24hours after the pain visual analog scale (VAS score), recording the third postoperative day resting occurrence of pain, to evaluate the ear auxiliary analgesic effect.
⑤Recovery of gastrointestinal function observed:Record preoperative and postoperative24hours the number of bowel sounds per minute, and the first bowel movement after the first time the exhaust to evaluate auricular functional recovery of the body to adjust the role of the digestive system.
⑥Third postoperative day review of biochemical indicators to evaluate physiological changes auricular adjustment function.
⑦By enzyme-linked immunosorbent assay (ELISA) detection of tumor necrosis factor (TNF-a), beta-endorPhin (beta-EP); thiobarbituric acid (TBA) malondialdehyde (MDA) content. To proven auricular point sticking and pressing analgesia, oxidative stress mechanism.
Results:
1. Literature search:The evaluation included a total of11RCT,710subjects. Mostly small trials, and methodological quality is not high, there are four randomized study refers only to the refers to "single-blind". The Meta analysis, display and simple acupuncture auxiliary intravenous anesthesia intravenous anesthesia endotracheal intubation compares the hemodynamic effects of advantages, other advantages can not be determined at each time point, suggesting that acupuncture on the body has a protective effect during stress. Use of narcotic drugs to determine the impact of superiority, suggesting that acupuncture on the body assisted sedation analgesia, reducing the use of narcotic drugs.
2. Clinical research
(1)The comparison of the three groups the patient's age, weight, ASA classification, surgical approach, TCM-difference between the groups was not statistically significant (P>0.05), comparable between the groups.(2)Three groups of cases the depth of sedation index difference was not statistically significant (P>0.05).(3) Patients in the three groups comparison of the amount of anesthetic propofol dose difference was not statistically significant (P>0.05), sufentanil differences among the three groups was statistically significant (P<0.05), and compared with the control group, group1and to respectively reduced by15.50%and22.73%. In each group various syndromes sufentinal dose comparative difference was not statistically significance (P>0.05).(4)Patients at each time Point of the heart rate, mean arterial pressure between groups difference was not statistically significant (P>0.05), heart rate and arterial blood pressure in surgery at each time point a slight change, but had no significant effect.(5) Three groups of patients status-trait anxiety inventory (STAI)score, group1and2scores than the control group, two groups of traits questionnaire (T-AI) score, no statistically significant difference between the groups (P>0.05); Three groups of patients preoperative S-AI score difference was not statistically significant (P>0.05), after three group scores were lower itself with the preoperative group difference was statistically significant (P<0.01), the difference between the three groups was statistically significant (P<0.05), postoperative ear scores were lower than the control guoup,2group and the difference was statistically significant (P<0.05), while group1and2difference was ststistically significant (P>0.05).Compare various syndromes in each group showed no significant difference (P>0.05).(6)Compared with the control group, auricular group1and2after the first day of pain VAS score difference was statistically significant (P<0.05), but VAS score difference between two trail groups was not statistically significant (P>0.05).Occurrence of pain on the third day after surgery compared with three statistically significant difference between the group (P<0.05). Compare various syndromes in each group showed no significant difference (P>0.05)7)Compared with the control group the auricular group1and group2bowel sounds preoperative difference was not statistically significant (P>0.05), but after the first day differences were statistically significant (P<0.05), were compared with the control group, ear1,2flatus, defecation time in advance, the difference was statistically significant (P<0.05), indicating that the auricular points therapy can promote intestinal peristalsis, helping the body as soon as possible to restore the digestive function. The syndrome in each group, the difference was not statistically significant (P>0.05), described auricular points therapy for various syndromes can be sused, without specificity.(8)Compared with control group, group1and2were no statistically significant difference in leukocyte (P>0.05), but were increased after surgery than before surgery, and extent of the control group is biggest, followed by group1, group2at least, explain the occurrence of auricular point therapy postoperative inflammation inhibitory trend.(9) ComPared with the control group, the absolute neutrophil count, neutrophil percentage auricular group1difference was not statistically significant (P>0.05), group2difference was statistically significant (P<0.05),(10)LymPhoid myeloid absolute value, the absolute value of the mononuclear granulocytes, hemoglobin, sodium, potassium, glucose concentrations among the three groups showed no significant difference (P>0.05).(11)Compared with the control group, ear1,2group the beta endorphins preoperative difference was statistically significant among the three groups after surgery, the difference was not statistically significant (P>0.05). Auriclar point therapy can make beta endorphin levels, which play the role of pain.(12)Among the three groups of tumor necrosis factor levels, the difference was not statistically significant (P>0.05).(13) Between the three grouPs of malondialdehyde content, the difference between the groups was statistically significant (P<0.05). Auriclar points therapy against oxidative stress, resistance to cell damage.
Conclusion:
This study shows that auricular magnetic auxiliary analgesia in laparoscopic surgery and perioperative role in the adjustment of body functions is sure. Pre-surgery can alleviate Patient stress, fear, anxiety, anti-pain system to start by adjusting the beta endorphins in the body, tumor necrosis factor and MDA, resist oxidative stress, to maintain the stability of the body, and reduce intraoPerative anesthesia Drug use. Promote patients with bowel movements, for the first time in advance exhaust, defecation, adjust gastrointestinal function, helps the body fast recovery after surgery.
引文
[1]张仁.中国针刺麻醉发展史,上海：上海科学技术出版社,1989,第一版：1-4.
[2]陈宥伊,李桂兰,陈泽林等.耳穴疗法的优势病种归纳分析[J].针灸临床杂志,2003,23(3)：1-3.
[3]王鹏,陈宇.腰-硬联合麻醉在腹腔镜子宫切除术中的应用[J].临床麻醉学杂志,2009,25(7)：628-629.
[4]金善爱,崔极哲,潘振祥,等.腰麻-硬膜外联合麻醉下妇科腹腔镜手术对呼吸和循环系统的影响[J].吉林大学学报(医学版),2005,31：460-461.
[5]鲍瑞军,王建波.腹腔镜妇科手术的麻醉及相关问题研究进展[J].中国误诊学杂志,2011,11(1)：30-31.
[6]庄心良,现代麻醉学(第三版),[M].北京：人民卫生出版社2004
[7]第13届国际疼痛大会,韩济生院士针刺镇痛大会报告[J].中国疼痛医学杂志,20105：2.
[8]杨军.瑞芬太尼丙泊酚靶控静脉麻醉用于妇科腹腔镜手术的效果评价[J].实用医院临床杂志,2010,7(1)：83-85.
[9]BovilljqwarrenPJ, SehullerJL, etal. ComParisonoffentanil,sufentanil, and alfentani anesthesia in Patients undergoing valvular heart surgery. AnesthAnalg. 1999:63:1081-1086.
[10]林鹰.麻醉性镇痛药与现代临床麻醉.中国处方药,2005,7：16.
[11]余守章.新型阿片类药物在病人自控镇痛中应用研究进展.中国疼痛医学杂志,2005,11,(6)：354-355.
[12]王曼.舒芬尼的临床应用近况.继续医学教育,2006,20(34)：66.
[13]林霖,王伟鹏,张燕婉,等.两种剂量芬太尼对冠状动脉旁路移植术患者血液动力学及血浆儿茶酚胺的影呵[J].中华麻醉学杂志,2004,5：460-461.
[14]蔡景峰.中医麻醉术简史[J].辽宁中医杂志,1980,4：38-40.
[15]王伟.中医麻醉历史、现状和前景[J].甘肃科技,2011,27(20)：178-179.
[16]江苏新医学院.中药大辞典[S].上海：上海科学技术出版社,1993.260.
[17]苟新元,洪英科等.中药蟾酥在人工流产手术中麻醉作用的研究[J].中国计划生育学杂志2003,1(87)：55-56.
[18]王本祥、现代中药药理与临床[M].天津科技翻译出版公司,2004：1036,1728.
[19]孙世明.蟾酥的现代临床应用进展[J].四川中医,1996,14(12)：12—13.
[20]金铁林、赵素云、汪海清等.中药验方表面麻醉拔牙的临床应用[J].现代口腔医学杂志,2000,14(3)：190
[21]孙述华.中药表面麻醉剂在耳鼻咽喉手术中的应用.四川中医,2001,19(6)：68.
[22]李万山、林励、廖惠芳等.辛酥酊外用皮肤表麻作用探讨[J].中药新药与临床药理,1995,10(3)：165—166.
[23]杨升华.中药表面麻醉剂的应用[J]中医外治杂志,2001,10(2)：30
[24]管遵信.中国耳针学[M].人民卫生出版社,1995.
[25]黄丽春.耳穴诊断治疗学(第一版)[M]北京：科学技术文献出版社1995
[26]Oleson, T. and R. Koening, A comParison of Chinese and Nogier auricular acuPuncture Points[J]. American Journal of AcuPuncture,1983,11 (3):205-223
[27]黄丽春编著.耳穴诊断学[M].北京：科学技术文献出版社1995：309.
[28][唐]孙思邈著,银海精微,人民卫生出版社影音,1956
[29]管遵信.耳诊诊治疾病的原理[J].中国针灸,1993(1)：42
[30]黄丽春.耳穴诊断治疗学[M].北京：科学技术文献出版社,1991
[31]张诗兴,周坤福,姜文方等.耳穴的脑、脊神经节投射[J].上海针灸杂志,2002,21(3)：35-36
[32]张启兵,张诗兴.耳针调节内脏功能的作用机制研究[J].广东药学院学报,2005,21(3)：330-331.
[33]刘维洲,许冠荪,张群群,等.耳廓神经支配与耳针对胃肠电活动影响的观察[J].针刺研究.1990,15(3)：187-190.
[34]管学忠,魏睦新.中医耳针治疗学的负反馈调节[J].针灸临床杂志,1998,14(8)：2-3
[35]王柞邦.关于耳穴作用规律的探讨[J],湖北中医学院学报2001,3(2)：13.
[36]朱兵,陈巩荪,许瑞征. 耳廓穴位电学特性的研究[J]. 中国针灸,1999,19(6)355
[37]李育良,李裕强,孙韬等.家兔内脏病理模型耳廓反应区的定位研究[J].针灸临床杂志,1995,11((1)：2—31
[38]朱元根,朱柏君,杨友泌,等. 大鼠实验性胃溃疡的耳穴反应和电针体穴的作用[J]中国针灸,1994,14(4)：39—41
[39]吕建平.针刺耳穴对家兔胃电的影响[J].上海针灸杂志,1991,10(1)：30
[40]武和平,毕联阳,沈平.自制耳穴按压丸应用于术后镇痛的临床观察和机理研究,上海中医药杂志,1994,(3)：28-30
[41]单秋华,孙冬梅,吴富东.耳穴贴压对女性更年期综合症患者血清内分泌素及p-内啡肽的影响,中国针灸,2003,23(11)：677
[42]吴连方,金有慧,赵卫红,等.分娩镇痛方法的临床研究,中华妇产科学杂志,1997,32(6)：363
[43]蒋文妹,徐正仪,陈水娟,等.耳针镇痛在康乐分娩中的前瞻性研究,现代妇产科进展,1997,6(3)：249
[44]杨佃会,韩晶,单秋华.耳穴综合疗法治疗缓解期普通偏头痛疗效观察及对患者血浆CGRP、ET的影响,中国针灸,2007,27(8)：569-571
[45]Kerns, R..D.Turk, and T. Rudy, The west haven-yale multidimensional Pain inventory (WHYMPI) [J]. Pain,1985,23(4):345-356.
[46]马培锋,刘国华,王传尊.棒针颤点耳穴痛点治疗感冒咽痛症57例[J].针灸临床杂志,2011,27(12)：13
[47]贾春生,郑丽娅,石晶等.耳穴透穴埋针刺法治疗偏头痛的临床疗效及对血浆5-羟色胺含量的影响[J].针刺研究,2010,35(6)：448-473.
[48]贾春生,马小顺,葛建军.耳针沿皮透穴刺法对颈椎病快速镇痛效应的初步观察[J].中国中医药信息杂志,2002,9(10)：56-57.
[49]贾春生,石晶,马小顺等.耳针沿皮透穴刺法与耳针直刺法对颈型、神经根型颈椎病快速镇痛效应的比较研究[J].针刺研究2007,32(3)：186-189.
[50]贾春生,李晓峰,马小顺等.耳针沿皮头次与直刺对肩周炎快速镇痛效应的比较[J].针刺研究,2008,22(5)：339-342.
[51]孙桂萍.耳穴磁疗治疗老年人腰背痛疗效观察[J].中国针灸,2007,27(2)：112-114
[52]罗惠郁.耳穴治疗腰痛的临床评估与机理研究[D].南京南京中医药大学,2010
[53]陈绮.耳穴埋针为主治疗腰椎间盘突出症继发根性坐骨神经痛的观察[D].广州：广州中医药大学2012.
[54]Sator-Katzenschlager SM, Szeles JC,Scharbert G, et al. Electrical stimulation of auricular acuPuncture Points is more effective than conventional manual auricular acuPuncture in chronic cervical Pain:a Pilot study [J].Anesth Analg. 2003,97(5):1469-1473.
[55]Wang SM, Kain ZN, White PF. AcuPuncture analgesia II:Clinical considerations [J].Anesthesia & Analgesia,2008,106 (2):19-21.
[56]Cherny N, RiPamonti C, Pereira J, et al. Strategies to manage the adverse effects of oral morPhine:an evidence-based rePort [J]. J Clin Oncol, 2001,19(9):2542-2554.
[57]刘振华,李卉,李彦等.盐酸羟考酮控释治疗中、重度疼痛研究进展[J].武警医学,2005.16(3)：211-213.
[58]殷蔚伯.肿瘤放射治疗手册[M].北京：中国协和医科大学车版社,2009：323.
[59]钟敏钰,胡作为,黄琳等.耳穴贴压联合强阿片类药物治疗中、重度癌痛50例疗效观察[J].中医杂志2012,53(13)：1123-1125.
[60]沈秋萍.耳穴穴注缓解癌痛的临床观察及机制研究[D].广州：广州中医药大学,2009,4
[61]章旭萍,叶巧珠,张新玉.耳穴压丸缓解癌痛伴抑郁状态的临床观察[J].浙江中医药大学学报,2012,36(6)：714-715.
[62]Alimi D, Rubino C, Pichard-Leandri E, Fermand-Brule S, Dubreuil-Lemaire ML, Hill C. Analgesic effect of auricular acuPuncture for cancer Pain:a randomized, blinded, controlled trial. [J]. Journal of Clinical Oncology,2003,21:4120-6.
[63]肖玮,耳穴镇痛验案3则[J].江苏中医药,2003,24(7)：47
[64]易志龙,杨德全,李勇华.耳针配合中药治疗乙型病毒性肝炎肝区疼痛62例[J].吉林中医药,2006,26(2)：52.
[65]金亚蓓,孙占玲,金慧芳.耳穴电针治疗子宫内膜异位症痛经的随机对照研究[J].2009,34(3)：188-192.
[66]李央,林金芳.子宫内膜异位症发病机理研究进展[J].中华妇产科杂志,2005,40(1)：55-57.
[67]信妙鸾.耳穴贴压治疗痛经1000例疗效观察[J].山西中医学院学报.2005;6(1)：42
[68]Park SY, Effect of the auriculotheraPy on dysmenorrhea in school-aged girls. J of Korean Acad Adult Nurs.2010, Oct,22(5):529-536.
[69]Pouresmail Z & Ibrahimzadeh R. Effects of acuPressure and ibuProfen on the severity of Primary dysmenorrhea. Journal of Traditional Chinese Medicine,2002; 22(3):205-210.
[70]朱莲芳,胡立丹,周嫦等.磁珠耳穴按压在动静脉内瘘血管穿刺中的应用[J].浙江中西医结合杂志,2007,17(3)：185-186.
[71]刘芳,方宗武.耳穴埋豆对肛肠病术后的镇痛效果观察[J].光明中医,2011,4(26)：762-763.
[72]童培建,汪海东,马镇川等.耳穴疗法在全膝关节置换围手术期镇痛的应用及疗效观察[J].中国中西医结合杂志,2010,30(9)：931-934.
[73]梁永妃,屠福汉,黄春霞.耳穴压籽法联合静脉镇痛在下肢骨科手术的临床应用[J].针刺研究,2011,
[74]王冬青.耳穴注射配合表面麻醉用于鼻内镜手术效果观察[J].中国针灸,2009(29)8：663-665.
[75]沈通一,毕联阳,张静等.耳穴按压对术后切口疼痛的疗效及其对血浆5-羟色胺的影响[J].中国中西医结合外科杂志2000,6(4)：231-233
[76]罗庆道.创伤性气滞血瘀疼痛的初步探讨[J].针灸研究,1980.5(1)：36
[77]程莘农.中国针灸学[M].第3版.北京：人民卫生出版社,1986：612-632
[78]颜湘蓉,云洁,杨惠英.耳穴压丸缓解眼科术后患者疼痛的临床研究[J].四川中医2009：27(10)：108-109
[79]田清玉,马艳秋,张巧荣等.耳穴贴压法分娩镇痛50例[J].中国针灸,2006,26(3)：212.
[80]吴剑斐,郑月红,张杏敏.耳穴刺激及次骼穴注射在分娩镇痛中的应用[J].医学理论与实践,2003,16(12)：1392.
[81]许娟,张秀举.耳针镇痛用于分娩的疗效观察[J].中国针灸,2001,21(7)：399.
[82]周军.耳穴埋籽防治痔术后疼痛的临床研究[D].南京南京中医药大学,2011
[83]马钦丽,范慧娟.应用磁珠耳穴疗法缓解肾绞痛的观察及护理[J].护士进修杂志,2011,26(10)：934-935.
[84]胡可,汪勇,吴文通等.耳穴穴位注射麻醉在甲状腺手术中的应用[J].上海针灸杂志2000,19(3)：21-22.
[85]T. I. Usichenko 1, Ch. Lehmann 2 and E. Ernst 3, Auricular acuPuncture for PostoPerative Pain control:a systematic review of randomised clinical trials [J]. Anaesthesia,2008, (11)63:1343-1348
[86]Tong PJ, Wang HD, Ma ZC, APPlication and effect of auricular acuPoint Pressing for analgesia in PerioPerative Period of total knee joint rePlacement [J]. Chinese Journal of Integrated Traditional and Western Medicine 2010,9,30(9):931-934.
[87]Taras I. Usichenko, Sven Kuchling, Torsten Witstruck, Dragan Pavlovic, Maria Zach, et al. Auricular acuPuncture for Pain relief after ambulatory knee surgery:a randomized trial [J]. CMAJ 2007,176(2),179-183
[88]Robert Greif, Sonja Laciny, Masoud Mokhtarani, Anthony G. Doufas, Maryam Bakhshandeh, LeoPold Dorfer, Daniel I. Sessler. Transcutaneous Electrical Stimulation of an Auricular AcuPuncture Point Decreases Anesthetic Requirement [J]. Anesthesiology 2002,96:306-312
[89]刘峰,高士杰,胡慧刚等.大黄治疗休克后胃肠功能障碍的临床研究[J].中国急救医学, 2003,23(1)：38-39.
[90]LIU K, H SU CC, CH IA YY. Effect of dexam ethasone on PostoP-erative em esis and Pain[J]. Br J Anaesthesia,1998,80:85-86.
[91]TH UNE A, APPELGREN L, H AGLIND E. Prevention of PostoP-erative nausea and vom iting after laParoscoPic cholecystectom y. AProsPective random ised study of m etoeloPram ide and transderm al hyoscine[J]. Eur J Surgery,1995,161:265-268.
[92]W ETCH ER BY. Ondansetron decreases em etic sym Ptom s following outPatient laParoscoPy[J]. Anesthesiology,1990,73:A36.
[93]赵晓琴,叶铁虎,罗爱伦,等.腹腔镜胆囊切除术后患者恶心呕吐的预防[J].中华麻醉学杂志,1997,17(1)：46.
[94]Abodeely A, Schechter S, KliPfel A, et al. Does alvimoPan enhance return of bowel function in laParoscoPic right colectomy [J]. Am Surg,2011,77(11):1460 1462.
[95]张阳德,林伶,陈紫煜.耳穴按压对腹腔镜术后胃肠功能恢复的影响[J].中国内镜杂志,2011,17(10)：1014-1018
[96]张榆川.耳穴贴压法用于中老年人腹部手术牵拉反应的观察[J].四川中医,2004;22(8)：88.
[97]郑红霞,耳穴贴压促进妇科腹腔镜患者术后排气的观察[J].实用全科医学,2008,4,6(4)：340
[98]邱纬芬耳穴压丸对心脏术后排便和血管活性肠肽的影响[D].广州:广州中医药大学,2012
[99]金惠铭,王建枝.病理生理学[M].北京：人Ui卫生山版社,2006：189
[100]Onoue S, Misaka S, Yamada s. Structure_actity relationship of vasoactive intestinal PePtide(VIP):Potent agonists and Potential c]inical aPPlication, Naunyu Schniiedebcrgs Arch Pharmacol,2008,377(46):579
[101]Maney DL, Schoech SJ, SharP P.J, et al. liffccts of vasoactive.intestinal PePtide on Plasma Prolactin in Passerines[J]. Gen ComP Endocrinol,1998,113(3); 323
[102]徐韶怡,郑士立,王庆来等.耳穴针刺贴压对妇科术后恶心呕吐的抑制作用疗效观察[J].2009.34(2)：143-144.
[103]KIM Y, KIM CW, KIM KS. Clinical observation on PostoPerative vom iting treated by auricular acuPuncture [J]. Am J ChinM ed,2003,31(3):475-480.
[104]SAH M EDDINI M A, FAZELZADEH A. Does auricular acuPuncture reduce PostoPerative vom iting after cholecystectom y [J]. JAltern Com Plem ent M ed,2008, 14(10):1275-1279.
[105]江勇,王亚国,李震宇等.耳穴埋针治疗胃肠道术后呃逆临床疗效观察[J].蚌埠医学院学报,2010,35(5)：493-494.
[106]徐江宁.术前焦虑的研究进展[J].上海医学,2009,32(11)：1130-1133.
[107]李智.电针加耳穴贴压治疗失眠35例[J].新中医,2010,42(1)：88-89.
[108]张延东,王惠萍,王炜.耳穴贴压法对围术期患者焦虑及心率、血压的影响[J].护理学杂志(外科版),2007,22(8)：3-5.
[109]罗碧,李贻文等,耳穴压豆用于缓解术后麻醉不良反应的体会[J].山东中医杂志,2000,19(10)：612.
[110]乔光文,孙培华.耳穴贴压在心电监护拔牙中的作用[J].上海针灸杂志,2006,25(4)：26.
[111]韩晓玲,蔡晖.指压联合耳穴埋籽缓解普外科术前焦虑的临床研究[J].新中医,2012,29(6)：84-85.
[112]Wang SM, Peloqiun C, Kain ZN. The use of auricular acuPuncture to reduce PreoPerative anxiety [J]. Anesthesia & Analgesia 2001,93:1178-80.
[113]Wang SM, Maranets I, Weinberg ME, Caldwell-Andrews AA, Kain ZN. Parental auricular acuPuncture as an adjunct for Parental Presence during induction of anesthesia [J]. Anesthesiology 2004,100:1399-404.
[114]Karst M, Winterhalter M, Mu nte S, et al. Auricular acuPuncture for dental anxiety:a randomized controlled trial [J]. Anesthesia & Analgesia 2007,104:295-300.
[115]Matthias Karst, Michael Winterhalter, Sinikka Mu" nte, Boris Francki, APostolos Hon dronikos, Andre Eckardt, Ludwig HoyHartrmut Buhck, Michael Bernateck, Matthias Fink. Auricular AcuPuncture for Dental Anxiety:A Randomized Controlled Trial [J].Anesth Analg 2007,104:295-300
[116]Young-Chang P. Arai, Akihiro Ito, Soki Hibino, Sinnosuke Niwa and Wasa Ueda. Auricular AcuPunctures are Effective for the Prevention of PostoPerative Agitation in Old Patients [J].eCAM 2010,7(3):383-386
[117]李静,李幼平.不断完善与发展的Cochrane系统评价[J].中国循证医学杂志,2008,8(9)：742—743.
[118]陆寿康.刺法灸法学[M].北京：中国中医药出版社,2002
[119]Porta MA dictionary of ePidemiology. Fifth Edition. New York:Oxford University Press,2008:217.
[120]Porta MA dictionary of ePidemiology. Fifth Edition. New York:Oxford University Press,2008:154.
[121]卓开玉,张立敬.电针联合静脉全麻用于甲状腺次全切除术临床研究[J].山东中医杂志2010,12(12)：833-834
[122]王明山,陈怀龙,毕燕琳等.经皮穴位电刺激对丙泊酚主刀的全凭静脉麻醉的强化作用[J].临床麻醉学杂志2008,8(8)：726-728
[123]吴振,陈家骅,王义桥等.经皮穴位电刺激对小儿扁桃体切除术后躁动的影响[J].临床麻醉学杂志2012,1(1)：28-30
[124]幸志强.经皮穴位电刺激辅助静脉全麻的价值麻醉研究[D].广州,暨南大学2009
[125]贺必梅,杨博.经皮穴位电刺激复合TCI在全麻中镇痛效应及对心血管系统的影响[J].中国针灸2008,28(3)：219-221
[126]严彦念.经皮穴位电刺激复合静脉全麻行腔镜甲状腺手术的临床研究[D].广州暨南大学2011
[127]司俊丽.经皮穴位电刺激结合靶控输注技术在乳腺手术麻醉中效能评价的临床研究[D].广州广州中医药大学2010
[128]余建明,曲丕盛,范皓等.经皮穴位电刺激在乳腺癌根治手术中镇痛效应的研究[J].针刺研究2010,35(1)：43-46
[129]杨博,招伟贤,廖敏等.静脉全麻中经皮穴位电刺激的镇痛效应测定[J].广东医学2008,29(8)：1261-1262
[130]丁依红,顾陈怿,沈利荣等.不同麻醉方法对腹腔镜胆囊切除术患者T淋巴细胞免疫功能的影响及术后镇痛效果[J].中国针灸2011,31(5)：447-450
[131]朋立超,蒋克泉,杨美蓉.电针对全麻围气管插管期血流动力学的影响[J].中国针灸2005,25(12)：873-875
[132]徐建国,于世英,麻醉药品和精神药品规范化临床应用与管理[M]北京：人民卫生出版社,2007,10
[133]崔嵩生,耳穴贴压在围手术期辅助镇痛和机体调整作用的研究[D].广州广州中医药大学,2010.
[134]方积乾,徐勇勇.医学统计学[M].人民卫生出版社,623.
[135]乐杰.妇产科学[M].7版,北京：人民卫生出版社,2010：420-422.
[136]单秋华,韩友栋.电针耳穴心区对心脑血管功能的影响.中国针灸.1996;16(9)：9-12.
[137]吴锡强,耳穴神门穴的临床应用探讨[J].陕西中医.2009,30(10)：1374-1376.
[138]邱春复.耳穴贴压对心血管功能的即时影响[J],赣南医学院学报,1999,3,15(1);10-15
[139]广州军区后勤部卫生部编,常用新医疗法手册,人民卫生出版社,1970
[140]王槐昌,耳廓正面与背面穴位分布的规律性,祖国医学,1999；11：27-28
[141]李家琪,耳背穴管见,上海针灸杂志,1991,1：27-29
[142]黄丽春,耳穴诊断学,科学技术文献出版社,200
[143]沈桂琴,刘巧凤,耳穴排籽与对压治疗对乳腺癌患者术后睡眠障碍的护理干预[J].实用临床医药杂志,2011,15(8)：1-2
[144]Kober, Alexander, Scheck, Thomas, Schubert, Barbara, Strasser, Helmut, Gustorff, Burkhard, Bertalanffy, Petra, Wang, Shu-Ming, Kain, Zeev N. Hoerauf, Klaus. Auricular AcuPressure as a Treatment for Anxiety in PrehosPital TransPort Settings [J]. Anesthesiology 2003,98(6) 1328-1332.
[145]Wang SM, Peloqiun C, Kain ZN. The use of auricular acuPuncture to reduce PreoPerative anxiety [J]. Anesthesia & Analgesia 2001,93:1178-80.
[146]Wang SM, Maranets I, Weinberg ME, Caldwell-Andrews AA, Kain ZN. Parental auricular acuPuncture as an adjunct for Parental Presence during induction of anesthesia [J]. Anesthesiology 2004,100:1399-404.
[147]Karst M, Winterhalter M, Mu " nte S, et al. Auricular acuPuncture for dental anxiety:a randomized controlled trial [J]. Anesthesia & Analgesia 2007,104:295-300.
[148]张延东,王惠萍,王炜.耳穴贴压法对围术期患者焦虑及心率、血压的影响[J].护理学杂 志(外科版),2007,22(8)：3-5.
[149]Young-Chang P. Arai, Akihiro Ito, Soki Hibino, Sinnosuke Niwa and Wasa Ueda. Auricular AcuPunctures are Effective for the Prevention of PostoPerative Agitation in Old Patients [J].eCAM 2010,7(3):383-386
[150]罗碧,李贻文等,耳穴压豆用于缓解术后麻醉不良反应的体会[J].山东中医杂志,2000,19(10)：612.
[151]Matthias Karst, Michael Winterhalter, Sinikka Mu " nte, Boris Francki, APostolos Hon dronikos, Andre Eckardt, Ludwig HoyHartmut Buhck, Michael Bernateck, Matthias Fink. Auricular AcuPuncture for Dental Anxiety:A Randomized Controlled Trial [J].Anesth Analg 2007,104:295-300
[152]乔光文,孙培华.耳穴贴压在心电监护拔牙中的作用[J].上海针灸杂志,2006,25(4)：26.
[153]SPielberger CD, Gorsuch RL. Manual for the State-trait anxiety inventory (form Y)("self-evaluation questionnaire"). Palo Alto, CA:Consulting Psychologists Press,1983.
[154]汪向东,姜长青,马弘.心理卫生评定量表手册(增订版)北京：中国心理卫生杂志社,1999,238—240
[155]刘晓红.耳穴贴压法对肛肠科围术期病人焦虑的影响[J].护理研究2010,24(3)：805-807.
[156]HARA M, KAI Y, IKEMOTO Y. Enhancement by ProPofol of the gamma-aminobutyric acid A resPonse in dissociated hiPPocamPal Pyramidal neurons of the rat[J]. Anesthesiology,1994,81:988-994.
[157]BAHRI M A, SERET A, HANS P, et al. Does ProPofol alter membrane fluidity at clinically relevant concentrations? An ERS sPin label study[J]. BioPhysical Chemistry,2007,129:82-91.
[158]高洁.丙泊酚脂肪乳的制备工艺及质量控制研究[D].武汉：华中科技大学,2008.
[159]ClotZ MA, Nahata MC. Clinical uses of fentanyl, sufentanil and alfentanyl [J].Clin Pharm,1991,10(8):581-593.
[160]Monk JP, Beresford R, Ward A. Sufentanil:A review of its Phamracological ProPerties and theraPeutic use [J]. Durgs,1988,36 (3):286-313.
[161]张宁平,钱金桥.舒芬太尼的药理学特点及自控镇痛的应用进展[J].西南军医2010.12(6)：1151-1153.
[162]Thomson IR, Harding G, HudsonRJ. A comParison of fentanyl and sufentanil in Patients undergoing coronary artery byPass graft surgery. JCardiothoracVascAnesth,2000,14(6):652-656.
[163]王冬青.耳穴注射配合表面麻醉用于鼻内镜手术效果观察[J].中国针灸,2009,29(8)：663-665.
[164]吴松兆,尤怡.耳穴压豆配合表面马子行白内障囊外摘出术[J].眼外伤职业眼病杂志,2003,25(6)：395.
[165]王哲银,任永功,刁文波等.耳针联合硬膜外麻醉对硬膜外麻醉效果的影响[J].中国医 师进修杂志2006,29(11)：19-21.
[166]舒涛.穴位注药埋线法干预肛门病术后疼痛临床及实验研究[D]北京：中国中医科学院,2009
[167]Treede RD, Meyer Raja, SN, et al. PeriPheral and central meehanisms of cutaneous hyPeralgesia[J]. Prog Neurobiol,1992,38:397-421
[168]Patrzek D. Wall, Ronald Melzaek主编.赵宝昌,崔秀云主译.疼痛学,第3版(M).辽宁教育出版社,2000.02：32—39
[169]张琼萱.耳针麻醉200例人工流产的观察[J].云南中医学院学报,1993,16(3)：13-16.
[170]张晋平,吴景兰,王育文,等.耳针与表皮生长因子及ACTH的相关研究[J].中国针灸,1996,16(9)：40-42.
[171]刘俊杰,赵俊.现代麻醉学[M].北京：人民卫生出版社,1997：655-656.
[172]林治瑾.临床麻醉学[M].天津：科学技术出版社,1992：247.
[173]Hartwig AC. PeriPheral beta-endorPhin and Pain modulation[J]. Anesth Prog, 1991,38:75-78.
[174]向东方,司徒仪,邓时贵,等.电针耳廓穴区对子宫内膜异位症模型动物β-内啡肽及子宫活动影响的实验研究[J].国医论坛,2005,7(20)：46—47.
[175]Jarmukli N F, Ahn J, Iranmanesh A, et al. Effect of raised Plasma beta-endorPhin concentrations on PeriPheral Pain and angina thresholds in Patients with stable angina. Heart,1999,82(2):204-209.
[176]Takeshige C, Nakamura A, Asamoto S, et al. Positive feedback action of Pituitary beta-endorPhin on acuPuncture analgesia afferent Pathway. Brain Res Bull,1992,29(1):37-44.
[177]Yang Q G, Hang Y N, Sun D J. Effect of combined drug-acu-Puncture anesthesia on hyPothalamo-Pituitary adrenocortical axis resPonse and glucose metabolism in oPen-heart surgery Patients. Zhongguo Zhong Xi Yi Jie He Za Zhi,2001,21(10):729-731.
[178]Sancbez J.A., Perez J.. Am. J. Kid.Dis. [J],1997,30(4):483-488
[179]Suter M, Martinet 0, SPertini F. Reduced acute Phase resPonse after laParoscoPic total extraPeritoneal bilateral hernia rePair comPared to oPen rePair with the stoPPa Procedure. Surg Endose.2002 Aug:16(8):1214-1219.
[180]Allaouchiche,—B et al. Anesth—Analg,2001 Oct:93(4):981-5
[181]SchmidleyJW. Free radical sincen tral nervous syste mischemia. Stroke,1990,21:1086
[2]陈宥伊,李桂兰,陈泽林等.耳穴疗法的优势病种归纳分析[J].针灸临床杂志,2003,23(3)：1-3.
[3]王鹏,陈宇.腰-硬联合麻醉在腹腔镜子宫切除术中的应用[J].临床麻醉学杂志,2009,25(7)：628-629.
[4]金善爱,崔极哲,潘振祥,等.腰麻-硬膜外联合麻醉下妇科腹腔镜手术对呼吸和循环系统的影响[J].吉林大学学报(医学版),2005,31：460-461.
[5]鲍瑞军,王建波.腹腔镜妇科手术的麻醉及相关问题研究进展[J].中国误诊学杂志,2011,11(1)：30-31.
[6]庄心良,现代麻醉学(第三版),[M].北京：人民卫生出版社2004
[7]第13届国际疼痛大会,韩济生院士针刺镇痛大会报告[J].中国疼痛医学杂志,20105：2.
[8]杨军.瑞芬太尼丙泊酚靶控静脉麻醉用于妇科腹腔镜手术的效果评价[J].实用医院临床杂志,2010,7(1)：83-85.
[9]BovilljqwarrenPJ, SehullerJL, etal. ComParisonoffentanil,sufentanil, and alfentani anesthesia in Patients undergoing valvular heart surgery. AnesthAnalg. 1999:63:1081-1086.
[10]林鹰.麻醉性镇痛药与现代临床麻醉.中国处方药,2005,7：16.
[11]余守章.新型阿片类药物在病人自控镇痛中应用研究进展.中国疼痛医学杂志,2005,11,(6)：354-355.
[12]王曼.舒芬尼的临床应用近况.继续医学教育,2006,20(34)：66.
[13]林霖,王伟鹏,张燕婉,等.两种剂量芬太尼对冠状动脉旁路移植术患者血液动力学及血浆儿茶酚胺的影呵[J].中华麻醉学杂志,2004,5：460-461.
[14]蔡景峰.中医麻醉术简史[J].辽宁中医杂志,1980,4：38-40.
[15]王伟.中医麻醉历史、现状和前景[J].甘肃科技,2011,27(20)：178-179.
[16]江苏新医学院.中药大辞典[S].上海：上海科学技术出版社,1993.260.
[17]苟新元,洪英科等.中药蟾酥在人工流产手术中麻醉作用的研究[J].中国计划生育学杂志2003,1(87)：55-56.
[18]王本祥、现代中药药理与临床[M].天津科技翻译出版公司,2004：1036,1728.
[19]孙世明.蟾酥的现代临床应用进展[J].四川中医,1996,14(12)：12—13.
[20]金铁林、赵素云、汪海清等.中药验方表面麻醉拔牙的临床应用[J].现代口腔医学杂志,2000,14(3)：190
[21]孙述华.中药表面麻醉剂在耳鼻咽喉手术中的应用.四川中医,2001,19(6)：68.
[22]李万山、林励、廖惠芳等.辛酥酊外用皮肤表麻作用探讨[J].中药新药与临床药理,1995,10(3)：165—166.
[23]杨升华.中药表面麻醉剂的应用[J]中医外治杂志,2001,10(2)：30
[24]管遵信.中国耳针学[M].人民卫生出版社,1995.
[25]黄丽春.耳穴诊断治疗学(第一版)[M]北京：科学技术文献出版社1995
[26]Oleson, T. and R. Koening, A comParison of Chinese and Nogier auricular acuPuncture Points[J]. American Journal of AcuPuncture,1983,11 (3):205-223
[27]黄丽春编著.耳穴诊断学[M].北京：科学技术文献出版社1995：309.
[28][唐]孙思邈著,银海精微,人民卫生出版社影音,1956
[29]管遵信.耳诊诊治疾病的原理[J].中国针灸,1993(1)：42
[30]黄丽春.耳穴诊断治疗学[M].北京：科学技术文献出版社,1991
[31]张诗兴,周坤福,姜文方等.耳穴的脑、脊神经节投射[J].上海针灸杂志,2002,21(3)：35-36
[32]张启兵,张诗兴.耳针调节内脏功能的作用机制研究[J].广东药学院学报,2005,21(3)：330-331.
[33]刘维洲,许冠荪,张群群,等.耳廓神经支配与耳针对胃肠电活动影响的观察[J].针刺研究.1990,15(3)：187-190.
[34]管学忠,魏睦新.中医耳针治疗学的负反馈调节[J].针灸临床杂志,1998,14(8)：2-3
[35]王柞邦.关于耳穴作用规律的探讨[J],湖北中医学院学报2001,3(2)：13.
[36]朱兵,陈巩荪,许瑞征. 耳廓穴位电学特性的研究[J]. 中国针灸,1999,19(6)355
[37]李育良,李裕强,孙韬等.家兔内脏病理模型耳廓反应区的定位研究[J].针灸临床杂志,1995,11((1)：2—31
[38]朱元根,朱柏君,杨友泌,等. 大鼠实验性胃溃疡的耳穴反应和电针体穴的作用[J]中国针灸,1994,14(4)：39—41
[39]吕建平.针刺耳穴对家兔胃电的影响[J].上海针灸杂志,1991,10(1)：30
[40]武和平,毕联阳,沈平.自制耳穴按压丸应用于术后镇痛的临床观察和机理研究,上海中医药杂志,1994,(3)：28-30
[41]单秋华,孙冬梅,吴富东.耳穴贴压对女性更年期综合症患者血清内分泌素及p-内啡肽的影响,中国针灸,2003,23(11)：677
[42]吴连方,金有慧,赵卫红,等.分娩镇痛方法的临床研究,中华妇产科学杂志,1997,32(6)：363
[43]蒋文妹,徐正仪,陈水娟,等.耳针镇痛在康乐分娩中的前瞻性研究,现代妇产科进展,1997,6(3)：249
[44]杨佃会,韩晶,单秋华.耳穴综合疗法治疗缓解期普通偏头痛疗效观察及对患者血浆CGRP、ET的影响,中国针灸,2007,27(8)：569-571
[45]Kerns, R..D.Turk, and T. Rudy, The west haven-yale multidimensional Pain inventory (WHYMPI) [J]. Pain,1985,23(4):345-356.
[46]马培锋,刘国华,王传尊.棒针颤点耳穴痛点治疗感冒咽痛症57例[J].针灸临床杂志,2011,27(12)：13
[47]贾春生,郑丽娅,石晶等.耳穴透穴埋针刺法治疗偏头痛的临床疗效及对血浆5-羟色胺含量的影响[J].针刺研究,2010,35(6)：448-473.
[48]贾春生,马小顺,葛建军.耳针沿皮透穴刺法对颈椎病快速镇痛效应的初步观察[J].中国中医药信息杂志,2002,9(10)：56-57.
[49]贾春生,石晶,马小顺等.耳针沿皮透穴刺法与耳针直刺法对颈型、神经根型颈椎病快速镇痛效应的比较研究[J].针刺研究2007,32(3)：186-189.
[50]贾春生,李晓峰,马小顺等.耳针沿皮头次与直刺对肩周炎快速镇痛效应的比较[J].针刺研究,2008,22(5)：339-342.
[51]孙桂萍.耳穴磁疗治疗老年人腰背痛疗效观察[J].中国针灸,2007,27(2)：112-114
[52]罗惠郁.耳穴治疗腰痛的临床评估与机理研究[D].南京南京中医药大学,2010
[53]陈绮.耳穴埋针为主治疗腰椎间盘突出症继发根性坐骨神经痛的观察[D].广州：广州中医药大学2012.
[54]Sator-Katzenschlager SM, Szeles JC,Scharbert G, et al. Electrical stimulation of auricular acuPuncture Points is more effective than conventional manual auricular acuPuncture in chronic cervical Pain:a Pilot study [J].Anesth Analg. 2003,97(5):1469-1473.
[55]Wang SM, Kain ZN, White PF. AcuPuncture analgesia II:Clinical considerations [J].Anesthesia & Analgesia,2008,106 (2):19-21.
[56]Cherny N, RiPamonti C, Pereira J, et al. Strategies to manage the adverse effects of oral morPhine:an evidence-based rePort [J]. J Clin Oncol, 2001,19(9):2542-2554.
[57]刘振华,李卉,李彦等.盐酸羟考酮控释治疗中、重度疼痛研究进展[J].武警医学,2005.16(3)：211-213.
[58]殷蔚伯.肿瘤放射治疗手册[M].北京：中国协和医科大学车版社,2009：323.
[59]钟敏钰,胡作为,黄琳等.耳穴贴压联合强阿片类药物治疗中、重度癌痛50例疗效观察[J].中医杂志2012,53(13)：1123-1125.
[60]沈秋萍.耳穴穴注缓解癌痛的临床观察及机制研究[D].广州：广州中医药大学,2009,4
[61]章旭萍,叶巧珠,张新玉.耳穴压丸缓解癌痛伴抑郁状态的临床观察[J].浙江中医药大学学报,2012,36(6)：714-715.
[62]Alimi D, Rubino C, Pichard-Leandri E, Fermand-Brule S, Dubreuil-Lemaire ML, Hill C. Analgesic effect of auricular acuPuncture for cancer Pain:a randomized, blinded, controlled trial. [J]. Journal of Clinical Oncology,2003,21:4120-6.
[63]肖玮,耳穴镇痛验案3则[J].江苏中医药,2003,24(7)：47
[64]易志龙,杨德全,李勇华.耳针配合中药治疗乙型病毒性肝炎肝区疼痛62例[J].吉林中医药,2006,26(2)：52.
[65]金亚蓓,孙占玲,金慧芳.耳穴电针治疗子宫内膜异位症痛经的随机对照研究[J].2009,34(3)：188-192.
[66]李央,林金芳.子宫内膜异位症发病机理研究进展[J].中华妇产科杂志,2005,40(1)：55-57.
[67]信妙鸾.耳穴贴压治疗痛经1000例疗效观察[J].山西中医学院学报.2005;6(1)：42
[68]Park SY, Effect of the auriculotheraPy on dysmenorrhea in school-aged girls. J of Korean Acad Adult Nurs.2010, Oct,22(5):529-536.
[69]Pouresmail Z & Ibrahimzadeh R. Effects of acuPressure and ibuProfen on the severity of Primary dysmenorrhea. Journal of Traditional Chinese Medicine,2002; 22(3):205-210.
[70]朱莲芳,胡立丹,周嫦等.磁珠耳穴按压在动静脉内瘘血管穿刺中的应用[J].浙江中西医结合杂志,2007,17(3)：185-186.
[71]刘芳,方宗武.耳穴埋豆对肛肠病术后的镇痛效果观察[J].光明中医,2011,4(26)：762-763.
[72]童培建,汪海东,马镇川等.耳穴疗法在全膝关节置换围手术期镇痛的应用及疗效观察[J].中国中西医结合杂志,2010,30(9)：931-934.
[73]梁永妃,屠福汉,黄春霞.耳穴压籽法联合静脉镇痛在下肢骨科手术的临床应用[J].针刺研究,2011,
[74]王冬青.耳穴注射配合表面麻醉用于鼻内镜手术效果观察[J].中国针灸,2009(29)8：663-665.
[75]沈通一,毕联阳,张静等.耳穴按压对术后切口疼痛的疗效及其对血浆5-羟色胺的影响[J].中国中西医结合外科杂志2000,6(4)：231-233
[76]罗庆道.创伤性气滞血瘀疼痛的初步探讨[J].针灸研究,1980.5(1)：36
[77]程莘农.中国针灸学[M].第3版.北京：人民卫生出版社,1986：612-632
[78]颜湘蓉,云洁,杨惠英.耳穴压丸缓解眼科术后患者疼痛的临床研究[J].四川中医2009：27(10)：108-109
[79]田清玉,马艳秋,张巧荣等.耳穴贴压法分娩镇痛50例[J].中国针灸,2006,26(3)：212.
[80]吴剑斐,郑月红,张杏敏.耳穴刺激及次骼穴注射在分娩镇痛中的应用[J].医学理论与实践,2003,16(12)：1392.
[81]许娟,张秀举.耳针镇痛用于分娩的疗效观察[J].中国针灸,2001,21(7)：399.
[82]周军.耳穴埋籽防治痔术后疼痛的临床研究[D].南京南京中医药大学,2011
[83]马钦丽,范慧娟.应用磁珠耳穴疗法缓解肾绞痛的观察及护理[J].护士进修杂志,2011,26(10)：934-935.
[84]胡可,汪勇,吴文通等.耳穴穴位注射麻醉在甲状腺手术中的应用[J].上海针灸杂志2000,19(3)：21-22.
[85]T. I. Usichenko 1, Ch. Lehmann 2 and E. Ernst 3, Auricular acuPuncture for PostoPerative Pain control:a systematic review of randomised clinical trials [J]. Anaesthesia,2008, (11)63:1343-1348
[86]Tong PJ, Wang HD, Ma ZC, APPlication and effect of auricular acuPoint Pressing for analgesia in PerioPerative Period of total knee joint rePlacement [J]. Chinese Journal of Integrated Traditional and Western Medicine 2010,9,30(9):931-934.
[87]Taras I. Usichenko, Sven Kuchling, Torsten Witstruck, Dragan Pavlovic, Maria Zach, et al. Auricular acuPuncture for Pain relief after ambulatory knee surgery:a randomized trial [J]. CMAJ 2007,176(2),179-183
[88]Robert Greif, Sonja Laciny, Masoud Mokhtarani, Anthony G. Doufas, Maryam Bakhshandeh, LeoPold Dorfer, Daniel I. Sessler. Transcutaneous Electrical Stimulation of an Auricular AcuPuncture Point Decreases Anesthetic Requirement [J]. Anesthesiology 2002,96:306-312
[89]刘峰,高士杰,胡慧刚等.大黄治疗休克后胃肠功能障碍的临床研究[J].中国急救医学, 2003,23(1)：38-39.
[90]LIU K, H SU CC, CH IA YY. Effect of dexam ethasone on PostoP-erative em esis and Pain[J]. Br J Anaesthesia,1998,80:85-86.
[91]TH UNE A, APPELGREN L, H AGLIND E. Prevention of PostoP-erative nausea and vom iting after laParoscoPic cholecystectom y. AProsPective random ised study of m etoeloPram ide and transderm al hyoscine[J]. Eur J Surgery,1995,161:265-268.
[92]W ETCH ER BY. Ondansetron decreases em etic sym Ptom s following outPatient laParoscoPy[J]. Anesthesiology,1990,73:A36.
[93]赵晓琴,叶铁虎,罗爱伦,等.腹腔镜胆囊切除术后患者恶心呕吐的预防[J].中华麻醉学杂志,1997,17(1)：46.
[94]Abodeely A, Schechter S, KliPfel A, et al. Does alvimoPan enhance return of bowel function in laParoscoPic right colectomy [J]. Am Surg,2011,77(11):1460 1462.
[95]张阳德,林伶,陈紫煜.耳穴按压对腹腔镜术后胃肠功能恢复的影响[J].中国内镜杂志,2011,17(10)：1014-1018
[96]张榆川.耳穴贴压法用于中老年人腹部手术牵拉反应的观察[J].四川中医,2004;22(8)：88.
[97]郑红霞,耳穴贴压促进妇科腹腔镜患者术后排气的观察[J].实用全科医学,2008,4,6(4)：340
[98]邱纬芬耳穴压丸对心脏术后排便和血管活性肠肽的影响[D].广州:广州中医药大学,2012
[99]金惠铭,王建枝.病理生理学[M].北京：人Ui卫生山版社,2006：189
[100]Onoue S, Misaka S, Yamada s. Structure_actity relationship of vasoactive intestinal PePtide(VIP):Potent agonists and Potential c]inical aPPlication, Naunyu Schniiedebcrgs Arch Pharmacol,2008,377(46):579
[101]Maney DL, Schoech SJ, SharP P.J, et al. liffccts of vasoactive.intestinal PePtide on Plasma Prolactin in Passerines[J]. Gen ComP Endocrinol,1998,113(3); 323
[102]徐韶怡,郑士立,王庆来等.耳穴针刺贴压对妇科术后恶心呕吐的抑制作用疗效观察[J].2009.34(2)：143-144.
[103]KIM Y, KIM CW, KIM KS. Clinical observation on PostoPerative vom iting treated by auricular acuPuncture [J]. Am J ChinM ed,2003,31(3):475-480.
[104]SAH M EDDINI M A, FAZELZADEH A. Does auricular acuPuncture reduce PostoPerative vom iting after cholecystectom y [J]. JAltern Com Plem ent M ed,2008, 14(10):1275-1279.
[105]江勇,王亚国,李震宇等.耳穴埋针治疗胃肠道术后呃逆临床疗效观察[J].蚌埠医学院学报,2010,35(5)：493-494.
[106]徐江宁.术前焦虑的研究进展[J].上海医学,2009,32(11)：1130-1133.
[107]李智.电针加耳穴贴压治疗失眠35例[J].新中医,2010,42(1)：88-89.
[108]张延东,王惠萍,王炜.耳穴贴压法对围术期患者焦虑及心率、血压的影响[J].护理学杂志(外科版),2007,22(8)：3-5.
[109]罗碧,李贻文等,耳穴压豆用于缓解术后麻醉不良反应的体会[J].山东中医杂志,2000,19(10)：612.
[110]乔光文,孙培华.耳穴贴压在心电监护拔牙中的作用[J].上海针灸杂志,2006,25(4)：26.
[111]韩晓玲,蔡晖.指压联合耳穴埋籽缓解普外科术前焦虑的临床研究[J].新中医,2012,29(6)：84-85.
[112]Wang SM, Peloqiun C, Kain ZN. The use of auricular acuPuncture to reduce PreoPerative anxiety [J]. Anesthesia & Analgesia 2001,93:1178-80.
[113]Wang SM, Maranets I, Weinberg ME, Caldwell-Andrews AA, Kain ZN. Parental auricular acuPuncture as an adjunct for Parental Presence during induction of anesthesia [J]. Anesthesiology 2004,100:1399-404.
[114]Karst M, Winterhalter M, Mu nte S, et al. Auricular acuPuncture for dental anxiety:a randomized controlled trial [J]. Anesthesia & Analgesia 2007,104:295-300.
[115]Matthias Karst, Michael Winterhalter, Sinikka Mu" nte, Boris Francki, APostolos Hon dronikos, Andre Eckardt, Ludwig HoyHartrmut Buhck, Michael Bernateck, Matthias Fink. Auricular AcuPuncture for Dental Anxiety:A Randomized Controlled Trial [J].Anesth Analg 2007,104:295-300
[116]Young-Chang P. Arai, Akihiro Ito, Soki Hibino, Sinnosuke Niwa and Wasa Ueda. Auricular AcuPunctures are Effective for the Prevention of PostoPerative Agitation in Old Patients [J].eCAM 2010,7(3):383-386
[117]李静,李幼平.不断完善与发展的Cochrane系统评价[J].中国循证医学杂志,2008,8(9)：742—743.
[118]陆寿康.刺法灸法学[M].北京：中国中医药出版社,2002
[119]Porta MA dictionary of ePidemiology. Fifth Edition. New York:Oxford University Press,2008:217.
[120]Porta MA dictionary of ePidemiology. Fifth Edition. New York:Oxford University Press,2008:154.
[121]卓开玉,张立敬.电针联合静脉全麻用于甲状腺次全切除术临床研究[J].山东中医杂志2010,12(12)：833-834
[122]王明山,陈怀龙,毕燕琳等.经皮穴位电刺激对丙泊酚主刀的全凭静脉麻醉的强化作用[J].临床麻醉学杂志2008,8(8)：726-728
[123]吴振,陈家骅,王义桥等.经皮穴位电刺激对小儿扁桃体切除术后躁动的影响[J].临床麻醉学杂志2012,1(1)：28-30
[124]幸志强.经皮穴位电刺激辅助静脉全麻的价值麻醉研究[D].广州,暨南大学2009
[125]贺必梅,杨博.经皮穴位电刺激复合TCI在全麻中镇痛效应及对心血管系统的影响[J].中国针灸2008,28(3)：219-221
[126]严彦念.经皮穴位电刺激复合静脉全麻行腔镜甲状腺手术的临床研究[D].广州暨南大学2011
[127]司俊丽.经皮穴位电刺激结合靶控输注技术在乳腺手术麻醉中效能评价的临床研究[D].广州广州中医药大学2010
[128]余建明,曲丕盛,范皓等.经皮穴位电刺激在乳腺癌根治手术中镇痛效应的研究[J].针刺研究2010,35(1)：43-46
[129]杨博,招伟贤,廖敏等.静脉全麻中经皮穴位电刺激的镇痛效应测定[J].广东医学2008,29(8)：1261-1262
[130]丁依红,顾陈怿,沈利荣等.不同麻醉方法对腹腔镜胆囊切除术患者T淋巴细胞免疫功能的影响及术后镇痛效果[J].中国针灸2011,31(5)：447-450
[131]朋立超,蒋克泉,杨美蓉.电针对全麻围气管插管期血流动力学的影响[J].中国针灸2005,25(12)：873-875
[132]徐建国,于世英,麻醉药品和精神药品规范化临床应用与管理[M]北京：人民卫生出版社,2007,10
[133]崔嵩生,耳穴贴压在围手术期辅助镇痛和机体调整作用的研究[D].广州广州中医药大学,2010.
[134]方积乾,徐勇勇.医学统计学[M].人民卫生出版社,623.
[135]乐杰.妇产科学[M].7版,北京：人民卫生出版社,2010：420-422.
[136]单秋华,韩友栋.电针耳穴心区对心脑血管功能的影响.中国针灸.1996;16(9)：9-12.
[137]吴锡强,耳穴神门穴的临床应用探讨[J].陕西中医.2009,30(10)：1374-1376.
[138]邱春复.耳穴贴压对心血管功能的即时影响[J],赣南医学院学报,1999,3,15(1);10-15
[139]广州军区后勤部卫生部编,常用新医疗法手册,人民卫生出版社,1970
[140]王槐昌,耳廓正面与背面穴位分布的规律性,祖国医学,1999；11：27-28
[141]李家琪,耳背穴管见,上海针灸杂志,1991,1：27-29
[142]黄丽春,耳穴诊断学,科学技术文献出版社,200
[143]沈桂琴,刘巧凤,耳穴排籽与对压治疗对乳腺癌患者术后睡眠障碍的护理干预[J].实用临床医药杂志,2011,15(8)：1-2
[144]Kober, Alexander, Scheck, Thomas, Schubert, Barbara, Strasser, Helmut, Gustorff, Burkhard, Bertalanffy, Petra, Wang, Shu-Ming, Kain, Zeev N. Hoerauf, Klaus. Auricular AcuPressure as a Treatment for Anxiety in PrehosPital TransPort Settings [J]. Anesthesiology 2003,98(6) 1328-1332.
[145]Wang SM, Peloqiun C, Kain ZN. The use of auricular acuPuncture to reduce PreoPerative anxiety [J]. Anesthesia & Analgesia 2001,93:1178-80.
[146]Wang SM, Maranets I, Weinberg ME, Caldwell-Andrews AA, Kain ZN. Parental auricular acuPuncture as an adjunct for Parental Presence during induction of anesthesia [J]. Anesthesiology 2004,100:1399-404.
[147]Karst M, Winterhalter M, Mu " nte S, et al. Auricular acuPuncture for dental anxiety:a randomized controlled trial [J]. Anesthesia & Analgesia 2007,104:295-300.
[148]张延东,王惠萍,王炜.耳穴贴压法对围术期患者焦虑及心率、血压的影响[J].护理学杂 志(外科版),2007,22(8)：3-5.
[149]Young-Chang P. Arai, Akihiro Ito, Soki Hibino, Sinnosuke Niwa and Wasa Ueda. Auricular AcuPunctures are Effective for the Prevention of PostoPerative Agitation in Old Patients [J].eCAM 2010,7(3):383-386
[150]罗碧,李贻文等,耳穴压豆用于缓解术后麻醉不良反应的体会[J].山东中医杂志,2000,19(10)：612.
[151]Matthias Karst, Michael Winterhalter, Sinikka Mu " nte, Boris Francki, APostolos Hon dronikos, Andre Eckardt, Ludwig HoyHartmut Buhck, Michael Bernateck, Matthias Fink. Auricular AcuPuncture for Dental Anxiety:A Randomized Controlled Trial [J].Anesth Analg 2007,104:295-300
[152]乔光文,孙培华.耳穴贴压在心电监护拔牙中的作用[J].上海针灸杂志,2006,25(4)：26.
[153]SPielberger CD, Gorsuch RL. Manual for the State-trait anxiety inventory (form Y)("self-evaluation questionnaire"). Palo Alto, CA:Consulting Psychologists Press,1983.
[154]汪向东,姜长青,马弘.心理卫生评定量表手册(增订版)北京：中国心理卫生杂志社,1999,238—240
[155]刘晓红.耳穴贴压法对肛肠科围术期病人焦虑的影响[J].护理研究2010,24(3)：805-807.
[156]HARA M, KAI Y, IKEMOTO Y. Enhancement by ProPofol of the gamma-aminobutyric acid A resPonse in dissociated hiPPocamPal Pyramidal neurons of the rat[J]. Anesthesiology,1994,81:988-994.
[157]BAHRI M A, SERET A, HANS P, et al. Does ProPofol alter membrane fluidity at clinically relevant concentrations? An ERS sPin label study[J]. BioPhysical Chemistry,2007,129:82-91.
[158]高洁.丙泊酚脂肪乳的制备工艺及质量控制研究[D].武汉：华中科技大学,2008.
[159]ClotZ MA, Nahata MC. Clinical uses of fentanyl, sufentanil and alfentanyl [J].Clin Pharm,1991,10(8):581-593.
[160]Monk JP, Beresford R, Ward A. Sufentanil:A review of its Phamracological ProPerties and theraPeutic use [J]. Durgs,1988,36 (3):286-313.
[161]张宁平,钱金桥.舒芬太尼的药理学特点及自控镇痛的应用进展[J].西南军医2010.12(6)：1151-1153.
[162]Thomson IR, Harding G, HudsonRJ. A comParison of fentanyl and sufentanil in Patients undergoing coronary artery byPass graft surgery. JCardiothoracVascAnesth,2000,14(6):652-656.
[163]王冬青.耳穴注射配合表面麻醉用于鼻内镜手术效果观察[J].中国针灸,2009,29(8)：663-665.
[164]吴松兆,尤怡.耳穴压豆配合表面马子行白内障囊外摘出术[J].眼外伤职业眼病杂志,2003,25(6)：395.
[165]王哲银,任永功,刁文波等.耳针联合硬膜外麻醉对硬膜外麻醉效果的影响[J].中国医 师进修杂志2006,29(11)：19-21.
[166]舒涛.穴位注药埋线法干预肛门病术后疼痛临床及实验研究[D]北京：中国中医科学院,2009
[167]Treede RD, Meyer Raja, SN, et al. PeriPheral and central meehanisms of cutaneous hyPeralgesia[J]. Prog Neurobiol,1992,38:397-421
[168]Patrzek D. Wall, Ronald Melzaek主编.赵宝昌,崔秀云主译.疼痛学,第3版(M).辽宁教育出版社,2000.02：32—39
[169]张琼萱.耳针麻醉200例人工流产的观察[J].云南中医学院学报,1993,16(3)：13-16.
[170]张晋平,吴景兰,王育文,等.耳针与表皮生长因子及ACTH的相关研究[J].中国针灸,1996,16(9)：40-42.
[171]刘俊杰,赵俊.现代麻醉学[M].北京：人民卫生出版社,1997：655-656.
[172]林治瑾.临床麻醉学[M].天津：科学技术出版社,1992：247.
[173]Hartwig AC. PeriPheral beta-endorPhin and Pain modulation[J]. Anesth Prog, 1991,38:75-78.
[174]向东方,司徒仪,邓时贵,等.电针耳廓穴区对子宫内膜异位症模型动物β-内啡肽及子宫活动影响的实验研究[J].国医论坛,2005,7(20)：46—47.
[175]Jarmukli N F, Ahn J, Iranmanesh A, et al. Effect of raised Plasma beta-endorPhin concentrations on PeriPheral Pain and angina thresholds in Patients with stable angina. Heart,1999,82(2):204-209.
[176]Takeshige C, Nakamura A, Asamoto S, et al. Positive feedback action of Pituitary beta-endorPhin on acuPuncture analgesia afferent Pathway. Brain Res Bull,1992,29(1):37-44.
[177]Yang Q G, Hang Y N, Sun D J. Effect of combined drug-acu-Puncture anesthesia on hyPothalamo-Pituitary adrenocortical axis resPonse and glucose metabolism in oPen-heart surgery Patients. Zhongguo Zhong Xi Yi Jie He Za Zhi,2001,21(10):729-731.
[178]Sancbez J.A., Perez J.. Am. J. Kid.Dis. [J],1997,30(4):483-488
[179]Suter M, Martinet 0, SPertini F. Reduced acute Phase resPonse after laParoscoPic total extraPeritoneal bilateral hernia rePair comPared to oPen rePair with the stoPPa Procedure. Surg Endose.2002 Aug:16(8):1214-1219.
[180]Allaouchiche,—B et al. Anesth—Analg,2001 Oct:93(4):981-5
[181]SchmidleyJW. Free radical sincen tral nervous syste mischemia. Stroke,1990,21:1086