丙泊酚联合瑞芬太尼对重度子痫前期孕妇行剖宫产术中对血流动力学的影响
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摘要
研究背景
重度子痫前期属于产科危重症,是引起孕产妇病死率增高的主要原因之一,行剖宫产术是治疗重度子痫前期孕妇的重要手段。因重度子痫前期孕妇具有特殊的病理生理改变而导致全身各重要脏器不同程度的损害,并且受多种体液因素影响,存在与正常孕妇截然不同的血流动力学改变。故部分重度子痫前期孕妇不适合行椎管内麻醉,如心衰、肺水肿等;或存在椎管内麻醉的禁忌症,如凝血功能障碍、肝酶明显升高、血小板明显减少等,必须选择全身麻醉行剖宫产术终止妊娠。然而,剖宫产术采用全身麻醉有其特殊性,既要保持足够的麻醉深度以保证孕妇循环稳定,同时应尽量避免全麻用药对胎儿的影响。
以往丙泊酚与瑞芬太尼在产科领域中使用存在争议,但随着研究与使用认识逐渐加深,其独特的药物代谢规律和联合使用在保持患者血流动力学稳定的优势,逐渐被产科麻醉领域重视,特别是在重症产科。另外,近年来关于在全麻下行剖宫产术方面的报道并不少,但对循环的评价多采用心率与血压等指标,较局限,而且缺乏完整性。有文献报道,对于健康孕妇,动脉血压值与心输出量相关性较好,可间接反映胎盘血流灌注情况;而对于子痫前期的孕妇,由于外周血管阻力大幅增加,动脉血压值与心输出量相关性差,不能反映真实胎盘灌注情况。因此,探讨重度子痫前期孕妇在丙泊酚联合瑞芬太尼全麻下行剖宫产术过程中整体血流动力学变化,为重度子痫前期孕妇手术及麻醉提供临床参考。
目的
探讨应用丙泊酚联合瑞芬太尼在重度子痫前期孕妇在全身麻醉下行剖宫产术过程中对孕妇血流动力学的影响。
方法
对象为2010年3月至2010年12月期间就诊于广州医学院第三附属医院产科受同一组产科医生诊治的ASA II～III级重度子痫前期早产孕妇15例,因存在椎管内麻醉禁忌症,需全身麻醉行剖宫产术,全麻用药选择丙泊酚与瑞芬太尼。采用自身对照方法,以孕妇入手术室时段所测量的血流动力学参数,包括平均动脉压(MAP)、中心静脉压(CVP)、心输出量(CO)、每搏量(SV)、周围血管阻力(SVR)、心率(HR)作为基础值,与以后时段各参数比较,统计方法采用单因素方差分析,P<0.05时认为有统计学意义。各血流动力学参数在以下时段测量: 1.基础值时段T1:入室后,麻醉诱导前; 2.麻醉诱导时段T2:药物诱导至气管插管前; 3.气管插管时段T3:气管插管过程中; 4.气管插管后时段T4:气管插管完成至切皮前10分钟; 5.开腹时段T5:切皮至子宫剖开前; 6.胎儿娩出时段T6:切开子宫娩出胎儿至使用催产素前; 7.催产素作用时段T7:使用催产素至催产素作用; 8.手术结束时段T8:关腹至手术结束; 9.拔管时段T9:呼吸恢复至拔除气管导管; 10.离室时段T10:离开手术室前。
结果
一、术中孕妇血流动力学的变化MAP于麻醉诱导插管后时段T2、T3、T4、T5、T6、T7、T8、T9、T10与基础值T1比较均有统计学意义,P<0.05。SVR在离室时段T10与基础值T1比较无统计学意义,P>0.05;其余时段T2、T3、T4、T5、T6、T7、T8、T9与基础值T1比较均有统计学意义,P<0.05。
CO在麻醉诱导后,在使用缩宫素阶段T7与基础值比较有统计学意义T1,P<0.05;其余时段T2、T3、T4、T5、T6、T8、T9、T10与基础值T1比较均无统计学意义,P>0.05。
HR与缩宫素使用时段T7、气管拔管时段T9与基础值T1比较有明显统计学意义,P<0.05;而在其他时段T2、T3、T4、T5、T6、T8、T10与基础值比较无统计学意义,P>0.05。
SV在缩宫素使用时段T7与基础值T1比较有统计学意义,P<0.05;而在其他时段T2、T3、T4、T5、T6、T8、T9、T10与基础值比较无统计学意义,P>0.05。CVP于麻醉后各时段T2、T3、T4、T5、T6、T7、T8、T9、T10与基础值比较均无统计学意义,P>0.05。但于机械通气时段(T4-T9)有上升趋势,从胎儿娩出后时段(T5)后上升趋势更明显。
二、新生儿情况
本组新生儿均为早产低体重儿,1min Apgar评分3分1名、4-7分12名,大于8分2名,经过使用纳洛酮、面罩吸氧、辅助通气、刺激呼吸等简单处理后,5min、10min Apgar评分均大于8分。新生儿脐动脉血pH值均大于7.2。
结论
1、常规剂量丙泊酚联合瑞芬太尼在重度子痫前期孕妇在全麻下剖宫产术中能改善孕妇外周血管痉挛状态,有效减轻后负荷,对心输出量影响较轻微。
2、常规剂量丙泊酚联合瑞芬太尼在重度子痫前期孕妇在全麻下行剖宫产术,能对母体心输出量维护尚好,保证胎盘灌注,对早产低体重儿呼吸影响轻微。
3、重度子痫前期孕妇在全麻下行剖宫产术中应用常规剂量缩宫素会导致循环系统短时间内明显的波动。
Background
Severe preeclampsia in critical condition,is one of leading causes of maternal mortality. Cesarean section is the most effective mean to rescue of the patients with severe preeclampsia. However, the patients with severe preeclampsia are both in the gestation period and having the special pathology physiology changes in circulatory system. The unique hemodynamics of them is greatly different from normal parturient women. Furthermore, some of them do not adapt or even are existing contraindication to the intrathecal anesthesia, such as coagulation disorders, liver function lesion, PLT decreasing and so on. So they have to choose general anesthesia for Cesarean section. General anesthesia on pregnant women undergoing cesarean section exist distinctiveness. Whether maintaining the enough anesthesia depth to guarantee that the pregnant woman circulates stably,or avoiding the general anesthesia medication as far as possible to effect the embryo.
Propofol and remifentanil are ones of the most widely used intravenous anesthetic,but there is a dispute constantly on its useing in obstetric anesthesia. As the research and using experience gradually deepened, they are beginning to use in obstetric. In recent years, papers about clinical application of general anesthesia in cesarean section are so many. However, the evaluations of the cycle are only the heart rate and blood pressure measurements. In healthy patients, the maximum change in CO has been shown to correlate better with uteroplacental blood flow than upper arm blood pressure. Furthermore, in severe preeclampsia, an increased systemic vascular resistance (SVR) could render blood pressure a poor indicator of CO, but the information available on such patients during GA is scanty.
It is necessary to investigate the hemodynamic changes during GA for cesarean delivery in severe preeclampsia. A better understanding of the perioperative hemodynamic changes could contribute to a reduction in perioperative pulmonary edema, renal dysfunction, eclampsia, and neonatal morbidity.
Purpose
To observe the hemodynamic effects and changes, of which the patients with severe preeclampsia on general anesthesia for cesarean section using propofol and remifentanil.
Methods
Adult patients aged 21-39 years old with ASA physical status II- III grade were scheduled for elective cesarean section. Being existing contraindication to the intrathecal anesthesia,they had to get general anesthesia for Cesarean section and chose Propofol and remifentanil. The patient was put right internal jugular vein catheterization, measuring central venous pressure(CVP)continuously. Put left radial artery puncture, arterial monitoring, measuring mean arterial blood pressure(MAP)continuously. Being used the GE ICG noninvasive hemodynamic monitoring system to measure cardiac output(CO)、Stroke Volume (SV) , systemic vascular resistance (SVR). Hemodynamic values were measured in the following defined time.
1.Baseline measurements T1
2.Induction of anesthesia T2(induction of GA until intubation)
3.Intubation T3(the 30-s period during intubation )
4.After intubation T4(from intubation to 10 minutes before skin incision)
5.Skin incision T5 (from skin incision to 30 s before uterine incision)
6.Postdelivery T6(the 30-s period from delivery to administration of oxytocin)
7.Peak oxytocin effect T7 (from administration of oxytocin to peak effect on CO)
8.End of surgery T8(30-s time period before skin closure)
9.Tracheal extubation T9(30-s time period during tracheal extubation)
10.Leaving operating room T10(30-s time period before leaving the operating room)
Results
1. Intraoperative hemodynamic changes in patients MAP at T9,SVR at T10,CO at T2、T3、T4、T5、T6、T8、T9、T10,HR at T2、T3、T4、T5、T6、T8、T10,SV at T2、T3、T4、T5、T6、T8、T9、T10,CVP at T2、T3、T4、T5、T6、T7、T8、T9、T10 comparing with the ones at T1 all were no significant difference,P>0.05。MAP at T2、T3、T4、T5、T6、T7、T8、T10 were lower than the ones at T1;SVR at T2、T3、T4、T5、T6、T7、T8、T9 were lower than the ones at T1;CO at T7 was higher than the one at T1;HR at T7、T9 was higher than the one at T1;SV at T7 was higher than the one at T1,P<0.05.
2. Effective of the infant. This study shows that all the infants were PLBW. Two infants’1min Apgar score were 3 points 1, twelve infants’were 4-7 points, two one’s more than 8 points. Through the using of naloxone, mask oxygen, assisted ventilation, stimulation of respiratory and other simple treatment, all the infants’5min 10minApgar scores were more than 8 points.
Conclusion
1.General Anesthesia using propofol and remifentanil in severe preeclampsia was associated with clinically insignificant changes in CO and available to reduce the afterload.
2.General Anesthesia using conventional dose of propofol and remifentanil in severe preeclampsia can ensure the cardiac output,can be little effective on respiratory of the PLBW.
3.Patients with severe preeclampsia perioperative cesarean section, conventional—dose oxytocin have significantly short -term fluctuations in hemodynamics.
重度子痫前期属于产科危重症,是引起孕产妇病死率增高的主要原因之一,行剖宫产术是治疗重度子痫前期孕妇的重要手段。因重度子痫前期孕妇具有特殊的病理生理改变而导致全身各重要脏器不同程度的损害,并且受多种体液因素影响,存在与正常孕妇截然不同的血流动力学改变。故部分重度子痫前期孕妇不适合行椎管内麻醉,如心衰、肺水肿等;或存在椎管内麻醉的禁忌症,如凝血功能障碍、肝酶明显升高、血小板明显减少等,必须选择全身麻醉行剖宫产术终止妊娠。然而,剖宫产术采用全身麻醉有其特殊性,既要保持足够的麻醉深度以保证孕妇循环稳定,同时应尽量避免全麻用药对胎儿的影响。
以往丙泊酚与瑞芬太尼在产科领域中使用存在争议,但随着研究与使用认识逐渐加深,其独特的药物代谢规律和联合使用在保持患者血流动力学稳定的优势,逐渐被产科麻醉领域重视,特别是在重症产科。另外,近年来关于在全麻下行剖宫产术方面的报道并不少,但对循环的评价多采用心率与血压等指标,较局限,而且缺乏完整性。有文献报道,对于健康孕妇,动脉血压值与心输出量相关性较好,可间接反映胎盘血流灌注情况;而对于子痫前期的孕妇,由于外周血管阻力大幅增加,动脉血压值与心输出量相关性差,不能反映真实胎盘灌注情况。因此,探讨重度子痫前期孕妇在丙泊酚联合瑞芬太尼全麻下行剖宫产术过程中整体血流动力学变化,为重度子痫前期孕妇手术及麻醉提供临床参考。
目的
探讨应用丙泊酚联合瑞芬太尼在重度子痫前期孕妇在全身麻醉下行剖宫产术过程中对孕妇血流动力学的影响。
方法
对象为2010年3月至2010年12月期间就诊于广州医学院第三附属医院产科受同一组产科医生诊治的ASA II～III级重度子痫前期早产孕妇15例,因存在椎管内麻醉禁忌症,需全身麻醉行剖宫产术,全麻用药选择丙泊酚与瑞芬太尼。采用自身对照方法,以孕妇入手术室时段所测量的血流动力学参数,包括平均动脉压(MAP)、中心静脉压(CVP)、心输出量(CO)、每搏量(SV)、周围血管阻力(SVR)、心率(HR)作为基础值,与以后时段各参数比较,统计方法采用单因素方差分析,P<0.05时认为有统计学意义。各血流动力学参数在以下时段测量: 1.基础值时段T1:入室后,麻醉诱导前; 2.麻醉诱导时段T2:药物诱导至气管插管前; 3.气管插管时段T3:气管插管过程中; 4.气管插管后时段T4:气管插管完成至切皮前10分钟; 5.开腹时段T5:切皮至子宫剖开前; 6.胎儿娩出时段T6:切开子宫娩出胎儿至使用催产素前; 7.催产素作用时段T7:使用催产素至催产素作用; 8.手术结束时段T8:关腹至手术结束; 9.拔管时段T9:呼吸恢复至拔除气管导管; 10.离室时段T10:离开手术室前。
结果
一、术中孕妇血流动力学的变化MAP于麻醉诱导插管后时段T2、T3、T4、T5、T6、T7、T8、T9、T10与基础值T1比较均有统计学意义,P<0.05。SVR在离室时段T10与基础值T1比较无统计学意义,P>0.05;其余时段T2、T3、T4、T5、T6、T7、T8、T9与基础值T1比较均有统计学意义,P<0.05。
CO在麻醉诱导后,在使用缩宫素阶段T7与基础值比较有统计学意义T1,P<0.05;其余时段T2、T3、T4、T5、T6、T8、T9、T10与基础值T1比较均无统计学意义,P>0.05。
HR与缩宫素使用时段T7、气管拔管时段T9与基础值T1比较有明显统计学意义,P<0.05;而在其他时段T2、T3、T4、T5、T6、T8、T10与基础值比较无统计学意义,P>0.05。
SV在缩宫素使用时段T7与基础值T1比较有统计学意义,P<0.05;而在其他时段T2、T3、T4、T5、T6、T8、T9、T10与基础值比较无统计学意义,P>0.05。CVP于麻醉后各时段T2、T3、T4、T5、T6、T7、T8、T9、T10与基础值比较均无统计学意义,P>0.05。但于机械通气时段(T4-T9)有上升趋势,从胎儿娩出后时段(T5)后上升趋势更明显。
二、新生儿情况
本组新生儿均为早产低体重儿,1min Apgar评分3分1名、4-7分12名,大于8分2名,经过使用纳洛酮、面罩吸氧、辅助通气、刺激呼吸等简单处理后,5min、10min Apgar评分均大于8分。新生儿脐动脉血pH值均大于7.2。
结论
1、常规剂量丙泊酚联合瑞芬太尼在重度子痫前期孕妇在全麻下剖宫产术中能改善孕妇外周血管痉挛状态,有效减轻后负荷,对心输出量影响较轻微。
2、常规剂量丙泊酚联合瑞芬太尼在重度子痫前期孕妇在全麻下行剖宫产术,能对母体心输出量维护尚好,保证胎盘灌注,对早产低体重儿呼吸影响轻微。
3、重度子痫前期孕妇在全麻下行剖宫产术中应用常规剂量缩宫素会导致循环系统短时间内明显的波动。
Background
Severe preeclampsia in critical condition,is one of leading causes of maternal mortality. Cesarean section is the most effective mean to rescue of the patients with severe preeclampsia. However, the patients with severe preeclampsia are both in the gestation period and having the special pathology physiology changes in circulatory system. The unique hemodynamics of them is greatly different from normal parturient women. Furthermore, some of them do not adapt or even are existing contraindication to the intrathecal anesthesia, such as coagulation disorders, liver function lesion, PLT decreasing and so on. So they have to choose general anesthesia for Cesarean section. General anesthesia on pregnant women undergoing cesarean section exist distinctiveness. Whether maintaining the enough anesthesia depth to guarantee that the pregnant woman circulates stably,or avoiding the general anesthesia medication as far as possible to effect the embryo.
Propofol and remifentanil are ones of the most widely used intravenous anesthetic,but there is a dispute constantly on its useing in obstetric anesthesia. As the research and using experience gradually deepened, they are beginning to use in obstetric. In recent years, papers about clinical application of general anesthesia in cesarean section are so many. However, the evaluations of the cycle are only the heart rate and blood pressure measurements. In healthy patients, the maximum change in CO has been shown to correlate better with uteroplacental blood flow than upper arm blood pressure. Furthermore, in severe preeclampsia, an increased systemic vascular resistance (SVR) could render blood pressure a poor indicator of CO, but the information available on such patients during GA is scanty.
It is necessary to investigate the hemodynamic changes during GA for cesarean delivery in severe preeclampsia. A better understanding of the perioperative hemodynamic changes could contribute to a reduction in perioperative pulmonary edema, renal dysfunction, eclampsia, and neonatal morbidity.
Purpose
To observe the hemodynamic effects and changes, of which the patients with severe preeclampsia on general anesthesia for cesarean section using propofol and remifentanil.
Methods
Adult patients aged 21-39 years old with ASA physical status II- III grade were scheduled for elective cesarean section. Being existing contraindication to the intrathecal anesthesia,they had to get general anesthesia for Cesarean section and chose Propofol and remifentanil. The patient was put right internal jugular vein catheterization, measuring central venous pressure(CVP)continuously. Put left radial artery puncture, arterial monitoring, measuring mean arterial blood pressure(MAP)continuously. Being used the GE ICG noninvasive hemodynamic monitoring system to measure cardiac output(CO)、Stroke Volume (SV) , systemic vascular resistance (SVR). Hemodynamic values were measured in the following defined time.
1.Baseline measurements T1
2.Induction of anesthesia T2(induction of GA until intubation)
3.Intubation T3(the 30-s period during intubation )
4.After intubation T4(from intubation to 10 minutes before skin incision)
5.Skin incision T5 (from skin incision to 30 s before uterine incision)
6.Postdelivery T6(the 30-s period from delivery to administration of oxytocin)
7.Peak oxytocin effect T7 (from administration of oxytocin to peak effect on CO)
8.End of surgery T8(30-s time period before skin closure)
9.Tracheal extubation T9(30-s time period during tracheal extubation)
10.Leaving operating room T10(30-s time period before leaving the operating room)
Results
1. Intraoperative hemodynamic changes in patients MAP at T9,SVR at T10,CO at T2、T3、T4、T5、T6、T8、T9、T10,HR at T2、T3、T4、T5、T6、T8、T10,SV at T2、T3、T4、T5、T6、T8、T9、T10,CVP at T2、T3、T4、T5、T6、T7、T8、T9、T10 comparing with the ones at T1 all were no significant difference,P>0.05。MAP at T2、T3、T4、T5、T6、T7、T8、T10 were lower than the ones at T1;SVR at T2、T3、T4、T5、T6、T7、T8、T9 were lower than the ones at T1;CO at T7 was higher than the one at T1;HR at T7、T9 was higher than the one at T1;SV at T7 was higher than the one at T1,P<0.05.
2. Effective of the infant. This study shows that all the infants were PLBW. Two infants’1min Apgar score were 3 points 1, twelve infants’were 4-7 points, two one’s more than 8 points. Through the using of naloxone, mask oxygen, assisted ventilation, stimulation of respiratory and other simple treatment, all the infants’5min 10minApgar scores were more than 8 points.
Conclusion
1.General Anesthesia using propofol and remifentanil in severe preeclampsia was associated with clinically insignificant changes in CO and available to reduce the afterload.
2.General Anesthesia using conventional dose of propofol and remifentanil in severe preeclampsia can ensure the cardiac output,can be little effective on respiratory of the PLBW.
3.Patients with severe preeclampsia perioperative cesarean section, conventional—dose oxytocin have significantly short -term fluctuations in hemodynamics.
引文
[1] Gogarten W. Preeclampsia and anesthesia. Curr Opin Anaesthesiol. 2009 Jun; 22(3):347-51. Review.
[2]曹潭毅主编.中华妇产科学.第1版.北京:人民卫生出版社,1999.
[3] Butwick AJ,Lipman SS,Carvalho B.Intraoperative forced air-warming during cesarean delivery under spinal anesthesia does not prevent maternal hypothermia[J]. Aealg.2007,105(5):1413—9.PMID:17959975.
[4]何沛,应用局麻施行腹膜外剖宫产术[J].桂林医学院学报,1991, 4 (1): 48~50.
[5] Dailland P et al.Anesthesiology,1989,71:827.
[6] Ngan Kee WD, Khaw KS, Ma KC,et al. Maternal andneonatal effects of remifentanil at induction of generalanesthesia for cesarean delivery. Anesthesiology, 2006; 104(1):14-20.
[7] Maefarlane AJ,Moise S,Smith D.Caesarean section using total intravenous anaesthesia in a patient with Ebstein’s anomaly complicated by supraventricular tachyeardia[J].Im J Obstet Anesth.2007.16(2):1 55—159.
[8] Habib AS,Helsley SE,Millar S,et a1.Anesthesia for cesarean section in a patient with spinal muscular atrophy[J].J Clin Anesth,2004.16(3):217—219.
[9] McCarroll CP,Paxton LD,Elliott P,et a1.Use of remifentanil in a patient with peripartum cardiomyopathy requiring caesarean section[J].BrJ Anaesth,2001,86(1):135—138.
[10] Mertens E,Saldien V,Coppejans H,el a1.Target controlled infusion of remifentanil and propofol for cesarean section in a patient with m multivalvular disease and severe pulmonary.
[11] Furuya A,Matsukawa T,Ozaki M,et al.Propofol anesthesia for cesarean section successfully managed in a patient with moyamoya disease[J].J Clin Anesth,1998,10(3):242—245.
[12] Llopis JE,Garcia—Aguado R,Sifre C,et a1.Total intravenous anaesthesia for caesarean section in a patient with Marfan’s syndrome[J].Int J Obstet Aneath,1997,6(1):59—62.
[13] Robson SC, Boys RJ, Rodeck C, Morgan B: Maternal and fetal haemodynamic effects of spinal and extradural anaesthesia for elective caesarean section. Br J Anaesth 1992; 68:54–9.
[14] Robert A. Dyer,Jenna L. Piercy,Anthony R. Reed:Hemodynamic Changes Associated with Spinal Anesthesia for Cesarean Delivery in Severe Preeclampsia. Anesthesiology 2008; 108:802–11.
[15]乐杰,谢幸,林仲秋主编。妇产科学[M ]。第七版,北京:人民卫生出版社,2008;08;94-95.
[16] Cotton DB , Lee W , Huhta JC , et al : Hemodynamic profile of severe pregnancy-induced hypertension,Am J Obstet Gynecol 158:523-529,1988.
[17] Bruno K et al Anesthesiology 1995:82(2)106.
[18]庄心良主编.现代麻醉学.北京:人民卫生出版社。
[19] Miller RD. Anesthesia. 2000.
[20] Claey MN Br J Anaesth,1988:60.
[21] Persado A.Br J Anaesth.1993:71(4):586.
[22] Vuyk J,Mertens MJ,Olofsen E,et al.Propofol anesthesia and rationa lopioid selection[J].Anesthesiology,1997,87(6):1549—1562.
[23] Tihtonen K, Koobi T, Yli-Hankala A, Uotila J: Maternal hemodynamics during cesarean delivery assessed by whole-body impedance cardiography. Acta Obstet Gynecol Scand 2005; 84:355–61.
[24] Miller RD. Anesthesia. 2000:2319.
[25] Robert A. Dyer, F.C.A, Jenna L. Piercy,et al: Hemodynamic Changes Associated with Spinal Anesthesia for Cesarean Delivery in Severe Preeclampsia.Anesthesiology 2008; 108:802–11.
[26] Skjolderbrand,Lyons G,Eklund J,Johansson H,et al:Uteroplacental blood flow measured by placental scintigraphy during epidural anaesthesia for caesarean section. Acta Anaesthesiol Scand 34;79-84,1990.
[27] Robson SC,Boys RJ,Rodeck C,et,al:Maternal and fetal haemodynmamic effects of spinal and extradural anaesthesia for elective caesarean section. Br J Anaesth 68:54-59,1992.
[28] Gin T et al. Anaesthesia,1990;64:148.
[29] Gin T et al。Br J Anaesth,1991;67:49.
[30] Valtonen M et al.Anaesthesia,1989;44:75.
[31]于力韩传宝刘华瑞芬太尼在剖宫产全麻时对新生儿的影响河北医药2007年12月第29卷第12期1338-1340。
[32]黄悦杭燕南,小儿瑞芬太尼药动学及临床研究进展《国外医学》麻醉学与复苏分册2005年第26卷第2期114-115
[33]黄悦,杭燕南.小儿雷米芬太尼药动学及临床研究进展.国外医学麻醉与复苏分册,2005,26:116-117
[34] Ngan Kee WD, Khaw KS, Ma KC,et al. Maternal andneonatal effects of remifentanil at induction of generalanesthesia for cesarean delivery. Anesthesiology, 2006; 104(1):14-20.
[35]白耀武钱金洪杨俊红全身麻醉剖宫产瑞芬太尼对孕妇及新生儿安全性的影响河北医药2009年8月第31卷第16期2067-2068
[36]邹雪芹,岳云.国人雷米芬太尼维持满意自主通气的EC50值.麻醉与监护论坛,2007,4:222-224.
[37] Shin YK,Kim YD.Collea JV.The effect of propofol on isolated human pregnant uterine muscle (J).Anesthesiology,1998.89(1):105—109
[38] Luo D,Wang QY,Huang W ,et al,.The effect of propofol on isolated human pregnant uterine muscles[J].J Sichuan Univ (Med Sci Edi ),2004,35(5):668—670
[39] Weis FR, Markello R, Mo B, Bochiechio P. Cardiovascular effects of oxytocin[J]. Obstet Gynecol 1975;46:211–4.
[40] Kee WD, Khaw KS,Ng FF.Prevention of hypotension during spinal anesthesia for cesarean delivery: An effective technique using combination phenylephrine infusion and crystalloid cohydration[J]. ANESTHESIOLOGY 2005;103:744–50.
[41]杨藻宸.药理学和药物治疗学[M].北京:人民卫生出版社,2000,111.
[1]吴新民,叶铁虎,岳云等.国产注射用盐酸瑞芬太尼有效性和安全性的评价[J].中华麻醉学杂志,2003,23(4):245-248
[2] Birnbach DJ,Browne IM.Anesthesia for Obstetrics. In:Miller RD.ed. Miller’s Anesthesia.6th ed(M).Philadelphia: Elsevier Churchill Livingstone,2005:2325.
[3]张瑞莲.异丙酚在静脉麻醉中的应用(综述)[J]。中国城乡企业卫生2005年12月第6期
[4] K am at SK , ShahMV,Chaudhary LS, et al Effect of in-duction-deliv-ery and uterine-delivery on apgar scoring ofthe newborn[J]. J Post-gradMed, 1991, 37(9): 125-127.
[5] Gin T et al. Anaesthesia, 1990, 64: 148
[6] Gin T et al .Br J Anaesth, 1991, 67: 49
[7] Valtonen M et al.Anaesthesia, 1989, 44: 758
[8] Dailland P et al.Anesthesiology, 1989, 71: 827
[9]于力,韩传宝,刘华.瑞芬太尼在剖宫产全麻时对新生儿的影响[J].河北医药2007年12月第29卷第12期1338-1340
[10]黄悦,杭燕南.小儿瑞芬太尼药动学及临床研究进展[J].《国外医学》麻醉学与复苏分册2005年第26卷第2期114-115
[11]黄悦,杭燕南.小儿雷米芬太尼药动学及临床研究进展.国外医学麻醉与复苏分册,2005,26:116-117
[12] Ngan Kee WD, Khaw KS, Ma KC,et al. Maternal andneonatal effects of remifentanil at induction of generalanesthesia for cesarean delivery[J]. Anesthesiology, 2006; 104(1):14-20.
[13]白耀武,钱金洪,杨俊红.全身麻醉剖宫产瑞芬太尼对孕妇及新生儿安全性的影响[J].河北医药2009年8月,第31卷第16期:2067-2068
[14]邹雪芹,岳云.国人雷米芬太尼维持满意自主通气的EC50值[J].麻醉与监护论坛,2007,4:222-224.
[15]何沛.应用局麻施行腹膜外剖宫产术[J].桂林医学院学报,1991, 4 (1): 48~50.
[16] Mueller MD, Bruhwiler H, Schupfer GK, et al. Higher rate of fetal acidemia after regional anesthesia for elective cesarean delivery [J].Obstet Gynecol, 1997, 90: 131~134.
[17] Roberts SW, Leveno KJ, Sidawi JE, et al. Fetal acidemia associated with regional anesthesia for elective cesarena delivery [J]. Obstet Gynecol, 1995, 85: 79~83.
[18]于力,韩传宝,周钦海,刘华.雷米芬太尼和氯胺酮全麻用于剖宫产的比较[J],临床麻醉学杂志2007年9月第23卷第9期:772-773
[19] Alon E et al. Anesthesiology,1993;78:562
[20] Jouppilla P et al.Acr:a Obstet Gynecol Scand,1979;58;249
[21] Samuel CH,Gershon L,Mark AR.主编.张友忠,荣风年主译.施奈德与莱文森产科麻醉学.济南:山东科学技术出版社,2005.147-156·
[22]高秀江,张志辉,毛瑞芬,等.瑞芬太尼与芬太尼对腹部手术患者全麻诱导期血液动力学的影响[J].中华麻醉学杂志,2005,25(2):149-50·
[23]何鞠颖,曹蓉,李守莉,闵龙秋.瑞芬太尼与氯胺酮用于剖宫产全麻时对血压、心率及胎儿评分影响的比较[J].华西医学2009,24(8):2114-2116
[24]曾葵,杨莹莹,黄瀚,黄蔚,陈筱静剖宫产全麻诱导使用瑞芬太尼对新生儿的影响四川大学学报(医学版) 2009;40(4):755 - 757
[25] Thompsen JP,Hall AP。Russell J,et a1.Effect of remifentanil Oil the haemndynamie response to orotraeheal intubation[J].Br J Anaesth,1998.80:467—469.
[26] Sneyd JR,Camu F,Doenicke A.et a1.Remifentanil and fentanyl during anaesthesia for major abdominal and gynaecologieal surgery . An open , comparative study of safety and efficacy[J].Eur J Anaesthesiol。2001,18:605—614.
[27]张宗旺,戴体俊,曾因明.瑞芬太尼的研究进展,俞卫锋主编.麻醉与复苏新论,第1版.,2001:24-27.
[28] Shin YK,Kim YD.Collea JV.The effect of propofol on isolated human pregnant uterine muscle [J].Anesthesiology,1998.89(1):105—109.
[29] Luo D,Wang QY,Huang W ,et al,.The effect of propofol on isolated human pregnant uterinemuscles[J].J Sichuan Univ (Med Sci Edi ),2004,35(5):668—670.
[30]黄绍强.丙泊酚在产科麻醉中应用的争议和进展[J].复旦学报(医学版)2009.6.(4):499-501
[31] Maefarlane AJ,Moise S,Smith D.Caesarean section using total intravenous anaesthesia in a patient with Ebstein’s anomaly complicated by supraventricular tachyeardia[J].Im J Obstet Anesth.2007.16(2):1 55—159.
[32] Habib AS,Helsley SE,Millar S,et a1.Anesthesia for cesarean section in a patient with spinal muscular atrophy[J].J Clin Anesth,2004.16(3):217—219.
[33] McCarroll CP,Paxton LD,Elliott P,et a1.Use of remifentanil in a patient with peripartum cardiomyopathy requiring caesarean section[J].BrJ Anaesth,2001,86(1):135—138.
[34] Mertens E,Saldien V,Coppejans H,el a1.Target controlled infusion of remifentanil and propofol for cesarean section in a patient with m multivalvular disease and severe pulmonary. hypertension[J].Acta Anaesthesiol Belg,2001,52(2):207—209.
[35] Furuya A,Matsukawa T,Ozaki M,et al.Propofol anesthesia for cesarean section successfully managed in a patient with moyamoya disease[J].J Clin Anesth,1998,10(3):242—245.
[36] Llopis JE,Garcia—Aguado R,Sifre C,et a1.Total intravenous anaesthesia for caesarean section in a patient with Marfan’s syndrome[J].Int J Obstet Aneath,1997,6(1):59—62.
[37]王树林,瑞芬太尼、丙泊酚静脉复合麻醉在全麻中的应用[J].中外医疗,2009第10期.
[38] Fujii Y,,Numazaki M.Dose—range effects of propofol for reducing emetic symptoms during cesarean delivery[J].Obstet Gynecol,2002,99(1):75—79.
[39] Numazaki M,Fujii Y.Reduction of emetic symptoms during cesarean delivery with antiemetics: propofol at subhypnotic dose versus t raditional antiemetics[J],J Clin Anesth,2003,15 (6):423—427.
[40] Fujii Y,Numazaki M..Randomized,double—blind comparison of subhypnotic—dose propofol alone and combined with dexamethasone for emesis in parturients undergoing cesarean delivery[J].CIin Ther 2004.26(8):1 286—1 291.
[41]陈丽云,陈扶雪,方彩云等.新生儿Apgar评分与相关因素分析[J].中外健康文摘, 2008, 5(1): 17-19.
[42] Sigalas J,GalaziosG,Tsikrikoni I, et a.l The influence of the mode of anaesthesia in the incidenceof neonatal morbidity after an elective caesarean section[ J]. ClinExp ObstetGyneco,l 2006, 33: 10-12
[43]庄心良主编.现代麻醉学.北京:人民卫生出版社,2003:179～184
[44]黄绍强.丙泊酚在产科麻醉中应用的争议和进展[J].复旦学报(医学版)2009.6.36(4):500-501
[45]施明杰,朱春仙,鲁惠顺.瑞芬太尼联合丙泊酚在剖宫产全麻中的应用[J].浙江预防医学2006年底18卷第9期:44-47
[46] Yau G et al Anaesthesia,1991;46:20
[47] Celleno D et al.BrJAnaesth,1989;62:649
[48] Van de Velde M,Teunkens A,Kuypers M,eta1.General anaesthesia with taget controlled infusion of propofol for planned caesarean section:maternal and neonatal efects of a remifentanil based technique[J].Int Obstet Anesth ,2004,13:153—158.
[49] Jean W,Dajun s,Hannah BL,el a1.Titration of ieoflurane using B1S index improves early recovery of elderly patients un-dergoing orthopediesurgerles[J].Can J Anaesth,2002,49(11):l3—18.
[50]郑观荣.瑞芬太尼、丙泊酚时段靶控诱导全麻对剖宫产新生儿呼吸的影响[J],山东医药2009年第49卷第22期:18~19
[51] Yegin A, Ertug Z,YilmazM, et a.l The effect of epidural anesthesia and generalanesthesia on newborns ofcesarean section[J].Turk JMed Sc,i 2003, 33: 311-314
[52] Mattingly JE,DA' lessio J,Ramanathan J.Effects ofobstet-ric analgesics and anesthetics on neonate: a review[ J].PaediatrDrugs, 2003, 5: 615-627
[53]陈珊.早期儿童神经心理发育评估[ J].实用儿科临床杂志,2008, 23(12): 892-89
[2]曹潭毅主编.中华妇产科学.第1版.北京:人民卫生出版社,1999.
[3] Butwick AJ,Lipman SS,Carvalho B.Intraoperative forced air-warming during cesarean delivery under spinal anesthesia does not prevent maternal hypothermia[J]. Aealg.2007,105(5):1413—9.PMID:17959975.
[4]何沛,应用局麻施行腹膜外剖宫产术[J].桂林医学院学报,1991, 4 (1): 48~50.
[5] Dailland P et al.Anesthesiology,1989,71:827.
[6] Ngan Kee WD, Khaw KS, Ma KC,et al. Maternal andneonatal effects of remifentanil at induction of generalanesthesia for cesarean delivery. Anesthesiology, 2006; 104(1):14-20.
[7] Maefarlane AJ,Moise S,Smith D.Caesarean section using total intravenous anaesthesia in a patient with Ebstein’s anomaly complicated by supraventricular tachyeardia[J].Im J Obstet Anesth.2007.16(2):1 55—159.
[8] Habib AS,Helsley SE,Millar S,et a1.Anesthesia for cesarean section in a patient with spinal muscular atrophy[J].J Clin Anesth,2004.16(3):217—219.
[9] McCarroll CP,Paxton LD,Elliott P,et a1.Use of remifentanil in a patient with peripartum cardiomyopathy requiring caesarean section[J].BrJ Anaesth,2001,86(1):135—138.
[10] Mertens E,Saldien V,Coppejans H,el a1.Target controlled infusion of remifentanil and propofol for cesarean section in a patient with m multivalvular disease and severe pulmonary.
[11] Furuya A,Matsukawa T,Ozaki M,et al.Propofol anesthesia for cesarean section successfully managed in a patient with moyamoya disease[J].J Clin Anesth,1998,10(3):242—245.
[12] Llopis JE,Garcia—Aguado R,Sifre C,et a1.Total intravenous anaesthesia for caesarean section in a patient with Marfan’s syndrome[J].Int J Obstet Aneath,1997,6(1):59—62.
[13] Robson SC, Boys RJ, Rodeck C, Morgan B: Maternal and fetal haemodynamic effects of spinal and extradural anaesthesia for elective caesarean section. Br J Anaesth 1992; 68:54–9.
[14] Robert A. Dyer,Jenna L. Piercy,Anthony R. Reed:Hemodynamic Changes Associated with Spinal Anesthesia for Cesarean Delivery in Severe Preeclampsia. Anesthesiology 2008; 108:802–11.
[15]乐杰,谢幸,林仲秋主编。妇产科学[M ]。第七版,北京:人民卫生出版社,2008;08;94-95.
[16] Cotton DB , Lee W , Huhta JC , et al : Hemodynamic profile of severe pregnancy-induced hypertension,Am J Obstet Gynecol 158:523-529,1988.
[17] Bruno K et al Anesthesiology 1995:82(2)106.
[18]庄心良主编.现代麻醉学.北京:人民卫生出版社。
[19] Miller RD. Anesthesia. 2000.
[20] Claey MN Br J Anaesth,1988:60.
[21] Persado A.Br J Anaesth.1993:71(4):586.
[22] Vuyk J,Mertens MJ,Olofsen E,et al.Propofol anesthesia and rationa lopioid selection[J].Anesthesiology,1997,87(6):1549—1562.
[23] Tihtonen K, Koobi T, Yli-Hankala A, Uotila J: Maternal hemodynamics during cesarean delivery assessed by whole-body impedance cardiography. Acta Obstet Gynecol Scand 2005; 84:355–61.
[24] Miller RD. Anesthesia. 2000:2319.
[25] Robert A. Dyer, F.C.A, Jenna L. Piercy,et al: Hemodynamic Changes Associated with Spinal Anesthesia for Cesarean Delivery in Severe Preeclampsia.Anesthesiology 2008; 108:802–11.
[26] Skjolderbrand,Lyons G,Eklund J,Johansson H,et al:Uteroplacental blood flow measured by placental scintigraphy during epidural anaesthesia for caesarean section. Acta Anaesthesiol Scand 34;79-84,1990.
[27] Robson SC,Boys RJ,Rodeck C,et,al:Maternal and fetal haemodynmamic effects of spinal and extradural anaesthesia for elective caesarean section. Br J Anaesth 68:54-59,1992.
[28] Gin T et al. Anaesthesia,1990;64:148.
[29] Gin T et al。Br J Anaesth,1991;67:49.
[30] Valtonen M et al.Anaesthesia,1989;44:75.
[31]于力韩传宝刘华瑞芬太尼在剖宫产全麻时对新生儿的影响河北医药2007年12月第29卷第12期1338-1340。
[32]黄悦杭燕南,小儿瑞芬太尼药动学及临床研究进展《国外医学》麻醉学与复苏分册2005年第26卷第2期114-115
[33]黄悦,杭燕南.小儿雷米芬太尼药动学及临床研究进展.国外医学麻醉与复苏分册,2005,26:116-117
[34] Ngan Kee WD, Khaw KS, Ma KC,et al. Maternal andneonatal effects of remifentanil at induction of generalanesthesia for cesarean delivery. Anesthesiology, 2006; 104(1):14-20.
[35]白耀武钱金洪杨俊红全身麻醉剖宫产瑞芬太尼对孕妇及新生儿安全性的影响河北医药2009年8月第31卷第16期2067-2068
[36]邹雪芹,岳云.国人雷米芬太尼维持满意自主通气的EC50值.麻醉与监护论坛,2007,4:222-224.
[37] Shin YK,Kim YD.Collea JV.The effect of propofol on isolated human pregnant uterine muscle (J).Anesthesiology,1998.89(1):105—109
[38] Luo D,Wang QY,Huang W ,et al,.The effect of propofol on isolated human pregnant uterine muscles[J].J Sichuan Univ (Med Sci Edi ),2004,35(5):668—670
[39] Weis FR, Markello R, Mo B, Bochiechio P. Cardiovascular effects of oxytocin[J]. Obstet Gynecol 1975;46:211–4.
[40] Kee WD, Khaw KS,Ng FF.Prevention of hypotension during spinal anesthesia for cesarean delivery: An effective technique using combination phenylephrine infusion and crystalloid cohydration[J]. ANESTHESIOLOGY 2005;103:744–50.
[41]杨藻宸.药理学和药物治疗学[M].北京:人民卫生出版社,2000,111.
[1]吴新民,叶铁虎,岳云等.国产注射用盐酸瑞芬太尼有效性和安全性的评价[J].中华麻醉学杂志,2003,23(4):245-248
[2] Birnbach DJ,Browne IM.Anesthesia for Obstetrics. In:Miller RD.ed. Miller’s Anesthesia.6th ed(M).Philadelphia: Elsevier Churchill Livingstone,2005:2325.
[3]张瑞莲.异丙酚在静脉麻醉中的应用(综述)[J]。中国城乡企业卫生2005年12月第6期
[4] K am at SK , ShahMV,Chaudhary LS, et al Effect of in-duction-deliv-ery and uterine-delivery on apgar scoring ofthe newborn[J]. J Post-gradMed, 1991, 37(9): 125-127.
[5] Gin T et al. Anaesthesia, 1990, 64: 148
[6] Gin T et al .Br J Anaesth, 1991, 67: 49
[7] Valtonen M et al.Anaesthesia, 1989, 44: 758
[8] Dailland P et al.Anesthesiology, 1989, 71: 827
[9]于力,韩传宝,刘华.瑞芬太尼在剖宫产全麻时对新生儿的影响[J].河北医药2007年12月第29卷第12期1338-1340
[10]黄悦,杭燕南.小儿瑞芬太尼药动学及临床研究进展[J].《国外医学》麻醉学与复苏分册2005年第26卷第2期114-115
[11]黄悦,杭燕南.小儿雷米芬太尼药动学及临床研究进展.国外医学麻醉与复苏分册,2005,26:116-117
[12] Ngan Kee WD, Khaw KS, Ma KC,et al. Maternal andneonatal effects of remifentanil at induction of generalanesthesia for cesarean delivery[J]. Anesthesiology, 2006; 104(1):14-20.
[13]白耀武,钱金洪,杨俊红.全身麻醉剖宫产瑞芬太尼对孕妇及新生儿安全性的影响[J].河北医药2009年8月,第31卷第16期:2067-2068
[14]邹雪芹,岳云.国人雷米芬太尼维持满意自主通气的EC50值[J].麻醉与监护论坛,2007,4:222-224.
[15]何沛.应用局麻施行腹膜外剖宫产术[J].桂林医学院学报,1991, 4 (1): 48~50.
[16] Mueller MD, Bruhwiler H, Schupfer GK, et al. Higher rate of fetal acidemia after regional anesthesia for elective cesarean delivery [J].Obstet Gynecol, 1997, 90: 131~134.
[17] Roberts SW, Leveno KJ, Sidawi JE, et al. Fetal acidemia associated with regional anesthesia for elective cesarena delivery [J]. Obstet Gynecol, 1995, 85: 79~83.
[18]于力,韩传宝,周钦海,刘华.雷米芬太尼和氯胺酮全麻用于剖宫产的比较[J],临床麻醉学杂志2007年9月第23卷第9期:772-773
[19] Alon E et al. Anesthesiology,1993;78:562
[20] Jouppilla P et al.Acr:a Obstet Gynecol Scand,1979;58;249
[21] Samuel CH,Gershon L,Mark AR.主编.张友忠,荣风年主译.施奈德与莱文森产科麻醉学.济南:山东科学技术出版社,2005.147-156·
[22]高秀江,张志辉,毛瑞芬,等.瑞芬太尼与芬太尼对腹部手术患者全麻诱导期血液动力学的影响[J].中华麻醉学杂志,2005,25(2):149-50·
[23]何鞠颖,曹蓉,李守莉,闵龙秋.瑞芬太尼与氯胺酮用于剖宫产全麻时对血压、心率及胎儿评分影响的比较[J].华西医学2009,24(8):2114-2116
[24]曾葵,杨莹莹,黄瀚,黄蔚,陈筱静剖宫产全麻诱导使用瑞芬太尼对新生儿的影响四川大学学报(医学版) 2009;40(4):755 - 757
[25] Thompsen JP,Hall AP。Russell J,et a1.Effect of remifentanil Oil the haemndynamie response to orotraeheal intubation[J].Br J Anaesth,1998.80:467—469.
[26] Sneyd JR,Camu F,Doenicke A.et a1.Remifentanil and fentanyl during anaesthesia for major abdominal and gynaecologieal surgery . An open , comparative study of safety and efficacy[J].Eur J Anaesthesiol。2001,18:605—614.
[27]张宗旺,戴体俊,曾因明.瑞芬太尼的研究进展,俞卫锋主编.麻醉与复苏新论,第1版.,2001:24-27.
[28] Shin YK,Kim YD.Collea JV.The effect of propofol on isolated human pregnant uterine muscle [J].Anesthesiology,1998.89(1):105—109.
[29] Luo D,Wang QY,Huang W ,et al,.The effect of propofol on isolated human pregnant uterinemuscles[J].J Sichuan Univ (Med Sci Edi ),2004,35(5):668—670.
[30]黄绍强.丙泊酚在产科麻醉中应用的争议和进展[J].复旦学报(医学版)2009.6.(4):499-501
[31] Maefarlane AJ,Moise S,Smith D.Caesarean section using total intravenous anaesthesia in a patient with Ebstein’s anomaly complicated by supraventricular tachyeardia[J].Im J Obstet Anesth.2007.16(2):1 55—159.
[32] Habib AS,Helsley SE,Millar S,et a1.Anesthesia for cesarean section in a patient with spinal muscular atrophy[J].J Clin Anesth,2004.16(3):217—219.
[33] McCarroll CP,Paxton LD,Elliott P,et a1.Use of remifentanil in a patient with peripartum cardiomyopathy requiring caesarean section[J].BrJ Anaesth,2001,86(1):135—138.
[34] Mertens E,Saldien V,Coppejans H,el a1.Target controlled infusion of remifentanil and propofol for cesarean section in a patient with m multivalvular disease and severe pulmonary. hypertension[J].Acta Anaesthesiol Belg,2001,52(2):207—209.
[35] Furuya A,Matsukawa T,Ozaki M,et al.Propofol anesthesia for cesarean section successfully managed in a patient with moyamoya disease[J].J Clin Anesth,1998,10(3):242—245.
[36] Llopis JE,Garcia—Aguado R,Sifre C,et a1.Total intravenous anaesthesia for caesarean section in a patient with Marfan’s syndrome[J].Int J Obstet Aneath,1997,6(1):59—62.
[37]王树林,瑞芬太尼、丙泊酚静脉复合麻醉在全麻中的应用[J].中外医疗,2009第10期.
[38] Fujii Y,,Numazaki M.Dose—range effects of propofol for reducing emetic symptoms during cesarean delivery[J].Obstet Gynecol,2002,99(1):75—79.
[39] Numazaki M,Fujii Y.Reduction of emetic symptoms during cesarean delivery with antiemetics: propofol at subhypnotic dose versus t raditional antiemetics[J],J Clin Anesth,2003,15 (6):423—427.
[40] Fujii Y,Numazaki M..Randomized,double—blind comparison of subhypnotic—dose propofol alone and combined with dexamethasone for emesis in parturients undergoing cesarean delivery[J].CIin Ther 2004.26(8):1 286—1 291.
[41]陈丽云,陈扶雪,方彩云等.新生儿Apgar评分与相关因素分析[J].中外健康文摘, 2008, 5(1): 17-19.
[42] Sigalas J,GalaziosG,Tsikrikoni I, et a.l The influence of the mode of anaesthesia in the incidenceof neonatal morbidity after an elective caesarean section[ J]. ClinExp ObstetGyneco,l 2006, 33: 10-12
[43]庄心良主编.现代麻醉学.北京:人民卫生出版社,2003:179～184
[44]黄绍强.丙泊酚在产科麻醉中应用的争议和进展[J].复旦学报(医学版)2009.6.36(4):500-501
[45]施明杰,朱春仙,鲁惠顺.瑞芬太尼联合丙泊酚在剖宫产全麻中的应用[J].浙江预防医学2006年底18卷第9期:44-47
[46] Yau G et al Anaesthesia,1991;46:20
[47] Celleno D et al.BrJAnaesth,1989;62:649
[48] Van de Velde M,Teunkens A,Kuypers M,eta1.General anaesthesia with taget controlled infusion of propofol for planned caesarean section:maternal and neonatal efects of a remifentanil based technique[J].Int Obstet Anesth ,2004,13:153—158.
[49] Jean W,Dajun s,Hannah BL,el a1.Titration of ieoflurane using B1S index improves early recovery of elderly patients un-dergoing orthopediesurgerles[J].Can J Anaesth,2002,49(11):l3—18.
[50]郑观荣.瑞芬太尼、丙泊酚时段靶控诱导全麻对剖宫产新生儿呼吸的影响[J],山东医药2009年第49卷第22期:18~19
[51] Yegin A, Ertug Z,YilmazM, et a.l The effect of epidural anesthesia and generalanesthesia on newborns ofcesarean section[J].Turk JMed Sc,i 2003, 33: 311-314
[52] Mattingly JE,DA' lessio J,Ramanathan J.Effects ofobstet-ric analgesics and anesthetics on neonate: a review[ J].PaediatrDrugs, 2003, 5: 615-627
[53]陈珊.早期儿童神经心理发育评估[ J].实用儿科临床杂志,2008, 23(12): 892-89