两种麻醉方法用于异位妊娠手术的回顾性分析
|
摘要
目的:观察和分析异位妊娠手术中能够预测血压波动的因素,比较全身麻醉与硬膜外麻醉用于异位妊娠手术对循环系统的影响和效价比,提出合理的麻醉选择流程。方法:将新疆医科大学第一附属医院2005-2006年间242例异位妊娠手术患者资料纳入回顾性分析,观察到麻醉记录单中最常见的不良反应是手术中血压的波动。第一步对可能造成血压波动的因素进行了筛选,利用Logistic多元回归技术进行逐步回归,建立回归方程。第二步用配对分组的原则选择了72例患者的资料,对比了两种麻醉方法对循环的影响。全身麻醉患者36例:咪唑安定0.15-0.2mg/kg、芬太尼0.1-0.2mg、维库溴胺0.1mg/kg行静脉麻醉诱导,持续静脉泵入丙泊酚4-6mg/kg·h、间断静脉注射芬太尼0.1-0.2mg及维库溴铵0.05mg/kg维持麻醉;硬膜外麻醉患者36例:穿刺点选择L_(1-2)或L_(2-3)间隙,试验剂量为2%利多卡因4-5ml,麻醉平面确切后硬膜外注入1%罗派卡因8-10ml,2.5小时后追加4-5ml。对2组患者术中血压波动的发生率、麻醉时间、麻醉费用进行观察比较。综合上述结果,提出此类手术麻醉选择的基本原则。结果:经回归分析,能够预测异位妊娠手术中血压波动的因素有术前休克指数、平均动脉压和不同麻醉方法等三个因素。接下来的对比分析得到的结果是:全身麻醉组共有5例(13.9%)患者发生了血压波动,连续硬膜外麻醉为15例(41.7%),2组间差异有统计学意义(P=0.009)。全身麻醉和硬膜外麻醉组的麻醉费用、药费、总费用分别为:897.6±67.1、414.4±122.7、1312.1±160.3和438.3±46.5、269.7±91.4、708.0±112.0元,两组间差异有统计学意义(P＜0.001)。全身麻醉组和硬膜外麻醉组的麻醉时间中位数、众数分别为为2.5h、2h和2h、2h,2组患者麻醉时间无统计学差异(P＜0.05)。结论:可以通过休克指数、平均动脉压和不同麻醉方法等因素预测异位妊娠手术中发生血压波动的可能性。根据术前休克的严重程度(主要由休克指数和平均动脉压体现)来决定麻醉方法,根据指南选择有创监测并进行积极的液体复苏。同一异位妊娠患者,应全身麻醉术时,血流动力学稳定,镇痛效果好,但费用明显高于连续硬膜外麻醉。
Objective:To observe and analyze the factors which can predict the probability of blood pressure disturbances in ectopic pregnancy operations and compare the differences of the cost-effects as well as effects on circulation using two different anesthesia techniques. Methods:One hundred and ninety-two patients in First Affiliation Hospital of Xinjiang Medical University were enrolled in the retrospective study. In a preliminary study ,a logistic model was developed to evaluate predictors of intraoperative blood disturbances. Next, Seventy-two patients undergone ectopic pregnancy operations were studied. Thirty-six patients in general anesthesia group performed with midazolam 0.15-0.2mg/kg、fentanyl 0.1-0.2 mg、vecuronium 0.1 mg/kg for induction followed by propofol infusion at the rate of 4-6 mg/kg·h and intermittent fentanyl 0.1-0.2 mg and vecuronium 0.05 mg/kg injection for maintenance. Thirty-six patients in epidural anesthesia group received 2% lidocaine 4-5 ml to inspect the effect of anesthesia then were injected with 1% ropivacine 8-10 ml and added with 4-5 ml after 2.5 hours. Hemodynamic disturbances、anesthesia times and direct costs in the two groups were observed and analyzed. Finally, a strategy was developed to help anesthetists to select reasonable method. Results: Preoperative factors, such as shock index, mean arterial pressure and different anesthesia method can predict the incidence of blood pressure disturbance in in ectopic pregnancy operations. Compared with general anesthesia group in which five patients (13.9%) suffered with blood pressure disturbances, the frequency of blood pressure disturbance in epidural anesthesia was 41.7% (15 cases). The differences were significant(P=0.009).The anesthesia costs、drugs costs、total costs in general anesthesia group and epidural anesthesia group were 897.6±67.1、414.4±122.7、1312.1±160.3 and 438.3±46.5、269.7±91.4、708.0±112.0 yuan(P<0.001), the differences were statistically significant. The median and mode of anesthesia time in general anesthesia group and epidural anesthesia group were 2.5h、2h and 2h、2h.there is no significant between them. Conclusions:Shock index, mean arterial pressure and different anesthesia method can predict the incidence of blood pressure disturbance in in ectopic pregnancy operations. Hemodynamic status may be more stable, effects of analgesia may be better in general anesthesia group compared with epidural anesthesia group. Total costs in general anesthesia group was higher than epidural anesthesia group.
Objective:To observe and analyze the factors which can predict the probability of blood pressure disturbances in ectopic pregnancy operations and compare the differences of the cost-effects as well as effects on circulation using two different anesthesia techniques. Methods:One hundred and ninety-two patients in First Affiliation Hospital of Xinjiang Medical University were enrolled in the retrospective study. In a preliminary study ,a logistic model was developed to evaluate predictors of intraoperative blood disturbances. Next, Seventy-two patients undergone ectopic pregnancy operations were studied. Thirty-six patients in general anesthesia group performed with midazolam 0.15-0.2mg/kg、fentanyl 0.1-0.2 mg、vecuronium 0.1 mg/kg for induction followed by propofol infusion at the rate of 4-6 mg/kg·h and intermittent fentanyl 0.1-0.2 mg and vecuronium 0.05 mg/kg injection for maintenance. Thirty-six patients in epidural anesthesia group received 2% lidocaine 4-5 ml to inspect the effect of anesthesia then were injected with 1% ropivacine 8-10 ml and added with 4-5 ml after 2.5 hours. Hemodynamic disturbances、anesthesia times and direct costs in the two groups were observed and analyzed. Finally, a strategy was developed to help anesthetists to select reasonable method. Results: Preoperative factors, such as shock index, mean arterial pressure and different anesthesia method can predict the incidence of blood pressure disturbance in in ectopic pregnancy operations. Compared with general anesthesia group in which five patients (13.9%) suffered with blood pressure disturbances, the frequency of blood pressure disturbance in epidural anesthesia was 41.7% (15 cases). The differences were significant(P=0.009).The anesthesia costs、drugs costs、total costs in general anesthesia group and epidural anesthesia group were 897.6±67.1、414.4±122.7、1312.1±160.3 and 438.3±46.5、269.7±91.4、708.0±112.0 yuan(P<0.001), the differences were statistically significant. The median and mode of anesthesia time in general anesthesia group and epidural anesthesia group were 2.5h、2h and 2h、2h.there is no significant between them. Conclusions:Shock index, mean arterial pressure and different anesthesia method can predict the incidence of blood pressure disturbance in in ectopic pregnancy operations. Hemodynamic status may be more stable, effects of analgesia may be better in general anesthesia group compared with epidural anesthesia group. Total costs in general anesthesia group was higher than epidural anesthesia group.
引文
铩颷1]许建营.异位妊娠[M].北京:中国医药科技出版社,2002.1-180
[2]Al-Mosawi A,Awash E,Hayat S,Asfar S.Ruptured extrauterine gestation inheterotopic pregnancy[J].Ann Saudi Med.2005 Sep-Oct,25(5):413-414
[3]Bharadwaj P,Erskine K.Heterotopic pregnancy:still a diagnostic dilemma[J].JObstet Gynaecol.2005 Oct;25(7):720-2
[4]Canis M,Savary D,Pouly JL,Wattiez A,Mage G.Ectopic pregnancy:criteria todecide between medical and conservative surgical treatment?[J].J Gynecol ObstetBiol Reprod,2003,32(7):S54-63
[5]R.D.Miller,R.F.Cucchiara,E.D.Miller,et al.Anesthesia 5th[M].ChurchillLivingstone,2001,(1):755-766
[6]Rout CC.Anaesthesia and analgesia for the critically ill parturient[J].Best Pract ResClin Obstet Gynaecol.2001,15(4):507-522
[7]谭红鹰,陈秉学,孙来保等.不同剂量可乐定复合罗呢卡因硬膜外麻醉的效应[J].中华麻醉学杂志.2003,23:28
[8]Wasserstrum N:Issues in fluid management during labor:General considerations[J].Clin Obstet Gynecol,1992,35:505
[9]林治瑾,主编.临床麻醉学第1版[M].天津:天津科学技术出版社,2001.6 06
[10]潘云.122例宫外孕手术的麻醉分析[J].浙江临床医学,2001,3(7):544
[11]黄清彩,詹晓光.218例宫外孕手术的麻醉分析[J].福建医药杂志2002,24(4):80
[12]叶英.异位妊娠639例临床分析[J].中国医师杂志.2007,9(3):347
[13]薛凤霞,焦书竹.异位妊娠的病因及诊治的进展[J].中国实用妇科与产科杂志,1999,15(4):247
[14]周力学,王良岸,黎淑芬等.休克型异位妊娠30例早期临床表现[J].临床医学.2007.27(3):45-46
[15]Murray H,Baakdah H,Bardell T,et al.Diagnosis and treatment of ectop icpregnancy[M].CMAJ,2005,173(8):905
[16]Aust NZ.Trends in the incidence of ectop ic pregnancy in New South Wales between1990-1998[J].J Obstet Gynaecol,2001,41(4):436-438
[17]Ushakov FB,Elchala V,Aceman PJ,et al.Cervical pregnancy:past and future[J].Obster Gynecol Scand,1997,76(9):797-781
[18]Mark DP,Judith ET,Pamela LD.妇产科急症学诊断和处理[M].郎景和,向阳,刘 俊涛,译.北京:人民卫生出版社、2005:49255
铩颷19]王晓萍,刘喻,钟伏莲.异位妊娠286例临床分析[J].宁夏医学杂志,2007,28(1):89-90
[20]卢焕管.腹腔镜手术治疗异位妊娠236例临床分析[J].中国实用妇科与产科杂志,2003,8(8):493
[21]林秋华.腹腔镜手术治疗输卵管妊娠的几个相关问题[J].中国实用妇科与产科杂志,2003,11(11):663
[22]Martin D.Preoperative visits to reduce patient anxiety:a study[J].Nurstand,1996,10:33-38
[23]郭安梅,董希玮,朱迎梅等.术前手术病人对麻醉认知及需求的调查[J].中华麻醉学杂志,2003,23(4):300-301
[24]赵东江,王者咸,周林平.围手术期心理支持疗法用于术后镇痛的临床研究[J].临床麻醉学杂志,2000,7(4):174-176
[25]孙家潭,葛衡江,刘怀琼.围术期输血对机体免疫功能抑制的研究进展[J].国外医学麻醉学与复苏分册,2000,21(5):285-288
[26]孙大金,杭燕南,主编.实用临床麻醉学[M].第1版.北京:中国医药科技出版社,2001.839
[27]张志龙,费剑春.cAMP信使系统和全麻机制[J].《国外医学.麻醉学与复苏分册》,200t,22(5):260-262
[28]Walter G,Bussow K,Cahill D,et al.Protein arrays for gene espression[J]F Med SciAnesth Resus,August 2005,26(14):203
[29]顾健腾,陶国才.蛋白质芯片与全身麻醉机制[J].《国外医学》麻醉学与复苏分册,2005,26(4):203-205
[30]宋建钢,曹云飞,俞卫锋.PET与全麻作用的中枢区域定位研究[J].《国外医学》麻醉学与复苏分册,2004,25(2):108-110
[31]刘晓峰,柴伟,杨永慧等.芬太尼预处理对家兔急性失血性休克心肌损伤的影响[J].第四军医大学学报,2007,28(1):79-81
[32]Kato R,Ross S,Foex P.Fentanyl protects the heart against ischemic injury via opioidreceptors,adenosine A1 receptors and KATP channel linked mechanisms in rats[J].Br J Anaesth,2000,84(6):204-214.
[33]Kato R,Foex P.Fentanyl reduces infarction but not stunning via delta2 opioidreceptors and protein kinase C in rats[J].Br J Anaesth,2000,84(5):608-614
[34]许讴,刘仁光.麻醉药预处理的心肌保护作用机制研究近况[J].中国心血管研究杂志,2005,3(1):73-75
[35]Benedict PE,BenedictMB,Su TP,et al.Opiate drugs and delta2 recep tor-mediated myocardial protection[J].Circulation,1999,100(11):Ⅱ357-Ⅱ360
铩颷36]刘莹莹,林春水,阮骆阳,等.利多卡因对失血性休克兔细胞因子的影响[J]实用医学杂志,2007,33(4):461-464
[37]Taniguchi T,Shibata K,Yamamoto K,et al.Effects of lidocaine administration onhemodynamics and cytokine responses to endotoxemia in rabbits[J].Crit Care Med,2000,28(3):755-759
[38]Onah HE,Oguanuo TC,Mgbor SO.An evaluation of the shock index in predictingruptured ectopic pregnancy[J].J Obstet Gynaecol.2006 Jul;26(5):445-7
[39]阮战伟,潘景业,沈志坚,等.失血性休克大鼠中性粒细胞表面CD18和血清TNF-α的变化[J].实用医学杂志,2006,22(7):726-764
[40]Runat L,Ekatrom P,Gietcksky K,et al.Pentoxifyline improves surives survival andreduces tumor mecrosis factor,interleukin-6 and endothelinl in fulminantintraabdominal spepsis in rats[J].Shock,1995,12(10):4
[41]Brealey D,Brand M,Hargreaves I,et al.Association between mitochondrialdysfunction and severity and outcome of septic shock[J].Lancet,2002,360(20):219-223
[42]萧正伦,黄海鹭,徐远达,等.低剂量内毒素对低血容量性休克兔前炎症细胞因子的影响[J].中国危重病急救医学,2000,12(6):346-349
[43]Knoferl MW,Angele MK,Diodato MD,et al.Female sex hormones regulatemacrophage function after trauma hemorrhage and prevent increased death rate fromsubsequent sepsis[J].Ann Surg 2002 Jan,235(1):105-112
[44]朱志宏.创伤失血性休克后机体反应的性别二态性[J].世界急危重病医学杂志,2006,3(3):1215-1217
[45]蔡秀军,牟一平,黄迪宇等.高渗氯化钠溶液治疗失血性休克的实验研究[J].中华创伤杂志,2001,17(2):110
[46]蹇华盛,陈淑芳,朱艳芳等.高渗氯化钠羟乙基淀粉40用于失血性休克院前急救的临床观察[J].创伤外科杂志,2003,5(6):475
[47]Murao Y,loomis wolf hoyt.Effect of dose of hypertonic saline on its potential toprevent lung tissue damage in mouse model of hemorrhagic shock[J].Shock,2003,20(1):29
[48]Revell M,Greaves I,Porter K.Endpoints for fluid resuscitation in hemorrhagic shock[J].J Trauma,2003,54(5):S63-S67
[49]Kumar A,Parrillo JE.Shock:classification,pathophysiology and approach tomanagement[A].In:Parrilo JE,Dellinger RP ed.Critical Care Medicine[M].2nd ed,Missouri:Mosby.2001
铩颷50]Martin GS.Lewis CA.Fluid management in shock[J].Semin Respir Crit Care Meal,2004,25(6):683-693
[51]Nolan J.Fluid resuscitation for the trauma patient[J].Resuscitation,2001,48:57-69
[52]刘玉春,马燕兰,王建荣,等.不同补液温度对失血性休克兔二胺氧化酶和心肌酶变化的影响[J].中国危重急救医学,2005,17(1):39-41
[53]孙慕义.生命伦理学的知识场域与现象学问题[J].伦理学研究,2007,1:76-77
[54]Miles SH,Lane LW,Bickel J,et al.Medical Ethics Education.,Coming of Age[J],Acad Med,1989(64):705
[55]高志炎,陈仁彪,丘祥兴.临床实践中的伦理问题(3)[J].外科理论与实践,2004,9(1):25
[56]Stoelting RK.Chair-ASA Task force on value-based anesthesia.Decision making forcost-effective,quality care[J].ASA Newsletter,1995.59:6
铩颷1]许建营.异位妊娠[M].北京:中国医药科技出版社,2002.2
[2]张秀华.创伤性和失血性休克的急救与护理[J].实用护理杂志,1996,12(11):484
[3]廖玲.30例异位妊娠腹腔内出血的抢救与护理[J].华夏医学,2006,5(18):792
[4]Ong BC,bin-Katjo J,Tan BL,et al.Acute failure of oxygen delivery[J].Anesthesiology,2001,95(4):1038-9
[5]谢荣主编.麻醉学[M].北京:科学出版社,1994.529
[6]潘云.122例宫外孕手术的麻醉分析[J].浙江临床医学,2001,3(7):544
[7]黄清彩,詹晓光.218例宫外孕手术的麻醉分析[J].福建医药杂志,2002,24(4):80
[8]孙燕.宫外孕应用腰麻硬膜外联合麻醉的体会[J].中原医刊,2004,31(8):27-28
[9]邵素娟,蒋征文,吕金等.1458例宫外孕患者的麻醉处理[J].现代中西医结合杂志,2005,14(21):2861-62
[10]李巧媛,孙义.喉罩全麻在宫外孕手术中的应用[J].内蒙古医学杂志,2004,36(9):664-665
[11]张庆明.氯胺酮复合异丙酚用于宫外孕手术麻醉观察[J].临床医学进展,2004,13(1):46-47
[12]乌宇彤,曹宇芳,王进香等.静脉复合麻醉在宫外孕休克手术的应用[J].内蒙古医学杂志,2004,36(6):438
[13]王育栋,王燕,许睿等.妇科腹腔镜手术603例麻醉体会[J].西北国防医学杂志,2005,26(3):224
[14]刘家天,周惠萍,黄伟波等.妇科腹腔镜手术的麻醉与管理[J].临床医药实践杂志,2004,13(12):895
[15]Carpenter RI,Eger EI Ⅱ,Johnson BH,et al.The extent of metabolism of inhaledanesthetics in humans[J].Anesthesiology,1986,65:201
[16]李黎,张建辉,田培玲.异丙酚全凭静脉麻醉在妇科腹腔镜手术中的应用[J].医药论坛杂志,2005,26(22):46-47
[17]Barker SJ:Blood volume measurement:The next intraoperative monitor[J]?Anesthesiology 1998,89:1310
[18]Aranda M,Mihn F,Garrett S.et al:Continuous cardiac outputcatheters[J].Anesthesiology,1998,89:1592
[19]林雪贞.宫外孕出血性休克患者的麻醉体会[J].现代中西医结合,2002,11(20):1988
铩颷20]Wasserstrum N:Issues in fluid management during labor:General considerations[J].Clin Obstet Gynecol,1992,35:505
[21]Kaye AD and Grogono AW.Fluid and electrolyte physiology[M].In:Miller RD,eds.Anesthesia(5~(th)edition).New York.Churchill Livingstone,2000,1586-1662
[22]Rosenthal MH.Intraoperative fluid mamagement-what and how much[J]?Chest,1999,115(5):1065-1125
[23]Practice Guidelines for blood component therapy:A report by the American Societyof Anesthesiologists Task Force on Blood Component Therapy[J].Anesthesiology,1996,84:732
[24]李力.休克指数与平均动脉压在宫外孕中的临床意义[J].中级医刊,1990,6(4):35
[25]张振均.妇产科出血性休克的救治[J].实用妇科手术与产科杂志,1990,6(2):60.
[26]Schlag G,Redl H,ed.Shock sepsis,and organ failure-nitric oxide[J].Springer-Vellag:Berlin,1993.56-59
[27]张忠汉,崔健君.严重宫外孕休克病人手术的麻醉管理[J].实用妇科手术与产科杂志,1989,5(5):243
[28]Dampney RA.Functional organization of central pathways regulating thecardiovascular system[J].PhysioRev,1994,74(2):323-64
[29]Casati A,Valentini G,Ferrari S,et al.Cardiorespiratorychanges duringgynaecological laparoscopy by abdominal wall elevation:comparison with carbondioxide pneumoperitoneum[J].Br J Anaesth,1997,78:51
[30]Lemaire BMD,Van Erp WFM.Laparoscopic surgery during pregnancy[J].SurgEndosc,1997,11:15
[31]Bures E,Fusciardi J,Lanquetot H,et al.Ventilatory effects of laparoscopiccholecystectomy[J].Acta Anaesthesiol Scand,1996,40:566
[32]Sato K,Kawamura T,Wakusawa R.Hepatic blood flow and function in eldelypatients undergoing laparoscopic cholecystectomy[J].Anesth Analg,2000,90:1189
[33]Karayiannakis AJ,Makri GG,Mantzioka A,et al.Systemic sress response afterlaparoscopic or open cholecystectomy:A randomized trial[J].Br J Surg,1997,84:468
[34]张锦虹,林伟,李成等.腹腔镜手术治疗异位妊娠的临床分析[J].云南医药,2005,26(3):245-246
[2]Al-Mosawi A,Awash E,Hayat S,Asfar S.Ruptured extrauterine gestation inheterotopic pregnancy[J].Ann Saudi Med.2005 Sep-Oct,25(5):413-414
[3]Bharadwaj P,Erskine K.Heterotopic pregnancy:still a diagnostic dilemma[J].JObstet Gynaecol.2005 Oct;25(7):720-2
[4]Canis M,Savary D,Pouly JL,Wattiez A,Mage G.Ectopic pregnancy:criteria todecide between medical and conservative surgical treatment?[J].J Gynecol ObstetBiol Reprod,2003,32(7):S54-63
[5]R.D.Miller,R.F.Cucchiara,E.D.Miller,et al.Anesthesia 5th[M].ChurchillLivingstone,2001,(1):755-766
[6]Rout CC.Anaesthesia and analgesia for the critically ill parturient[J].Best Pract ResClin Obstet Gynaecol.2001,15(4):507-522
[7]谭红鹰,陈秉学,孙来保等.不同剂量可乐定复合罗呢卡因硬膜外麻醉的效应[J].中华麻醉学杂志.2003,23:28
[8]Wasserstrum N:Issues in fluid management during labor:General considerations[J].Clin Obstet Gynecol,1992,35:505
[9]林治瑾,主编.临床麻醉学第1版[M].天津:天津科学技术出版社,2001.6 06
[10]潘云.122例宫外孕手术的麻醉分析[J].浙江临床医学,2001,3(7):544
[11]黄清彩,詹晓光.218例宫外孕手术的麻醉分析[J].福建医药杂志2002,24(4):80
[12]叶英.异位妊娠639例临床分析[J].中国医师杂志.2007,9(3):347
[13]薛凤霞,焦书竹.异位妊娠的病因及诊治的进展[J].中国实用妇科与产科杂志,1999,15(4):247
[14]周力学,王良岸,黎淑芬等.休克型异位妊娠30例早期临床表现[J].临床医学.2007.27(3):45-46
[15]Murray H,Baakdah H,Bardell T,et al.Diagnosis and treatment of ectop icpregnancy[M].CMAJ,2005,173(8):905
[16]Aust NZ.Trends in the incidence of ectop ic pregnancy in New South Wales between1990-1998[J].J Obstet Gynaecol,2001,41(4):436-438
[17]Ushakov FB,Elchala V,Aceman PJ,et al.Cervical pregnancy:past and future[J].Obster Gynecol Scand,1997,76(9):797-781
[18]Mark DP,Judith ET,Pamela LD.妇产科急症学诊断和处理[M].郎景和,向阳,刘 俊涛,译.北京:人民卫生出版社、2005:49255
铩颷19]王晓萍,刘喻,钟伏莲.异位妊娠286例临床分析[J].宁夏医学杂志,2007,28(1):89-90
[20]卢焕管.腹腔镜手术治疗异位妊娠236例临床分析[J].中国实用妇科与产科杂志,2003,8(8):493
[21]林秋华.腹腔镜手术治疗输卵管妊娠的几个相关问题[J].中国实用妇科与产科杂志,2003,11(11):663
[22]Martin D.Preoperative visits to reduce patient anxiety:a study[J].Nurstand,1996,10:33-38
[23]郭安梅,董希玮,朱迎梅等.术前手术病人对麻醉认知及需求的调查[J].中华麻醉学杂志,2003,23(4):300-301
[24]赵东江,王者咸,周林平.围手术期心理支持疗法用于术后镇痛的临床研究[J].临床麻醉学杂志,2000,7(4):174-176
[25]孙家潭,葛衡江,刘怀琼.围术期输血对机体免疫功能抑制的研究进展[J].国外医学麻醉学与复苏分册,2000,21(5):285-288
[26]孙大金,杭燕南,主编.实用临床麻醉学[M].第1版.北京:中国医药科技出版社,2001.839
[27]张志龙,费剑春.cAMP信使系统和全麻机制[J].《国外医学.麻醉学与复苏分册》,200t,22(5):260-262
[28]Walter G,Bussow K,Cahill D,et al.Protein arrays for gene espression[J]F Med SciAnesth Resus,August 2005,26(14):203
[29]顾健腾,陶国才.蛋白质芯片与全身麻醉机制[J].《国外医学》麻醉学与复苏分册,2005,26(4):203-205
[30]宋建钢,曹云飞,俞卫锋.PET与全麻作用的中枢区域定位研究[J].《国外医学》麻醉学与复苏分册,2004,25(2):108-110
[31]刘晓峰,柴伟,杨永慧等.芬太尼预处理对家兔急性失血性休克心肌损伤的影响[J].第四军医大学学报,2007,28(1):79-81
[32]Kato R,Ross S,Foex P.Fentanyl protects the heart against ischemic injury via opioidreceptors,adenosine A1 receptors and KATP channel linked mechanisms in rats[J].Br J Anaesth,2000,84(6):204-214.
[33]Kato R,Foex P.Fentanyl reduces infarction but not stunning via delta2 opioidreceptors and protein kinase C in rats[J].Br J Anaesth,2000,84(5):608-614
[34]许讴,刘仁光.麻醉药预处理的心肌保护作用机制研究近况[J].中国心血管研究杂志,2005,3(1):73-75
[35]Benedict PE,BenedictMB,Su TP,et al.Opiate drugs and delta2 recep tor-mediated myocardial protection[J].Circulation,1999,100(11):Ⅱ357-Ⅱ360
铩颷36]刘莹莹,林春水,阮骆阳,等.利多卡因对失血性休克兔细胞因子的影响[J]实用医学杂志,2007,33(4):461-464
[37]Taniguchi T,Shibata K,Yamamoto K,et al.Effects of lidocaine administration onhemodynamics and cytokine responses to endotoxemia in rabbits[J].Crit Care Med,2000,28(3):755-759
[38]Onah HE,Oguanuo TC,Mgbor SO.An evaluation of the shock index in predictingruptured ectopic pregnancy[J].J Obstet Gynaecol.2006 Jul;26(5):445-7
[39]阮战伟,潘景业,沈志坚,等.失血性休克大鼠中性粒细胞表面CD18和血清TNF-α的变化[J].实用医学杂志,2006,22(7):726-764
[40]Runat L,Ekatrom P,Gietcksky K,et al.Pentoxifyline improves surives survival andreduces tumor mecrosis factor,interleukin-6 and endothelinl in fulminantintraabdominal spepsis in rats[J].Shock,1995,12(10):4
[41]Brealey D,Brand M,Hargreaves I,et al.Association between mitochondrialdysfunction and severity and outcome of septic shock[J].Lancet,2002,360(20):219-223
[42]萧正伦,黄海鹭,徐远达,等.低剂量内毒素对低血容量性休克兔前炎症细胞因子的影响[J].中国危重病急救医学,2000,12(6):346-349
[43]Knoferl MW,Angele MK,Diodato MD,et al.Female sex hormones regulatemacrophage function after trauma hemorrhage and prevent increased death rate fromsubsequent sepsis[J].Ann Surg 2002 Jan,235(1):105-112
[44]朱志宏.创伤失血性休克后机体反应的性别二态性[J].世界急危重病医学杂志,2006,3(3):1215-1217
[45]蔡秀军,牟一平,黄迪宇等.高渗氯化钠溶液治疗失血性休克的实验研究[J].中华创伤杂志,2001,17(2):110
[46]蹇华盛,陈淑芳,朱艳芳等.高渗氯化钠羟乙基淀粉40用于失血性休克院前急救的临床观察[J].创伤外科杂志,2003,5(6):475
[47]Murao Y,loomis wolf hoyt.Effect of dose of hypertonic saline on its potential toprevent lung tissue damage in mouse model of hemorrhagic shock[J].Shock,2003,20(1):29
[48]Revell M,Greaves I,Porter K.Endpoints for fluid resuscitation in hemorrhagic shock[J].J Trauma,2003,54(5):S63-S67
[49]Kumar A,Parrillo JE.Shock:classification,pathophysiology and approach tomanagement[A].In:Parrilo JE,Dellinger RP ed.Critical Care Medicine[M].2nd ed,Missouri:Mosby.2001
铩颷50]Martin GS.Lewis CA.Fluid management in shock[J].Semin Respir Crit Care Meal,2004,25(6):683-693
[51]Nolan J.Fluid resuscitation for the trauma patient[J].Resuscitation,2001,48:57-69
[52]刘玉春,马燕兰,王建荣,等.不同补液温度对失血性休克兔二胺氧化酶和心肌酶变化的影响[J].中国危重急救医学,2005,17(1):39-41
[53]孙慕义.生命伦理学的知识场域与现象学问题[J].伦理学研究,2007,1:76-77
[54]Miles SH,Lane LW,Bickel J,et al.Medical Ethics Education.,Coming of Age[J],Acad Med,1989(64):705
[55]高志炎,陈仁彪,丘祥兴.临床实践中的伦理问题(3)[J].外科理论与实践,2004,9(1):25
[56]Stoelting RK.Chair-ASA Task force on value-based anesthesia.Decision making forcost-effective,quality care[J].ASA Newsletter,1995.59:6
铩颷1]许建营.异位妊娠[M].北京:中国医药科技出版社,2002.2
[2]张秀华.创伤性和失血性休克的急救与护理[J].实用护理杂志,1996,12(11):484
[3]廖玲.30例异位妊娠腹腔内出血的抢救与护理[J].华夏医学,2006,5(18):792
[4]Ong BC,bin-Katjo J,Tan BL,et al.Acute failure of oxygen delivery[J].Anesthesiology,2001,95(4):1038-9
[5]谢荣主编.麻醉学[M].北京:科学出版社,1994.529
[6]潘云.122例宫外孕手术的麻醉分析[J].浙江临床医学,2001,3(7):544
[7]黄清彩,詹晓光.218例宫外孕手术的麻醉分析[J].福建医药杂志,2002,24(4):80
[8]孙燕.宫外孕应用腰麻硬膜外联合麻醉的体会[J].中原医刊,2004,31(8):27-28
[9]邵素娟,蒋征文,吕金等.1458例宫外孕患者的麻醉处理[J].现代中西医结合杂志,2005,14(21):2861-62
[10]李巧媛,孙义.喉罩全麻在宫外孕手术中的应用[J].内蒙古医学杂志,2004,36(9):664-665
[11]张庆明.氯胺酮复合异丙酚用于宫外孕手术麻醉观察[J].临床医学进展,2004,13(1):46-47
[12]乌宇彤,曹宇芳,王进香等.静脉复合麻醉在宫外孕休克手术的应用[J].内蒙古医学杂志,2004,36(6):438
[13]王育栋,王燕,许睿等.妇科腹腔镜手术603例麻醉体会[J].西北国防医学杂志,2005,26(3):224
[14]刘家天,周惠萍,黄伟波等.妇科腹腔镜手术的麻醉与管理[J].临床医药实践杂志,2004,13(12):895
[15]Carpenter RI,Eger EI Ⅱ,Johnson BH,et al.The extent of metabolism of inhaledanesthetics in humans[J].Anesthesiology,1986,65:201
[16]李黎,张建辉,田培玲.异丙酚全凭静脉麻醉在妇科腹腔镜手术中的应用[J].医药论坛杂志,2005,26(22):46-47
[17]Barker SJ:Blood volume measurement:The next intraoperative monitor[J]?Anesthesiology 1998,89:1310
[18]Aranda M,Mihn F,Garrett S.et al:Continuous cardiac outputcatheters[J].Anesthesiology,1998,89:1592
[19]林雪贞.宫外孕出血性休克患者的麻醉体会[J].现代中西医结合,2002,11(20):1988
铩颷20]Wasserstrum N:Issues in fluid management during labor:General considerations[J].Clin Obstet Gynecol,1992,35:505
[21]Kaye AD and Grogono AW.Fluid and electrolyte physiology[M].In:Miller RD,eds.Anesthesia(5~(th)edition).New York.Churchill Livingstone,2000,1586-1662
[22]Rosenthal MH.Intraoperative fluid mamagement-what and how much[J]?Chest,1999,115(5):1065-1125
[23]Practice Guidelines for blood component therapy:A report by the American Societyof Anesthesiologists Task Force on Blood Component Therapy[J].Anesthesiology,1996,84:732
[24]李力.休克指数与平均动脉压在宫外孕中的临床意义[J].中级医刊,1990,6(4):35
[25]张振均.妇产科出血性休克的救治[J].实用妇科手术与产科杂志,1990,6(2):60.
[26]Schlag G,Redl H,ed.Shock sepsis,and organ failure-nitric oxide[J].Springer-Vellag:Berlin,1993.56-59
[27]张忠汉,崔健君.严重宫外孕休克病人手术的麻醉管理[J].实用妇科手术与产科杂志,1989,5(5):243
[28]Dampney RA.Functional organization of central pathways regulating thecardiovascular system[J].PhysioRev,1994,74(2):323-64
[29]Casati A,Valentini G,Ferrari S,et al.Cardiorespiratorychanges duringgynaecological laparoscopy by abdominal wall elevation:comparison with carbondioxide pneumoperitoneum[J].Br J Anaesth,1997,78:51
[30]Lemaire BMD,Van Erp WFM.Laparoscopic surgery during pregnancy[J].SurgEndosc,1997,11:15
[31]Bures E,Fusciardi J,Lanquetot H,et al.Ventilatory effects of laparoscopiccholecystectomy[J].Acta Anaesthesiol Scand,1996,40:566
[32]Sato K,Kawamura T,Wakusawa R.Hepatic blood flow and function in eldelypatients undergoing laparoscopic cholecystectomy[J].Anesth Analg,2000,90:1189
[33]Karayiannakis AJ,Makri GG,Mantzioka A,et al.Systemic sress response afterlaparoscopic or open cholecystectomy:A randomized trial[J].Br J Surg,1997,84:468
[34]张锦虹,林伟,李成等.腹腔镜手术治疗异位妊娠的临床分析[J].云南医药,2005,26(3):245-246