曲马多自控镇痛对上腹部手术患者免疫功能的影响  

Effect of Patient-controlled Intravenous Tramadol Analgesia on the Immune Function of Patients after Epigastric Surgery

作　　者：雷李培[1] 樊理华[2] 朱丽萍[3] 吴碧波[1] 

机构地区：[1]温州医学院附属第五医院麻醉科,浙江丽水323000 [2]温州医学院附属第六医院麻醉科,浙江丽水323000 [3]温州医学院附属第五医院检验科,浙江丽水323000

出　　处：《医药导报》2006年第4期292-295,共4页Herald of Medicine

摘　　要：目的探讨曲马多静脉自控镇痛对上腹部手术患者免疫功能的影响。方法30例择期上腹部手术患者,采用静吸复合气管内插管全麻,术后镇痛患者随机分为观察组和对照组各15例。术后观察组给予曲马多静脉自控镇痛,曲马多负荷量1.5 mg.kg-1,背景剂量为0.3 mg.kg-1.h-1,单次追加剂量0.1 mg.k-g1,锁定时间20 m in,共48 h。对照组在疼痛时[疼痛目视模拟评分(VSA)>5分]肌内注射哌替啶1 mg.kg-1。并分别于麻醉前、术毕,术后1,3,7 d检测血浆白细胞介素(IL)-2、IL-6、IL-10及肿瘤坏死因子-α(TNF-α)。结果对照组术后VAS明显高于观察组,两组术后IL-6、IL-10、TNF-α含量均上升,IL-2均明显下降,但对照组上升或下降更显著(P<0.01),观察组恢复较对照组早,两组间比较差异有显著性(P<0.05)。结论曲马多静脉自控镇痛可减轻患者术后免疫抑制,有利于机体恢复。Objective To study the effect of patient-controlled intravenous analgesia （PCIA） with the use of tramadol on the immune function of patients after epigastric surgery. Methods 30 adult patients scheduled for epigastric surgery and subjected to combined intravenous and tracheal inhalation anesthesia were randomly divided into two equal groups, the trial group and control group. Patients of the trial group subjected to postoperative PCIA with tramadol were given each an initial dose of 1.5 mg ·kg^-1 of tramadol followed by a maintenance dose of 0.3 mg ·kg^-1·h^-1 for 48 h. During this period, a single additional dose of 0.1 mg ·kg^-1 of the drug was given if no apparent analgesic effects was induced. Patients of the control group were given each an IM injection of 1 mg ·kg^-1 of pethidine on demand（ visual analog score[ VAS ] 〉 5）. Plasma interlukin （IL）-2, IL-6, IL-10 and tumor necrosis factor-α（TNF-α） were determined before the anesthesia, at the termination of the surgery as well as 1,3 and 7 d after the operation. Results Postoperative VAS in patients of the control group was strikingly higher than that in those of the trial group. Plasmas content of IL-6, IL-10,TNF-α were increased , while that of IL-2 was significantly decreased in patients of both groups after the operation. However, the changes in the levels of these cytokines were more prominent in patients of the control group than those in patients of the trial group （P 〈0.01 ） . The return of the plasma levels of these cytokines to normal took place earlier in patients of the trial group, the difference between the 2 groups being significant （P 〈 0.05 ）. Conclusion PCIA with tramadol was shown to alleviate the immunosuppression and promote the recovery in postoperative patients.

关 键 词：曲马多 静脉自控镇痛 免疫功能 

分 类 号：R971.2[医药卫生—药品] R656[医药卫生—药学]