吗啡和曲马多术后镇痛对胃癌患者T淋巴细胞亚群及NK细胞的影响  

Effects of morphine and tramadol on T-lymphocyte subsets and natural-killer cells during postoperative analgesia in gastric cancer patients

作　　者：王忠云[1] 顾海军[1] 金文杰[1] 唐琦峰[2] 钱燕宁[1] 

机构地区：[1]南京医科大学第一附属医院麻醉科,210029 [2]南京医科大学附属苏州医院麻醉科

出　　处：《临床麻醉学杂志》2007年第10期800-802,共3页Journal of Clinical Anesthesiology

基　　金：江苏省医学重点人才项目(RC2002058)

摘　　要：目的观察吗啡和曲马多术后镇痛对胃癌患者T淋巴细胞亚群及自然杀伤(NK)细胞的影响。方法40例ASAⅠ或Ⅱ级在静脉全身麻醉下择期行胃癌根治术的患者,随机分为吗啡组和曲马多组,每组20例,术毕以电子镇痛泵分别行吗啡和曲马多自控静脉镇痛。在麻醉前(基础值)、手术1.5h、术后24、48、72h五个时间点测定T淋巴细胞亚群(CD3+、CD4+、CD8+)及NK细胞(CD3-CD16+CD56+)。结果两组CD4+、CD4+/CD8+、CD3-CD16+CD56+在手术1.5h降低(P<0.05),CD3+在术后24h降低(P<0.05);术后48h吗啡组上述指标仍然较低(P<0.05),而曲马多组已经恢复至麻醉前水平,两组间比较差异有统计学意义(P<0.05);术后72h两组上述指标均恢复至基础值水平。两组CD8+在各时点差异无统计学意义。结论胃癌患者术后行自控静脉镇痛时曲马多对T淋巴细胞亚群及NK细胞的抑制比吗啡小。Objective To observe the effects of morphine and tramadol on T-lymphocyte subsets and natural-killer cells during postoperative analgesia in gastric cancer patients, Methods Forty patients（ASA class Ⅰ or Ⅱ） scheduled for gastric cancer operations under general anesthesia were randomly allocated to morphine group and tramadol group with 20 cases each. The patients received patient-controlled intravenous analgesia postoperatively. T-lymphocyte subsets（CD3^＋ , CD4^＋ and CD8^＋） and natural-killer cells（CD3^- CD16^＋ CD56^＋） were measured by flow cytometry at five time points：before anesthesia（baseline）, at 1.5 h after incision, 24,48 and 72 h after operation. Results CD4^＋ ,CD4^＋/CD8^＋ and CD3^-CD16^＋ CD56^＋ decreased at 1.5 h after incision and CD3^＋ decreased at 24 h after operation in both groups （P 〈 0. 05）. CD3＋ , CD4^＋/CD8^＋ and CD3^＋ CD16^＋ CD56^＋ still decreased in morphine group at 48 h after operation（P〈0. 05）, which were not in tramadol group. CD3^＋ and CD4^＋/CD8^＋ and CD3 CD16^＋ CD56^＋ returned to the baselines in both groups at 72 h after operation. Conclusion The inhibiting effect of tramadol on the T-lymphocyte subsets and naturalkiller cells is less than that of morphine during postoperative analgesia in gastric cancer patients.

关 键 词：吗啡 曲马多 镇痛 胃癌 T淋巴细胞 NK细胞 

分 类 号：R614[医药卫生—麻醉学]