吗啡复合氯胺酮治疗顽固性癌痛的免疫调节及其机制探讨  

Study on immune regulation and its mechanism of morphine combined with ketamine in treating patients＇ intractable cancer pain

作　　者：周乃宝[1] 王凯国[1] 李浩[1] 

机构地区：[1]山东省肿瘤医院麻醉科,济南250117

出　　处：《国际麻醉学与复苏杂志》2011年第6期747-750,共4页International Journal of Anesthesiology and Resuscitation

基　　金：山东省自然科学基金（ZR2011HM039）

摘　　要：背景顽固性癌痛在所有癌痛患者中约占3％－20％，严重影响患者的生存质量，同时疼痛导致的过度应激会严重降低机体免疫功能。吗啡复合氯胺酮治疗顽固性癌痛在理论上可以减轻患者的免疫抑制，但是目前国内外尚缺乏实验数据的支持。目的初步探讨吗啡复合氯胺酮治疗顽固性癌痛的免疫调节及其机制。内容吗啡是目前临床使用最广泛的治疗晚期癌痛药物，但吗啡长期大量应用会导致耐受及痛觉过敏，同时它本身也可抑制机体免疫功能。小剂量氯胺酮可拮抗吗啡的这些作用并减少吗啡用量，两者复合有协同或相加作用，通过缓解疼痛减轻机体过度应激来减轻患者的免疫抑制。同时两种药物也可直接作用于免疫细胞的相应受体引起其功能数量的变化，其机制可能与核因子κB（nuclear factor—κB，NF—κB）、一氧化氮（NO）、环磷酸腺苷和环磷酸鸟苷等物质存在密切关系。趋向为研究吗啡复合氯胺酮对顽固性癌痛患者免疫功能方面的影响提供珲论支持。Background Patients with intractable cancer pain make up approximately 3%-20% of those with cancer pain, and the intractable pain has adverse impact on patients＂ life quality. The excess stress reaction caused by the acute pain will also inhibit immune function severely. Although theoretically, morphine combined with ketamine in treating patients＂ intractable cancer pain can relieve the immunosuppressive suppression effect, at present it is still lack of clinical data to support the theory. Objective This review initially investigates the immune regulation and its mechanism of morphine combined with ketamine in treating patients1 intractable cancer pain. Content Morphine is the most important and most widely-used clinical drug in relieving pain in patients with advanced cancer, but the long-term, and extensive use of morphine may leads to tolerance, hyperalgesia and immune suppression. Low-dose of ketamine can antagonize those adverse effects of morphine and decrease the consumption of morphine. The combination of these two drugs will generate synergism and addition effects, and inhibit immune suppression by relieving pain and excessive stress. At the same time, these two drugs can act on the corresponding immunoeyte receptors directly and may change the quantity and function of the receptors which was mediated by NF-κB, NO, cAMP and cGMP. Trend This paper will provide theoretical support for the study of the immunological effects of morphine combined with ketamine in treating patients＂ intractable cancer pain.

关 键 词：吗啡 氯胺酮 顽固性癌痛 免疫 

分 类 号：R730.5[医药卫生—肿瘤]