舒芬太尼或曲马多术后镇痛对患者免疫功能的影响  

The effects of tramadol or sufentanil on immune function during postoperative anagesia

作　　者：胡崇辉[1] 胡桂英[1] 傅理[1] 徐军[1] 陈元良[1] 吴俊琪[1] 

机构地区：[1]浙江省金华市中心医院,金华321000

出　　处：《浙江创伤外科》2012年第3期302-304,共3页Zhejiang Journal of Traumatic Surgery

基　　金：金华市技术创新工程项目(2009-3-02)

摘　　要：目的通过评价自控静脉舒芬太尼或曲马多镇痛对腹腔镜胆囊切除术(LC)后患者血浆中细胞因子及免疫细胞的影响,探讨不同种类镇痛药物对术后早期患者免疫功能的影响。方法 80例LC术患者用抽签法随机分为2组(每组40例):A组患者为术后自控静脉舒芬太尼镇痛;B组患者为术后自控静脉曲马多镇痛。观察麻醉前30分钟、手术后即刻、术后24小时、术后72小时4个时点患者血浆中白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)及T细胞总数、NK细胞、CD4+及CD8+细胞的水平,以视觉模拟评分法(VAS)评分评价各组患者术后2、24、48、72小时的镇痛效果。结果术后各时点A组、B组的VAS评分无统计学差异(P>0.05);两组除术毕即刻T细胞总数较麻醉前基础值升高外(均P<0.05),余时间段T细胞总数、NK细胞、CD4+及CD8+细胞的变化与基础值及组间比较均无统计学意义(均P>0.05);两组患者术毕即刻至术后72小时血浆IL-2水平与麻醉前值比较均降低(均P<0.05),两组患者术毕即刻IL-6、IL-10水平与麻醉前值比较均显著升高(均P<0.05),并持续升高至术后24小时达峰值后逐渐下降,但术后72小时两组患者IL-6、IL-10水平仍高于术前。结论舒芬太尼和曲马多对LC患者术后均取得良好的镇痛效果,并且两者的免疫抑制作用无明显差异。Objective To explore the effects of different analgesic efficacy on immune function, by evaluating the effects of tramadol and sufentanil on expressions of plasma cytokines and immunocyte in postoperative analgesia patients underwent LC. Methods A total of 80 patients un- derwent LC were randomly divided into 2 groups （n=40 in each） based on the different analgesic strategies. The patients in group A were given with sufentanil IV-PCA, while group B with tramadol IV-PCA. Blood interleukin-2 （IL-2）,IL-6,IL-10, T lymphocyte, natural-killer cell,CD4＋ and CD8＋ were measured at 4 time points,i.e.30 minutes before anesthesia, instantly after surgery, 24 hours after surgery and 72 hours after surgery. The anal- gesic degrees were evaluated by visual analogue scale （VAS） respectively at 2 hours, 24 hours, 48 hours and 72 hours after surgery in different groups of patients. Results There was no significant difference in VAS score between tramadol and sufentanil groups （P〉0.05） at every time point. The amount of T lymphocyte of 2 groups after surgery instantly were both significantly higher than pre-anesthesia （P〈O.05）. Compared with pre-anesthesia, there were no significant differences of other immunocyte（CD4＋,CD8＋,NK cell） at other time points, and also between the 2 groups （P〉0.05）.The lev- els of IL-2 at every time point were significantly lower than pre-anesthesia in both of the 2 groups （P〈0.05）. The levels of IL-6 and IL-10 after surgery instantly were both significantly higher than pre-anesthesia （P〈0.05）, which kept on increasing until 24 hours after surgery. But the levels of IL-6 and IL-10 72 hours after surgery were still higher than pre-anesthesia. Conclusion Sufentanil and tramadol both can effectively achieve the analgesia and there was no significant difference in immune suppression function between the 2 groups.

关 键 词：镇痛 腹腔镜胆囊切除术 舒芬太尼 曲马多 免疫 

分 类 号：R971.2[医药卫生—药品]