术后不同镇痛药对结直肠癌患者预后的影响  

Prognostic impact of different analgesics after colorectal surgery

作　　者：庞倩芸[1] 陈博[1] 邓小园[1] 刘红亮[1] 

机构地区：[1]重庆市肿瘤研究所/医院/癌症中心麻醉科,重庆市400030

出　　处：《中国肿瘤临床》2016年第14期635-638,共4页Chinese Journal of Clinical Oncology

基　　金：重庆市卫计委面上项目(编号:2011-2-364)资助~~

摘　　要：目的：观察术后不同镇痛药静脉自控镇痛（patient-controlled intravenous analgesia,PCIA）对结直肠癌患者预后的影响。方法：选取2010年1月至2012年12月重庆市肿瘤医院行结直肠癌手术的患者460例,TNM分期Ⅰ~Ⅱ期,ASAⅠ-Ⅱ级,随机分为5组,术毕分别给予舒芬太尼、地佐辛、布托啡诺、吗啡和曲马多行PCIA,记录各组术后镇痛效果、NK细胞活性和Th1/Th2比率、近期并发症以及远期肿瘤复发转移率,健康志愿者作为对照组。结果：各试验组术后静息状态下VAS评分均〈3分,吗啡组皮肤瘙痒发生率和术后住院时间显著高于其它组（P〈0.05）,曲马多组术后恶心呕吐发生率显著高于其它组（P〈0.05）;NK细胞活性和Th1/Th2比率各试验组于术毕均显著下降,曲马多组和舒芬太尼组以及地佐辛组和布托啡诺组中分别于术后7 d、14 d恢复至对照水平（P〉0.05）,但吗啡组术后14 d仍显著低于对照水平（P〈0.05）;患者术后3年内肿瘤复发转移率由高到低依次为吗啡组、布托啡诺组、地佐辛组、舒芬太尼组和曲马多组。结论：结直肠癌患者术后使用曲马多和舒芬太尼给予PCIA可促进术后免疫功能恢复且减少复发转移率。Objective： To assess the effect of patient-controlled intravenous analgesia （PCIA） with different postoperative analgesics on prognosis after colorectal surgery. Methods： A total of 460 colorectal cancer patients （TNM Ⅰ - Ⅱ） who underwent elective surgery within January 2010 to December 2012 in Chongqing Cancer Hospital were randomly divided into five groups for PCIA with sufentanil, dezocine, butorphanol, morphine, and tramadol. We evaluated the analgesic efficacy, detected NK cell activity and Thl/Th2 ratio from peripheral blood, and observed short-term complications and long-term cancer recurrence and metastasis. Healthy volunteers served as the control group. Results： The morphine group displayed a VAS score of less than 3 in the rest state and showed the longest hospital stay and the highest incidence of pruritus （P〈0.05）. The incidence of postoperative nausea and vomiting was the highest in the tramadol group （P〈0.05）. NK cell activity and Thl/Th2 ratio decreased in all experimental groups after surgery. NK activity and Thl/Th2 ratio returned to the control level 7 days after surgery in the tramadol and sulfentanil groups and 14 days after surgery in the dezocine and butorphanol groups （P〉0.05）, whereas those in the morphine group remained low （P〈0.05）. The incidences of cancer recurrence and metastasis were ranked as follows： morphine 〉 butorphnol 〉 dezocine〉sufentanil 〉tramadol. Conclusion： Tramadol and sufentanil used in PCIA after colorectal surgery could facilitate the recovery of immune function and reduced the incidence of recurrence and metastasis.

关 键 词：术后镇痛 结直肠癌 细胞免疫 复发转移 

分 类 号：R614[医药卫生—麻醉学] R735.34[医药卫生—外科学]