羟考酮与吗啡术后镇痛对结肠癌根治术患者血小板活性和细胞免疫功能的影响  

Effects of post-operative analgesia with oxycodone or morphine for patients undergoing colon cancer radical surgery on platelet activity and cellular immunity

作　　者：廖美娟[1] 郑雪琴[1] 冯舒韵[1] 李云[1] 刘洪珍[1] 杨承祥[1] 

机构地区：[1]中山大学附属佛山医院麻醉科,528000

出　　处：《临床麻醉学杂志》2017年第6期542-545,共4页Journal of Clinical Anesthesiology

基　　金：佛山市科技创新平台资助项目(2014016)

摘　　要：目的评价羟考酮与吗啡术后镇痛对结肠癌根治术患者血小板活化和细胞免疫功能的影响。方法择期行腹腔镜结肠癌根治术患者40例,男23例,女17例,ASAⅠ或Ⅱ级,随机分为羟考酮组(O组)和吗啡组(M组),每组20例。O组PCIA泵配方为羟考酮1 mg/kg加托烷司琼6mg,M组为吗啡1mg/kg加托烷司琼6 mg。于麻醉诱导前5 min(T_0)、手术结束后4h(T_1)、24h(T_2)、48h(T_3)采集静脉血样,测定血小板膜糖蛋白(GPⅡb/Ⅲa)、P-选择素(CD62P)、NK细胞、NKT细胞、自然调节性T(nTreg)细胞含量和血小板聚集率(PAR)。结果与T_0时比较,T_1时O组,T_1、T_2时M组GPⅡb/Ⅲa、CD62P、PAR和nTreg细胞含量明显升高(P<0.05);T_1时O组,T_1~T_3时M组NK、NKT细胞含量明显降低(P<0.05)。与M组比较,T_2、T_3时O组GPⅡb/Ⅲa、CD62P、PAR和nTreg细胞含量明显降低,NK、NKT细胞含量明显升高(P<0.05)。结论与吗啡比较,羟考酮术后镇痛可抑制血小板过度活化,对细胞免疫功能抑制较轻,此作用对防治结肠癌根治术患者围术期肿瘤细胞血行转移或有积极意义。Objective To investigate the effects of post-operative analgesia with oxycodone or morphine for patients undergoing colon cancer radical surgery on platelet activation and cellular immunity.Methods Forty colon cancer patients scheduled for radical surgery,23 males and 17 females,ASA physical statusⅠ orⅡ,were randomly divided into 2groups（n=20each）：oxycodone group（group O）and morphine group（group M）.Patient-controlled intravenous analgesia（PCIA）was used for post-operative analgesia.PCIA solution contained oxycodone 1mg/kg and tropisetron 6mg in 100 ml normal saline in group O or morphine 1mg/kg and tropisetron 6mg in 100 ml normal saline in group M.Blood samples were obtained from the patients at 5min before anesthesia induction（T0）,4hafter surgery（T1）,24 hafter surgery（T2）and 48 hafter surgery（T3）.The levels of glycoprotein（GP）Ⅱb/Ⅲa,P-selection（CD62P）,natural killer（NK）cells,NKT cells,and natural Treg（nTreg）cells were detected.The platelet aggregation rate（PAR）was determined.Results Compared with T0,the levers of GPⅡb/Ⅲa,CD62 P,PAR and nTreg cells were significantly higher at T1 in group O and at T1,T2 in group M（P〈0.05）.Compared with T0,the levels of NK and NKT cells were decreased significantly at T1 in group O and at T1-T3 in group M（P〈0.05）.The levels of GPⅡb/Ⅲa,CD62 P,PAR and nTreg cells at T2 and T3in group O were decreased significantly as compared with group M（P〈0.05）.The levels of NK cells,NKT cells at T2 and T3in group O were significantly higher than those in group M.Conclusion Post-operative analgesia with oxycodone for patients undergoing colon cancer radical surgery exhibits a more significant effect of decreasing platelets activity and presents a less disturbance on cellular immunity as compared with morphine.

关 键 词：阿片类 结肠肿瘤 血小板 细胞免疫 

分 类 号：R614[医药卫生—麻醉学] R735.35[医药卫生—外科学]