曲马多静脉自控镇痛对胃癌术后血浆TNF-α,IL-2,IL-6水平的影响

The effect of patient-controlled intravenous tramadol analgesia on cytokines in plasma of patients after surgery of gastrointestinal carcinoma

目的 :探讨曲马多静脉自控镇痛对胃癌患者术后血浆的TNF α、IL 2、IL 6影响。方法 :ASAⅠ～Ⅱ级、32例择期胃、贲门癌根治术患者 ,采用静吸复合气管内插管全麻 ,术后患者随机分为二组 (PCIA组 ,对照T组 ,n =32 ) ,检测术前1h、术后 1d、术后 3d、术后 7d血浆TNF α、IL 2、IL 6水平。另取 30例健康成年人的血浆作为正常对照。结果 :两组术前TNF α、IL 2较正常对照显著降低 (P <0 0 1) ,IL 6较正常对照上升明显 (P <0 0 1)。两组IL 2在术后 1d、3d较术前显著降低 (P <0 0 1) ,但两组间无明显差异 (P >0 0 5 )。两组TNF α、IL 2在术后 1d、3d均明显升高 (P <0 0 1) ,T组上升更显著 (P<0 0 1)。结论 :曲马多静脉自控镇痛可减轻患者术后免疫抑制 ,有利于机体恢复。

Objective:To investigate the effect of patient-controlled intravenous analgesia(PCIA) using tramadol on cytokines in plasma of patients after surgery of gastrointestinal carcinoma. Methods:ASA Ⅰ-Ⅱ,32 adult patients undergoing gastrointestinal carcinoma radical operation were randomly divided into two groups: group P received tramadol by PCIA; group T received tramadol intramuscularly on demand, balanced general anesthesia was used in both P and T groups. Blood samples for determination of TNF- α, IL-2, IL-6 level in plasma were taken at lh before operation, 1d, 3d, 7d after operation. In addition, 30 plasma samples from healthy adults were used as control group.Results:TNF-α, IL-2 level in plasma was significantly lower in both P and T group than normal value (P< 0.01) ;but IL-6 level was significantly higher in both P and T groups than normal value (P<0.01). IL-2 level in both P and T groups significantly decreased in ld and 3d after operation (P<0.01). There was no significant difference between P and T group (P>0.05). TNF-α, IL-2 level in both P and T groups significantly increased in 1d and 3d after operation (P<0.01). However, TNF-α and IL-6 level in T group were higher than that in P group(P<0.01).Conclusion:PCIA with tramadol might improve the recovery of immunity function in these patients after radical surgery of gastrointestinal carcinoma.