吗啡和曲马多术后镇痛对卵巢癌患者T淋巴细胞亚群及NK细胞影响的比较研究

Morphine and Tramadol on Postoperative Pain in Patients with Ovarian Cancer, T lymphocyte Subsets and NK Cells in the Comparative Research

目的比较吗啡和曲马多硬膜外自控镇痛(PCEA)对卵巢癌患者T淋巴细胞亚群及NK细胞的影响。方法卵巢癌患者40例,均在全麻复合硬膜外麻醉下行卵巢癌根治术,术毕随机分为2组,每组20例,Ⅰ组为曲马多复合罗哌卡因,Ⅱ组为吗啡复合罗哌卡因,分别于麻醉前、手术2h、术后24、48h、术后72h采集外周静脉血测定T淋巴细胞亚群(CD3+、CD4+、CD8+)及NK细胞。结果 2组CD4+、CD4+/CD8+、NK细胞在手术2h降低(P<0.05),CD3+在术后24h降低(P<0.05),术后48hⅡ组上述指标仍较低,而Ⅰ组已恢复至麻醉前水平,2组比较有显著差异(P<0.05),术后72h2组上述指标均恢复至麻醉前水平,2组CD8+术后各时点与麻醉前比较无显著差异(P>0.05)。结论曲马多复合罗哌卡因术后硬膜外自控镇痛(PCEA)对卵巢癌患者T淋巴细胞亚群及NK细胞的影响较吗啡小。

Objective To compare the effects of morphine and tramadol patient--controlled epidural analgesia （PCEA） in patients with ovarian cancer,T lymphocytes and NK cells.Methods 40 patients with ovarian cancer,are in general anesthesia combined with epidural anesthesia for resection of ovarian cancer,of surgery were randomly divided into two groups,n=20. I group tramadol ropivacaine,II group,morphine,ropivacaine,respectively,before anesthesia,surgery 2h,after 24h,48h,72h after collection of peripheral blood T lymphocyte subsets determined （CD3＋,CD4＋,CD8＋） and NK cells.Results There were CD4 ＋,CD4＋/CD8＋,NK cells in surgery 2h lower （P〈0.05）,CD3＋24h after surgery decreased （P〈0.05）,after 48h lI group,these indicators are still low,The group I has been restored to the level before anesthesia,two groups were significantly different （P〈0.05）,72h after the target groups before anesthesia and recovery to the level of CD8 ＋ after the two groups before anesthesia each time point compared with no significant difference （P〉0.05）.Conclusion tramadol epidural ropivacaine analgesia （PCEA） in patients with ovarian cancer,T lymphocytes and NK cells are weaker than morphine.