曲马多和吗啡术后镇痛对胃癌手术患者免疫功能的影响

The effects of tramadol and morphine on immune function in gastric cancer surgeries

目的比较曲马多和吗啡术后镇痛对胃癌患者术后镇痛效果及免疫功能的影响。方法择期行胃癌根治术患者40例,ASAⅠ或Ⅱ级,随机均分为硬膜外吗啡镇痛组(Ⅰ组)、静脉吗啡镇痛组(Ⅱ组)、硬膜外曲马多镇痛组(Ⅲ组)和静脉曲马多镇痛组(Ⅳ组)。记录各时点视觉模拟(VAS)评分、术后48 h PCA有效按压次数、胃肠功能恢复时间、镇痛满意度及不良反应发生;同时测定T淋巴细胞亚群(CD3+、CD4+、CD8+)、NK细胞及镇痛期间血清中白细胞介素-2(IL-2)。结果四组患者均达到满意的镇痛效果。与麻醉前比较,术毕、术后1 d四组和术后2 dⅠ、Ⅱ组CD3+、CD4+、CD8+及NK细胞水平明显降低(P<0.05)。与Ⅱ组比较,术后1 dⅠ、Ⅲ、Ⅳ组CD3+、CD4+及NK细胞水平明显升高(P<0.05)。术后2 dⅢ、Ⅳ组恢复至麻醉前水平;术后3 dⅠ、Ⅱ组上述指标恢复至麻醉前水平。与麻醉前比较,术毕、术后1、2 d四组IL-2水平均降低,且Ⅰ、Ⅱ组显著低于Ⅲ、Ⅳ组(P<0.05),术后1 d达最低值后逐渐回升,于术后3 d达麻醉前水平。结论与吗啡比较,曲马多术后镇痛可减轻胃癌患者围术期T淋巴细胞亚群和NK细胞水平下降的程度,减轻术后细胞免疫功能的抑制。

Objective To investigate the effects of tramadol and morphine on immune function in gastric cancer surgeries. Methods Forty ASA Ⅰ or Ⅱ patients, scheduled for selective gastric cancer surgery were divided into four groups. They received postoperative analgesia with epidural morphine （group Ⅰ）, intravenous morphine（group Ⅱ）, epidural tramadol（group Ⅲ）, and intravenous tramadol（group Ⅳ）. Visual analog scale （VAS）, the recovery of gastrointestinal function, patient analgesic satisfaction and the adverse events were recorded. T lymphocyte subsets （CD3 ＋, CD4＋, CD8 ＋）, NK cells and the serum levels of interleukin-2（IL-2） were also detected. Results Postoperative pain was effectively relieved in every group. CD3＋, CD4＋, CD8＋ and NK cells were significantly decreased postoperatively and 1 day after surgery in four groups compared with their baselines. The decrements were decrased significantly in group Ⅰ and Ⅱ 2 days after surgery, but they recovered to the base levels in group Ⅲ and Ⅳ. At 3 day after surgery, CD3＋, CD4＋, CD8 ＋ and NK cells of group Ⅰ and Ⅱ recovered completely. The serum levels of IL-2 were decreased in four groups, reached the minimum on I day after surgery, and recovered to the base levels on 3 days after surgery. Conclusion Compared with morphine, postoperative analgesia with tramadol has a more mild effect on T-lymphocytes subsets and NK cell numbers and thus promotes patients recovery after gastric cancer surgery.