瑞芬太尼术后镇痛对肿瘤患者T淋巴细胞亚群的影响

Effects of PCIA with remifentanil or fentanyl on the distribution of T-lymphocytes in cancer patients

目的观察瑞芬太尼和芬太尼术后镇痛对肿瘤患者T淋巴细胞亚群的影响。方法肿瘤手术患者40例,ASAⅠ或Ⅱ级,随机均分为瑞芬太尼组(R组)和芬太尼组(F组),两组患者均行静-吸复合麻醉。两组术毕分别采用瑞芬太尼或芬太尼行静脉自控镇痛(PCIA),于麻醉前、术后24、48、72 h抽血测定患者T淋巴细胞亚群(CD3+、CD4+、CD8+),并行VAS评分。结果两组患者术后VAS评分差异无统计学意义。术后24 h两组患者CD3+、CD4+、CD4+/CD8+均显著低于麻醉前(P<0.05)。术后48 h R组CD3+、CD4+、CD4+/CD8+已恢复到麻醉前水平,而F组仍明显低于麻醉前和R组(P<0.05)。术后72 h两组T淋巴细胞亚群均恢复至麻醉前水平。结论瑞芬太尼术后静脉自控镇痛能减轻肿瘤患者术后免疫抑制,对机体免疫功能有一定的保护作用。

Objective To investigate the effects of PCIA with remifentanil or fentanyl on the distribution of T-lymphocyte subsets in cancer patients. Methods Forty cancer patients undergoing radical operation were randomly assigned into two groups. The postoperative analgesics were remifentanil （group R） or fentanil （group F）. Peripheral blood samples were obtained before anesthesia, 24, 48, and 72 h after operation. The T-lymphocyte subsets were measured by flow cytometry. The analgesic effect was evaluated by visual analog score. Results There was no significant difference in visual analogue score between group R and F. The amount of CD3＋,CD4＋, CD8＋,CD4＋/CD8＋ lymphocytes significantly decreased 24 h after operation in both groups （P〈 0.05）. In group R the amount of CD3＋ ,CD4＋ ,CD4＋/CD8＋ lymphocytes were recovered nearly to baseline 48 h postoperatively in group R, but in group F it was significantly lower than group R（P〈 0.05）. The whole T cell subsets recovered 72 h postoperatively in both groups. Conclusion Postoperative analgesia with remifentanil can relieve surgery-induced immune depression in cancer patients.