帕瑞昔布联合吗啡术后静脉镇痛对胃癌患者淋巴细胞亚群和自然杀伤细胞活性的影响

Effect of postoperative analgesia with parecoxib combined with morphine on T-lymphocyte subsets and natural killer cells in patients with gastric cancer surgery

目的观察帕瑞昔布联合吗啡术后静脉镇痛对胃癌患者淋巴细胞亚群和自然杀伤细胞(NK细胞)的影响。方法选择胃癌根治术患者40例,随机分为帕瑞昔布联合吗啡镇痛组(PM组,n=20)和吗啡镇痛组(M组,n=20)。两组患者均接受相同的麻醉方法。术毕分别用帕瑞昔布联合吗啡和单纯吗啡行静脉术后镇痛,采用视觉模拟评分法(VAS)镇痛评分评价镇痛效果,并分别于麻醉前、术毕、术后24h及术后48h抽取静脉血,用流式细胞仪检测T淋巴细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+比值及NK细胞(CD16+、CD56+/CD45+)的变化。结果两组患者术后VAS评分比较差异无统计学意义(P>0.05);两组患者CD3+、CD4+淋巴细胞在术毕、术后24h及48h均较麻醉前明显降低(P<0.05),两组患者的NK细胞(CD16+、CD56+/CD45+)、CD4+/CD8+在术毕及术后24h也低于麻醉前(P<0.05)。CD8+在各时点变化差异无统计学意义(P>0.05)。与M组相比,PM组在术后24hNK细胞(CD16+、CD56+/CD45+)、CD3+、CD4+、CD4+/CD8+明显增高(P<0.05);PM组在术后48hNK细胞(CD16+、CD56+/CD45+)、CD4+/CD8+已恢复到麻醉前水平(P>0.05),而M组仍处于较低水平(P<0.05)。结论帕瑞昔布联合吗啡和单纯吗啡术后镇痛都取得良好的镇痛效果,但前者更有利于胃癌患者术后细胞免疫功能的恢复。

Objective To evaluate the effect of postoperative analgesia with parecoxib combined with morphine on T-lymphocyte subsets and natural killer cells in the patients with gastric cancer surgery.Methods Forty patients undergoing gastric cancer surgery were randomly assigned into two groups： group FM and M.All patients were given the same anaesthetic techniques.Then the patients received post-operative analgesia with parecoxib combined with morphine in the group FM after operation but only morphine in the group M.The analgesic effects of three groups were estimated with VAS score after operation in different time points.Blood samples were collected before induction of anaesthesia and at 0h,24h,48h after operation,respectively.The T-lymphocyte subsets and natural killer cells（NK） were measured by flow cytometry.Results There was no significant difference in visual analogue scal（VAS） between the group FM and M.In both groups,the amounts of CD3＋,CD4 ＋lymphocyte were decreased significantly at 0,24,48h after operation than before anaesthesia（P0.05）.the amounts of NK cells（CD16＋,CD56＋/CD45＋） and CD4＋/CD8＋ also were decreased significantly at 0h and 24h after operation than before anaesthesia（P0.05）.The CD8＋ lymphocyte had no difference in every time point（P0.05）.Compared to the group M,the amounts of NK cells（CD16＋,CD56＋/CD45＋）,CD3＋,CD4＋ and CD4＋/CD8＋ were increased significantly at 24h after operation（P0.05）.In the group PM,the amounts of NK cells（CD16＋,CD56＋/CD45＋） and CD4＋/CD8＋ were recovered to preanaesthesic level at 48h（P0.05）,while in the group M,it was still lower than preanaesthesia level（P0.05）.Conclusion Postoperative analgesia with parecoxib combined with morphine or with morphine alone shows a similar postoperative analgesic effect in inpatients undergoing gastric cancer surgery,but the former is more beneficial to recover the cell-immunity of the patients suffering gastric cancer surgery.