地佐辛和吗啡术后镇痛对结直肠癌手术病人T淋巴细胞亚群和NK细胞水平的影响

EFFECTS OF POSTOPERATIVE ANALGESIA WITH DEZOCINE AND MORPHINE ON T-LYMPHOCYTE SUBSETS AND NK CELL IN COLORECTAL CANCER PATIENTS

目的比较地佐辛和吗啡术后镇痛对结直肠癌病人T淋巴细胞亚群及NK细胞水平的影响。方法选择择期全麻下行结直肠癌根治术的病人40例,随机分为吗啡组(M组,n=20)和地佐辛组(D组,n=20)。术毕前10min,D组静脉注射地佐辛0.1mg/kg,M组静脉注射吗啡0.1mg/kg,麻醉清醒后连接病人自控静脉镇痛泵分别行吗啡和地佐辛术后镇痛。术后随访观察、记录两组病人VAS评分及不良反应,并分别于麻醉前(T0)、术后12h(T1)、术后24h(T2)、术后48h(T3)采集静脉血,应用流式细胞仪检测外周T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)及NK细胞水平。结果两组病人各时间点VAS评分无显著性差异(P>0.05)。M组不良反应发生率高于D组(χ2=5.584,P<0.05)。与T0相比,M组病人T1～T3时点CD3+、CD4+、CD4+/CD8+及NK细胞水平明显降低(F=4.968～23.477,P<0.05),D组病人CD3+、CD4+、CD4+/CD8+、NK细胞水平在T1、T2时点明显降低(F=5.948～9.010,P<0.05),在T3点已经恢复至T0水平;D组病人T1～T3时点CD3+、CD4+、CD4+/CD8+及NK细胞水平均高于M组(t=2.154～2.512,P<0.05);两组各时点CD8+水平差异均无显著性(P>0.05)。结论地佐辛术后镇痛对结直肠癌病人T淋巴细胞亚群及NK细胞的抑制作用比吗啡小。

Objective To compare the effects of postoperative analgesia with dezocine and morphine on T lymphocyte subsets and NK ceils in patients with colorectal cancer （CRC）. Methods Forty patients scheduled for selective operation for CRC were equaly randomized to morphine group and dezocine group. At 10min before completion of the operation, intravenous dezocine （0.1 mg/kg） was given to patients in dezocine group, and intravenous morphine （0.1 mg/kg） to those in the morphine group. When the patients awaked from analgesia, a self-control analgesic pump was connected, and postoperative analgesia with dezoeine or morphine was given to them seperately. The following items were included in the postoperatve observation： VAS score and adverse effects, venous blood was collected before anesthesia （TO）, and 12 h （T1）, 24 h （T2） and 48 h （T3） after surge- ry for the detection of the values T-lymphocyte subsets （CD3＋ , CD4＋ , CD8＋ , CD4＋/CD8＋ ） and NK cell activities. Results No significant differences of VAS were found between the two groups （P〈0.05）, but the adverse effects were more in morphine than that in dezocine （χ^2=5. 584,P〈0.05）. Compared with TO, the CD3＋ , CD4＋ , CD4＋/CD8＋ and NK cells at T1 to T3 point in morphine group declined （F=4. 968 23. 477,P〈0.05） ; that in dezocine group at T1 and T2 decreased （F= 5. 948-9. 010, P〈0.05） ,and returned to the baselines at T3. The levels of CD3＋ , CD4＋ , CD4＋/CD8＋ and NK cells at T1 to T3 point in dezo- cine group were higher than that in morphine group （t=2. 154--2. 512,P〈0.05）, but the difference of CDSq- among each time point between the two groups was not significant （P〈0.05）. Conclusion The depressant action of dezoeine on the T-lympho- cyte subsets and NKcells is weaker than that of morphine.