曲马多与舒芬太尼术后镇痛对肿瘤手术切除患者NK细胞活力的影响

Effect of tramadol or sufentanil on NK cells activities of cancer patients after tumor surgery excision as patient controlled analgesia.

目的比较使用曲马多或舒芬太尼为肿瘤患者接受手术后实施术后镇痛治疗时对自然杀伤细胞(NK)活力的影响。方法 40例择期实施乳腺恶性肿瘤切除的患者随机分为两组各20例,分别接受曲马多1 000 mg(T组)或舒芬太尼100μg(S组)的术后镇痛治疗,在术后24 h、48 h进行镇痛的VAS评分。分别于术前,术后2 h、12h、24 h、48 h抽取外周血液,测量NK细胞活力,并在两组之间进行比较。结果术后24 h、48 h,S组VAS均低于T组,其中第24小时,两组间差异有统计学意义(P<0.05);两组NK细胞活力在手术后均有下降,其中第2小时下降最为明显,但两组间差异无统计学意义,术后第24小时及48小时,两组间差异有统计学意义,T组恢复速度明显快于S组(P<0.05)。结论曲马多镇痛效果较舒芬太尼稍差,但其对NK细胞活力的抑制作用明显低于舒芬太尼。

Objective To compare the effect of tramadol or sufentanil in immune system of breast cancer patients who received tumor surgery excision, when they were administered with patients controlled analgesia （PCA）. Methods Forty patients scheduled for tumor excision were assigned to two groups randomly, group T and group S, to be administered with tramadol or sufentanil as PCA respectively. VAS data were collected at 24 h and 48 h after surgery. Blood samples were collected before surgery, 2 h, 12 h, 24 h and 48 h after surgery from peripheral veins. Results VAS in group S at 24 h after surgery were significantly lower than that in group T （P〈 0.05）. When it came to 48 h, VAS in group S were still lower than in group T but with no significantly differences. Both of the groups had a significant decreasing activity of NK cells, the recovery speed in group T was significantly higher than that in group S. There were significant difference in group T and group S at 12 h, 24 h and 48 h after surgery. Conclusion The effects of PCA with tramadol are not as good as sufentanil in tumor excision of cancer patients, but suppressions in NK cells activities of Tramadol are significantly lower than that of Sufentanil.