曲马多、吗啡术后自控镇痛对肺癌患者外周血T淋巴细胞亚群的影响比较

Effects of Patient-Controlled Analgesia with Tramadol or Morphine on T-lymph ocyte Subsets in Patients of Lung Cancer after Pneumonectomy

目的:比较曲马多、吗啡术后自控镇痛对肺癌患者行肺叶切除术后外周血T淋巴细胞亚群的影响。方法:20例患者采用美国麻醉医师协会分级法(ASA)分级,均为Ⅰ～Ⅱ级肺癌患者,择期行肺叶切除手术。随机分为曲马多、吗啡术后自控镇痛组。两组患者均接受相同的气管插管静脉复合吸入麻醉。分别于麻醉前、术毕、术后4h、术后24h采取外周静脉血,用流式细胞仪检测T淋巴细胞亚群CD3+、CD4+、CD8+及CD4+/CD8+。结果:两组患者术毕及术后4hCD3+、CD4+、及CD4+/CD8+明显低于术前(P<0.05),术后24h曲马多组虽然仍低于术前值,但已有所恢复,反之吗啡组上述各数值尚未上升。结论:曲马多自控镇痛较吗啡能改善术后细胞免疫抑制。

Objective:To investigate the effects of patient-controlled analge sia with tramadol or morphine on the T-lymphocyte subsets in patients with lung cancer after pneumonectomy. Methods:Twenty ASA Ⅰ-Ⅱgrade patients after pneu monectomy were randomly allocated into two groups,the tramadol group(group T) a nd the morphine group(group M). All the patients were given the identical intrav enous-inhaled anesthesia,and the patient-controlled analgesia with tramadol o r morphine.In group T,loading dose of tramadol was 2 mg·kg-1,maintenance dos e 20 mg·h-1,PCA 20 mg and lockout time 15 min,while in group M,loading dose of morphine was 0.1 mg·kg-1,maintenance dose 1 mg·h-1,PCA 1 mg and lockou t time 15 min.Peripheral blood samples were obtained before anesthesia,and afte r operation 0,4 h and 24 h respectively(T1,T2,T3,T4).The T-lymphocyte subse ts were measured by flow cytometer. Results:In both groups,the amount of CD3+ ,CD4+,and CD4+/CD8+was significantly decreased at T2 and T3 than at T1 (P< 0.05). In group M the amount of CD3+,CD4+,and CD4+/CD8+remained low at T4 ,but in group T the amount of CD3+,CD4+,and CD4+/CD8+was much enhanced at T4 than at T2 (P< 0.05). Conclusion:The immunosuppressive capacity of tramadol was lower than morphine.