比较吗啡和氯诺昔康术后镇痛对机体免疫功能的影响

A comparison of effects of postoperative analgesia with morphine or lornoxicam on immunoreaction

目的 比较吗啡和氯诺昔康用于术后镇痛对手术患者免疫功能的影响。方法 36例ASAⅠ～Ⅱ级静脉全麻下行腹腔镜胆囊切除术患者 ,随机分成三组 ,每组 1 2例。Ⅰ组用 0 .0 3%吗啡PCA镇痛 ;Ⅱ组用 0 .0 2 4 %氯诺昔康PCA镇痛 ;Ⅲ组为生理盐水对照组。分别测定诱导前、拔管前、术后 2 4h、术后 72h血浆内毒素、C 反应蛋白 (CRP)、白细胞介素 2 (IL 2 )、白细胞介素 6 (IL 6 )、白细胞介素 1 0 (IL 1 0 )及游离白细胞介素 2受体 (sIL 2R)。结果 内毒素含量各组术后均明显升高 ,组间比较无显著性差异。各组CRP术后均升高 ,但术后 2 4hⅡ组升幅最小 (P <0 .0 5 )。术后 72hⅠ、Ⅱ组IL 2仍降低 (P <0 0 5 ) ,Ⅲ组已恢复 (P >0 0 5 )。术后 2 4hⅠ、Ⅱ组IL 6升幅则较Ⅲ组少(P <0 0 5 )。Ⅱ组L 1 0术后升幅较Ⅰ、Ⅲ组显著 (P <0 0 5 )。术后 2 4hⅠ、Ⅱ组sIL 2R术后升高较Ⅲ组明显 (P <0 0 5 )。结论 氯诺昔康术后镇痛控制炎性应激反应比吗啡有效 ,能较好地维持细胞因子平衡 。

Objective To compare the effects of postoperative analgesia with morphine or lornoxicam on immunoreactions. Methods 36 patients (ASAⅠ Ⅱ)undergoing laparoscopic cholecystectomy were randomly allocated into three groups(with 12 cases each ). PCA with 0 03% morphine was used in GroupⅠ, PCA with 0 024% lornoxicam in GroupⅡ, and Group Ⅲ was given no PCA as a control group. Total intravenous anesthesia was administered. Plasma endotoxin, CRP, sIL 2R, IL 2, IL 6 and IL 10 were measured before anesthesia and extubaion, at postoperative 24h and 72h. Results In all three groups, levels of endotoxin were increased significantly after operation ( P< 0 05) , but no significant difference among groups ( P> 0 05). Compared with the values before anesthesia, levels of CRP were increased significantly in all groups ( P< 0 05). CRP in group Ⅱ was lower than that in the other groups at postoperative 24h. At postoperative 72h,the levels of IL 2 in group Ⅰand Ⅱwere still lower ( P< 0 05),but that of group Ⅲ returned to the normal. At postoperative 24h,the levels of IL 6 in all three groups were increased significantly ( P< 0 05),but that of groupⅢ was higher than those of other groups( P< 0 05) . IL 10 increased significantly in all groups after operation( P< 0 05),but that of groupⅡ was higher than those of other groups ( P< 0 05) . At postoperative 24h,the levels of sIL 2R in all three groups were increased significantly( P< 0 05),but that of groupⅢ was lower than other groups( P< 0 05). Conclusions Postoperative analgesia with lornoxicam is more efficient than morphine in maintaining the balance of pro/anti inflammatory cytokine, alleviating inflammatory stress response and immunology injury.