持续鞘内注射吗啡镇痛对重度癌痛患者的疗效及细胞免疫功能的影响

Effects of continuous intrathecal morphine analgesia on severe cancer pain and cellular immune function in patients with different cancers

目的 探讨持续鞘内注射吗啡镇痛对重度癌痛患者的镇痛疗效和细胞免疫功能的影响.方法 重度癌症疼痛患者40例,疼痛评分(NRS)＞6,随机分为鞘内组和常规组,每组20例.鞘内组接受皮下药物泵持续鞘内注射吗啡镇痛;常规组接受常规途径吗啡镇痛.于镇痛前(T0)及镇痛后1日(T1)、7日(T2)、15日(T3)及30日(T4)时记录两组患者T淋巴细胞亚群和NK细胞水平及NRS评分;并统计吗啡日均用量及不良反应.结果 T0、T2时,两组患者CD3-、CD4-、CD8-、CD4+/CD8+和NK细胞百分比差异无统计学意义(P＞ 0.05);T1时,鞘内组CD3-、CD4+、CD4+/CD8+和NK细胞低于常规组(P＜0.05);T3、T4时,鞘内组CD3+、CD4+/CD4+/CD8+和NK细胞水平高于常规组(P＜ 0.05);T4时,鞘内组CD8+值低于常规组(P＜0.05).两组患者各时点NRS评分差异无统计学意义(P＞0.05);鞘内组患者不良反应发生率低于常规组(P＜0.05).结论 持续鞘内注射吗啡镇痛对重度癌痛患者可有效镇痛,并可改善细胞免疫功能,不良反应少.

Objective To explore the effects of continuous intrathecal morphine analgesia on severe cancer pain and cellular immune function in patients with different cancers.Methods Forty patients with severe cancer pain,NRS ＞ 6,were randomly divided into two groups,intratbecal group and routine group,20 cases in each group.Patients in intrathecal group were treated with continuous intrathecal morphine analgesia,while routine group with routine morphine analgesia.The counts of T lymphocyte suhsets and NK cells,and NRS were measured before intrathecal injection (T0) and at 1 day(T1),7 days (T2),15 days(T3),and 30 days(T4) after analgesia.The amount of daily morphine,the incidence of adverse reactions were recorded.Results No statistical differences were found in peripheral T lymphocyte subsets(CD3+,CD4+,CD8+,CD4+/CD8+) and NK cell connts between the two groups at T0,T2 (P ＞ 0.05).While the above indicators in intrathecal group were significantly lower than those in routine group at T1 (P＜ 0.05).The cell percentages of T lymphocyte subsets CD3+,CD4+,CD4+/CD8+and NK cells in intrathecal group were significantly higher than those in routine group at T3 and T4(P＜ 0.05);while the cell percentage of T lymphocyte subsets CD8-was lower in the intrathecal group at T4 (P ＜ 0.05).There were no statistical differences in N R S between the two groups at each time point (P ＞ 0.05).The incidence of adverse reaction was significantly lower in the intrathecal group than that in routine group (P ＜ 0.05).Conclusion Continuous intrathecal morphine analgesia can effectively relieve the severe cancer pain,improve cell immune function,with less adverse reactions.