在术后镇痛期间，哪种药物引起的免疫抑制最轻——吗啡、曲马多还是曲马多与氯诺昔康联用？

Which has the least immunity depression during postoperative analgesia--morphine, tramadol, or tramadol with lornoxicam?

作者信息

Wang Z Y, Wang C Q, Yang J J, Sun J, Huang Y H, Tang Q F, Qian Y N

机构信息

Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, PR China.

出版信息

Clin Chim Acta. 2006 Jul 15;369(1):40-5. doi: 10.1016/j.cca.2006.01.008. Epub 2006 Feb 17.

DOI:10.1016/j.cca.2006.01.008

PMID:16487501

Abstract

BACKGROUND

Analgesics are commonly used to provide pain relief after surgery. These drugs produce some extended depression of immunity. A prospective randomized controlled trial was designed to observe expressions of T-lymphocyte subsets (CD3(+), CD3(+)CD4(+) and CD3(+)CD8(+)), natural-killer cells (CD3(-)CD16(+)CD56(+)), and activated T-lymphocytes (CD3(+)CD25(+)) of patients undergoing gastric cancer surgeries and receiving patient-controlled intravenous analgesia (PCIA).

METHODS

Forty-five patients undergoing elective gastric cancer surgeries under general anesthesia were randomly allocated into 3 groups. Group I received PCIA using morphine after surgery, group II using tramadol, and group III using tramadol with lornoxicam. The analgesic efficacy was evaluated by visual analog scale (VAS) and Bruggrmann comfort scale (BCS). Expressions of CD3(+), CD3(+)CD4(+), CD3(+)CD8(+), CD3(-)CD16(+)CD56(+), and CD3(+)CD25(+) were measured as percentages of total lymphocytes by flow cytometer at 5 time points.

RESULTS

There was no significant difference in analgesic efficacy and the baselines of CD3(+), CD3(+)CD4(+), CD3(+)CD8(+), CD3(-)CD16(+)CD56(+), and CD3(+)CD25(+) in all groups. Compared with the baseline, CD3(+)CD8(+) had no changes in all groups at any time point. Ninety minutes after incision, CD3(+), CD3(+)CD4(+), CD3(-)CD16(+)CD56(+), and CD3(+)CD25(+) were lower in all groups (P<0.05). 24 h after surgery, CD3(+), CD3(+)CD4(+), CD3(-)CD16(+)CD56(+), and CD3(+)CD25(+) were lower in group I and group II (P<0.05); meanwhile CD3(+), CD3(+)CD4(+), and CD3(+)CD25(+) returned to the baseline but CD3(-)CD16(+)CD56(+) was still low (P<0.05) in group III. 48 h after surgery, CD3(+), CD3(+)CD4(+), CD3(-)CD16(+)CD56(+), and CD3(+)CD25(+) returned to the baseline in group II and group III, but not in group I (P<0.05). 72 h after surgery, CD3(+), CD3(+)CD4(+), CD3(+)CD4(+)/CD3(+)CD8(+) returned to the baseline, but CD3(+)CD25(+) and CD3(-)CD16(+)CD56(+) were still low in group I (P<0.05).

CONCLUSION

PCIA using lornoxicam with tramadol has the same good analgesic efficacy and less immunity depression than PCIA using morphine or tramadol.

摘要

背景

镇痛药常用于术后缓解疼痛。这些药物会导致一定程度的免疫功能延长抑制。一项前瞻性随机对照试验旨在观察接受自控静脉镇痛（PCIA）的胃癌手术患者的T淋巴细胞亚群（CD3(+)、CD3(+)CD4(+)和CD3(+)CD8(+)）、自然杀伤细胞（CD3(-)CD16(+)CD56(+)）及活化T淋巴细胞（CD3(+)CD25(+)）的表达情况。

方法

45例在全身麻醉下接受择期胃癌手术的患者被随机分为3组。I组术后使用吗啡进行PCIA，II组使用曲马多，III组使用曲马多联合氯诺昔康。通过视觉模拟评分法（VAS）和布罗格曼舒适量表（BCS）评估镇痛效果。在5个时间点用流式细胞仪检测CD3(+)、CD3(+)CD4(+)、CD3(+)CD8(+)、CD3(-)CD16(+)CD56(+)和CD3(+)CD25(+)占总淋巴细胞的百分比。

结果

所有组的镇痛效果以及CD3(+)、CD3(+)CD4(+)、CD3(+)CD8(+)、CD3(-)CD16(+)CD56(+)和CD3(+)CD25(+)的基线水平均无显著差异。与基线相比，所有组在任何时间点CD3(+)CD8(+)均无变化。切开后90分钟，所有组的CD3(+)、CD3(+)CD4(+)、CD3(-)CD16(+)CD56(+)和CD3(+)CD25(+)均降低（P<0.05）。术后24小时，I组和II组的CD3(+)、CD3(+)CD4(+)、CD3(-)CD16(+)CD56(+)和CD3(+)CD25(+)降低（P<0.05）；同时，III组的CD3(+)、CD3(+)CD4(+)和CD3(+)CD25(+)恢复至基线水平，但CD3(-)CD16(+)CD56(+)仍较低（P<0.05）。术后48小时，II组和III组的CD3(+)、CD3(+)CD4(+)、CD3(-)CD16(+)CD56(+)和CD3(+)CD25(+)恢复至基线水平，但I组未恢复（P<0.05）。术后72小时，I组的CD3(+)、CD3(+)CD4(+)、CD3(+)CD4(+)/CD3(+)CD8(+)恢复至基线水平，但CD3(+)CD25(+)和CD3(-)CD16(+)CD56(+)仍较低（P<0.05）。