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目的:比较曲马多、吗啡对食管癌术后患者的镇痛疗效以及对机体免疫功能的影响。方法:将本院50例行食管癌手术患者随机分成对A组和B组,A组接受硬膜外吗啡镇痛,B组接受硬膜外曲马多镇痛,常规监测心电图(ECG)、无创血压(BP)、心率(HR)、血氧饱和度(SPO2)、呼气末二氧化碳分压(PETCO2)。记录两组患者不同时间点视觉模拟疼痛(VAS)评分、不良反应发生率、外周血T淋巴细胞亚群(CD3+、CD4+、CD8+)、NK细胞的变化。结果:两组患者均得到满意的术后镇痛效果,术后1d,A、B两组患者外周血T淋巴细胞亚群、NK细胞的水平较术前降低(P<0.05),且A组降低幅度明显大于B组(P<0.05);术后2d,A组外周血T淋巴细胞亚群、NK细胞的水平虽有所升高,但仍较术前降低(P<0.05),B组CD3+、CD4+、CD8+及NK细胞水平恢复至术前水平;术后3d,A组上述指标恢复至麻醉前水平。结论:曲马多在镇痛的同时对机体外周血T淋巴细胞亚群和NK细胞水平影响较小,减轻了麻醉对细胞免疫功能的抑制效应。
Objective: To compare the analgesic effects of tramadol and morphine on postoperative esophageal cancer patients and their effects on immune function. Methods: Fifty patients undergoing esophageal cancer surgery were randomly divided into group A and group B, group A received epidural morphine analgesia, group B received epidural tramadol analgesia, routine monitoring electrocardiogram (ECG) Noninvasive BP, HR, SPO2 and PETCO2. The VAS scores, the incidence of adverse reactions, the changes of T lymphocyte subsets (CD3 +, CD4 +, CD8 +) and NK cells in the two groups at different time points were recorded. Results: The postoperative analgesic effect was satisfactory in both groups. On the 1st postoperative day, the levels of T lymphocyte subsets and NK cells in peripheral blood of A and B patients were lower than those before operation (P <0.05) (P <0.05). The levels of T lymphocyte subsets and NK cells in peripheral blood of group A increased at 2 days after operation, but were still lower than those before operation in group B (P <0.05) The levels of CD3 +, CD4 +, CD8 + and NK cells returned to their preoperative levels. After 3d, the above indexes in group A returned to pre-anesthesia levels. CONCLUSION: Tramadol has little effect on the level of T lymphocyte subsets and NK cells in the peripheral blood at the same time of analgesia, and alleviates the inhibitory effect of anesthesia on cellular immune function.