【摘要】 背景与目的:超前镇痛可缓解术后疼痛已得到麻醉学界广泛认可,然而目前尚无超前镇痛对于机体免疫系统影响方面的研究报道。本研究旨在观察氟比洛芬酯和曲马多超前镇痛对乳腺癌患者淋巴细胞计数的影响。方法:将80例按美国麻醉师协会分级为Ⅰ～Ⅱ级,并接受乳腺切除及腋窝淋巴结清扫术的乳腺癌患者随机分为4组(每组20例):氟比洛芬酯组(A组)、曲马多组(B组)、生理盐水对照组(C组)、氟比洛芬酯+曲马多组(D组)。麻醉诱导前15min及手术结束时,A组分别静脉注射氟比洛芬酯1、0.5mg/kg,B组分别静脉注射曲马多1、0.5mg/kg,C组分别静脉注射生理盐水各20ml,D组分别静脉注射氟比洛芬酯0.5mg/kg+曲马多0.5mg/kg、氟比洛芬酯0.25mg/kg+曲马多0.25mg/kg。分别于麻醉诱导前30min(T0)、术后30min(T0.5)、术后4h(T4)、术后24h(T24)采取患者外周静脉血,测定淋巴细胞总数、T细胞亚群(即CD3+、CD4+、CD8+标志细胞数)。结果:A组、D组T4、T24时的CD3+、CD4+、CD8+标志细胞数以及淋巴细胞总数与T0时相比均减少(P<0.05)。B组T0.5、T4、T24时的CD3+、CD4+、CD8+标志细胞数以及淋巴细胞总数与T0时相比均减少(P<0.05),T24时的CD3+、CD4+、CD8+标志细胞数以及淋巴细胞总数与T0.5时相比差异无显著性。C组T0.5、T4、T24时的CD3+、CD4+、CD8+标志细胞数以及淋巴细胞总数与T0时相比均显著减少(P<0.05),T24时的CD3+、CD4+、CD8+标志细胞数以及淋巴细胞总数与T0.5时相比显著减少(P<0.05)。T0.5、T4时,D组的CD3+、CD4+、CD8+标志细胞数以及淋巴细胞总数均高于C组(P<0.05)。结论:氟比洛芬酯和曲马多超前镇痛可以减轻手术及麻醉对于乳腺癌患者免疫功能的抑制,对乳腺癌患者免疫系统具有一定保护作用。更多还原

【Abstract】 Background and purpose:It is widely accepted that pre-emptive analgesia has great effects on alleviation of postoperative pain, while pre-emptive analgesic effect on immune system has not been well studied. In this study, we evaluated the effect of pre-emptive analgesia of flurbiprofen axetil and tramadol on lymphocyte counts in patients of breast cancer. Methods:In this prospective randomized, double-blind, placebo-controlled study, eighty patients were randomly assigned to one of four groups (n=20).Fifteen min before tracheal intubation,the FA group (group A) received iv flurbiprofen axetil 1 mg/kg, the tramadol group (group B) received iv tramadol 1 mg/kg, the control group (group C) received iv saline 20 ml, the combination group (group D) received iv flurbiprofen axetil 0.5 mg/kg and tramadol 0.5 mg/kg. At the end of surgery, the FA group (group A) patients received iv flurbiprofen axetil 0.5 mg/kg, the tramadol group (group B) patients received iv tramadol 0.5 mg/kg, the control group (group C) patients received iv saline 20 ml, the combination group (group D) patients received iv flurbiprofen axetil 0.25 mg/kg and tramadol 0.25 mg/ kg. Peripheral venous blood samples were collected 30 min before tracheal intubation(T0), 30 min postoperatively(T0.5), 4 hrs postoperatively(T4),24 hrs postoperatively(T24) for the determination of CD3+, CD4+, CD8+ and lymphocyte and measured by flow cytometry. Results:The characteristics of the patients in four groups were similar in terms ofage, body mass index (BMI), anesthesia time and operation time. There were no significant differences in CD3+, CD4+, CD8+ and lymphocytes at T0 among four groups. The CD3+, CD4+, CD8+ and lymphocytes decreased at T0.5, T4 , T24 as compared to those at T0 of group C (P<0.05). The CD3+, CD4+, CD8+ and lymphocytes decreased at T4 as compared to those at T0.5 of group C (P<0.05). The CD3+, CD4+, CD8+ and lymphocytes increased at T24 as compared to those at T4 but decreased at T24 than those at T0.5 of group C (P<0.05). The CD3+, CD4+, CD8+ and lymphocytes decreased at T4 , T24 as compared to those at T0 of group A and D (P<0.05). The CD3+, CD4+, CD8+ and lymphocytes decreased at T0.5, T4 , T24 as compared to those at T0 of group B (P<0.05). The CD3+, CD4+, CD8+ and lymphocytes decreased at T4 as compared to those at T0.5 of group B (P<0.05). There were no significant differences in CD3+, CD4+, CD8+ and lymphocytes between T0.5 and T24 of group B. The CD3+, CD4+, CD8+ and lymphocytes of group D were higher than those of group C at T0.5 and T4 (P<0.05). Conclusion:Pre-emptive analgesia of flurbiprofen axetil and tramadol has a positive effect on alleviating immunosuppression induced by surgery and anesthesia, thus it also protects the immune system in patients with breast cancer.更多还原