摘要
目的:全膝关节置换后会出现较严重的疼痛症状,应用不同镇痛药物对术后免疫功能有不同影响。实验观察全膝关节置换后应用曲马多和吗啡镇痛对T淋巴细胞亚群的影响。方法:①对象:选择2006-05/2007-05青岛大学医学院附属医院择期行全膝关节置换的患者40例,随机分成两组行自控镇痛:吗啡组和曲马多组,每组20例。②方法:吗啡组镇痛药为0.1%吗啡+0.01%氟哌利多,静脉自控镇痛方法为负荷量0.075mL/kg、持续剂量1mL/h、单次自控镇痛剂量0.5mL、锁定时间10min、每日最大量50mL;曲马多组镇痛药为1%曲马多+0.01%氟哌利多,静脉自控镇痛方法为负荷量0.15mL/kg、持续剂量1mL/h、单次自控镇痛剂量1mL、锁定时间10min、每日最大量70mL。③评估:分别于麻醉前、全膝关节置换后第1,3,5天,采用流式细胞仪技术测定T淋巴细胞亚群(CD3+、CD4+、CD8+)的水平。结果:40例患者均进入结果分析。①吗啡组关节置换后1d与置换前相比,CD3+、CD4+、CD8+均显著性减少(P<0.05),置换后3d有回升趋势,但仍低于置换前,置换后第5天恢复至置换前水平。②曲马多组CD3+、CD4+置换后1d与置换前比差异无显著性意义,置换后3d时高于置换前水平(P<0.05),置换后5d恢复至置换前水平,CD8+置换后各时间点无显著变化。结论:与吗啡相比,曲马多可明显增加CD3+和CD4+数量,从而有可能产生免疫增强作用,更适合用于全膝关节置换后镇痛。
AIM： Severe pains may occur following total knee replacement, and various analgesia drugs may have different effects on the postoperative immune function. This study observed and compared the effects of analgesia with morphine and tramadol on T-lymphocyte subsets after total knee replacement. METHODS： （1）Forty patients undergoing selective total knee replacement were enrolled from the Affiliated Hospital of Qingdao University Medical College between May in 2006 and May in 2007. They were randomly divided into two groups for patient-controlled intravenous analgesia （PCIA）： morphine group （n=20） and tramadol group （n=20）. （2）In morphine group, the analgesia consisted of 0.1% morphine ＋ 0.01% droperidol. PCIA setting： loading dose 0.075 mL/kg, background infusion 1 mL/h, PCIA bolus 0.5 mL, lock-out interval 10 minutes, and 24-hour limit 50 mL; In tramadol group, the analgesia consisted of 1% tramadol ＋ 0.01% droperidol. PCIA setting： loading dose 0.15 mL/kg, background infusion 1 mL/h, PCIA bolus 1 mL, lock-out interval 10 minutes, and 24-hour limit 70 mL. （3）Before anesthesia, and at 1, 3, 5 days after total knee replacement, the levels of T-lymphocyte subsets （CD3^＋, CD4^＋, CD8^＋） were determined by means of flow cytometry. RESULTS： All the 40 patients were involved in the result analysis. （1）In morphine group, the levels of CD3^＋, CD4^＋ and CD8^＋ decreased significantly at 1 day after operation compared with the baseline before operation （P 〈 0.05）, increased at 3 days, and recovered at 5 days. （2）In tramadol group, the levels of CD3^＋ and CD4^＋ didn＇t change at 1 day after operation compared with the baseline, but increased at 3 days （P 〈 0.05）, and recovered at 5 days. There was no remarkable change of CD8^＋ level at each time point after operation. CONCLUSION： Compared with morphine, tramadol can increase CD3^＋ and CD4^＋ levels obviously, thus possibly enhancing immunity. So tramadol is superior for the analgesia after total knee replacement.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第13期2421-2424,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
