地佐辛和吗啡对胃肠道肿瘤患者术中免疫功能的影响

目的:比较地佐辛和吗啡对胃肠道肿瘤患者术中T淋巴细胞群和NK细胞数量的影响。方法:60例胃肠道肿瘤行根治手术的患者,随机数字表法随机分为地佐辛(D)组和吗啡(M)组。D组麻醉前肌注地佐辛1 mg·kg^-1,M组麻醉前肌注吗啡1 mg·kg^-1。分别在麻醉前、手术1 h、术毕、术后1 h抽取患者外周静脉血,用流式细胞仪检测T淋巴细胞亚群(CD3⁺、CD3⁺ CD4⁺、CD3⁺ CD8⁺)、活化T细胞(CD3⁺ HLA-DR⁺)和自然杀伤(NK)细胞(CD3^-CD16⁺CD56⁺)数量的变化。术后随访观察、记录2组患者VAS评分及不良反应。结果:2组患者手术1 h时点CD3⁺、CD3⁺ CD4⁺、CD3⁺ CD4⁺/CD3⁺ CD8⁺、CD3⁺ HLA-DR⁺、NK细胞数量较麻醉前相比明显下降,M组各细胞数量在此时点明显低于D组。术毕和术后1 h 2组各细胞数量有所回升,但M组明显低于D组和麻醉前水平。2组患者VSA评分无显著差异(P>0.05)但D组术后不良反应发生率较M组低(P<0.05)。结论:地佐辛对胃肠道肿瘤患者术中T淋巴亚群和NK细胞抑制作用较吗啡小。

Effects of dezocine and morphine on intraoperative immune functions in gastrointestinal cancer patients

OBJECTIVE To observe effects of dezocine and morphine on T lymphocyte cells and natural killer (NK) cells in patients undergoing gastrointestinal cancer surgeries. METHODS Sixty patients undergoing selective gastric cancer surgeries were randomly divided into 2 groups. Patients in dezocine group received dezocine 1 mg kg^-1 intramuscularly before anesthesia and patients in morphine group received morphine 1 mg kg^-1 intramuscularly before anesthesia. CD3⁺, CD3⁺ CD4⁺, CD3⁺ CD8⁺, CD3⁺ CD4⁺/CD3⁺ CD8⁺, CD3⁺ HLA-DR⁺ and NK cells were measured by flow cytometery before anesthesia, 1 h after incision, at the end of operation, and 1 h after surgery. The following items were included for postoperative observation: VAS sore and adverse effects. RESULTS Compared with results before anesthesia, CD3⁺, CD3⁺ CD4⁺, CD3⁺ CD4⁺/CD3⁺ CD8⁺, CD3⁺ HLA-DR⁺ and NK cells were significantly decreased 1 h after incision in two groups (P<0.05). Levels of CD3⁺, CD3⁺ CD4⁺, CD3⁺ CD4⁺/CD3⁺ CD8⁺, CD3⁺ HLA-DR⁺ and NK cells were lower 1 h after incision in morphine group than in dezocine group (P<0.05). Levels of CD3⁺, CD3⁺ CD4⁺, CD3⁺ CD4⁺/CD3⁺ CD8⁺, CD3⁺ HLA-DR⁺ and NK cells were recovered to baseline values in group D rather than in group M at the end of surgery and 1 h after surgery (P<0.05). No significant difference of VAS was found between two groups (P>0.05), but adverse effects were more in morphine group than in dezocine group (P<0.05). CONCLUSION Depressant actions of dezocine is weaker on T lymphocytes subsets and NK cells than those of morphine in gastrointestinal cancer patients during operation.