Effects Of PCIA With Different Analgesics On Function Of Immunocytes, Cytokines, And The Serum Levels Of Heat Shock Protein 70 In Patients Underwent Gastric Cancer Operations

Objective To observe the effects of patient-controlled intravenous analgesia (PCIA) with different analgesics on expression of T-lymphocyte subsets (CD3~+, CD4~+ and CD8~+), Natural-killer cells (CD3~- CD16~+ CD56~+), lymphocyte CD25~+ , cytokines (IL-2, IL-6, IL-10 and sDL-2R) and the serum levels of heat shock protein 70 in patients underwent gastric cancer operations.Methods 45 patients ( ASA Ⅰ ~ Ⅱ ) scheduled for gastric cancer operations under general anesthesia were randomly allocated to three groups. PCIA with lornoxicam was given in group Ⅱ ,PCIA with tramadol was given in both group I and group Ⅲ,with additional treatment of 8mg lornoxicam iv before the induction of anesthesia and at the end of operation in group Ⅲ. The analgesic and sedative efficacy were evaluated by visual analog scale (VAS) and Bruggrmann comfort scale (BCS) after operations.Perioperative immune expression of T-lymphocyte subsets, natural-killer cells, cytokines and the serum levels of HSP70 were measured at five time points: before anesthesia, 90min after incision, 24h, 48h, and 72h after operation.Results (1) There were no statistically significant differences among the three groups with respect to biometric data, duration of surgery, intraoperative fluid administration and requirements for anesthetic drugs. No differences were observed for postoperative complications in all groups. A similar satisfactory analgesic efficacy was seen in all three groups. Total dosage of tramadol of group Ⅲ was 411. 7 ± 8. 4mg, which was significantly lower than that of group Ⅰ (436.2 ± 8. 1mg) within 72 hours ( P<0.01) . (2) Compared with the measurements before anesthesia, the values of CD3~+ were significantly decreased at 90min and 24h after incision in all patients ( P<0.05 ) . The values of CD4~+ were significantly decreased at 90min after incision in group Ⅰ and Ⅱ ( P<0.05 ) . At 90min after incision and 24h after operation, the values of natural-killer cell activities were significantly decreased ( P<0.05 ) in all groups. The values of CD25~+ were almost returned to the baseline in group Ⅲ ( P<0.05 ) at 24h after operation, and were significantly higher than the significantly decreased values of group Ⅰ and Ⅱ ( P<0.05 ). At 48h after operation, all measurements were returned to the baseline in all groups. (3) From 90min after incision, the values of IL-2 were significantly reduced in all patients compared with those beforeanesthesia ( P<0.05 ), and were still lower at 72h after operation in all groups ( P<0.05 ) . The values of sIL-2R were significantly increased in group I and II at 24h after operation ( P<0.05 ), and were significantly higher than that of groupDK P<0.05 ), which were still at the baseline levels( P>0.05 ). The values of IL-6 were significantly elevated in all patients from 24h after operation on, compared with those before anesthesia ( P<0.05 ) . The values of IL-10 were significantly increased in all patients after 24h post-operation compared with those before anesthesia ( P<0.05 ) , except the value of group II at 72h after operation ( P>0.05 ) . (4) The levels of HSP70 on the 90min after incision and on the 24h post operation was significantly higher than that before anesthesia in all three groups. In group ID, the levels of HSP70 on 24h post operation was significantly less than that on the 90min after incision (P<0.05), and than the levels at 24h post operation in group I (P<0.05).Conclusions PCIA with lornoxicam, tramadol, and the combination of both drugs have the same analgesic efficacy. Lornoxicam combinated with tramadol has less effects on the levels of CD25+, HSP70 and IL-2R, and it might be an ideal analgesia model for immunosuppressive patients, such as elder patients or those with carcinoma. The preemptive usage of lornoxicam combined with tramadol needed to be used after operation.