国际麻醉学与复苏杂志   2011, Issue (6): 31-31
    
吗啡复合氯胺酮治疗顽固性癌痛的免疫调节及其机制探讨
周乃宝, 王凯国, 李浩1()
1.山东省肿瘤医院
Study of cell immunomodulation and its mechanism of morphine associating with ketamine to cure patients’ intractable cancer pain
 全文:
摘要:

背景:顽固性癌痛在所有癌痛患者中约占3%-20%,严重影响患者的生存质量,同时疼痛导致的过度应激会严重降低机体免疫功能。吗啡复合氯胺酮治疗顽固性癌痛在理论上可以减轻患者的免疫抑制,但是目前国内外尚缺乏实验数据的支持。目的:本文初步探讨吗啡复合氯胺酮治疗顽固性癌痛的免疫调节及其机制。内容:吗啡是目前临床使用最广泛的治疗晚期癌痛药物,但吗啡长期大量应用会导致耐受及痛觉过敏,同时它本身也可抑制机体免疫功能。小剂量氯胺酮可拮抗吗啡的这些作用并减少吗啡用量,两者复合有协同或相加作用,通过缓解疼痛减轻机体过度应激来减轻患者的免疫抑制。同时两种药物也可直接作用于免疫细胞的相应受体引起其功能数量的变化,其机制可能与NF-κB、NO、cAMP和cGMP等物质存在密切关系。趋向:本文会为研究吗啡复合氯胺酮对顽固性癌痛患者免疫功能方面的影响提供理论支持。

关键词: 吗啡; 氯胺酮; 顽固性癌痛; 免疫
Abstract:

Background: Patients with intractable cancer pain compose about 3%-20% of those with cancer pain, and the intractable pain degrades patients’ life quality severely. The inordinately stress caused by the acute pain will also degrade immune function severely. Morphine associating with ketamine to cure patients’ intractable cancer pain can academically relieve immune suppression, which is still short of experimental data to support internationally now. Objective:This overview initially investigates the cell immunomodulation and its mechanism of morphine associating with ketamine to cure patients’ intractable cancer pain. Content:Morphine is the most important and most widely-used clinical drug for advanced cancer pain, but long-term and generously applicating morphine will lead to tolerance and hyperalgia, and morphine itself restrains organism immunization. Low-dose ketamine can antagonize thoseeffects of morphine and therefore decrease morphine dosage. Combination of these two drugs will generate synergism and addition effects of relieving immune suppression by relieving pain and excessive stress. At the same time, these two drugs can immediately act on the corresponding receptors of immunocytes and produce changes of function and quality. The mechanisms maybe intimately refer to NF-κB、NO、cAMP and cGMP. Trend:This paper will provide theoretical support for the study of the immunological effects of morphine associating with ketamine for the intractable cancer pain.

Key words: Morphine; Ketamine; Intractable cancer pain; Immunomodulation