摘要
目的：探讨CYP3A4＊1G基因多态性对下腹部手术患者舒芬太尼镇痛效果的影响。方法：选取择期全身麻醉下行下腹部手术的患者120例,年龄20~65岁,ASA I级或I级,接受术后患者自控镇痛（PCA）。采用焦磷酸测序法检测CYP3A4＊1G基因多态性,根据基因型将患者分成野生型纯合子（＊1/＊1）组、突变型杂合子（＊1/＊1G）组和突变型纯合子（＊1G/＊1G）组。于麻醉诱导前（T0）、气管插管后1 min（T1）、切皮时（T2）、拔气管导管时（T3）和拔管5 min后（T4）各时间点抽取非静脉输液侧肘静脉血,测定血浆皮质醇（Cor）和血管紧张素I（Ang-I）值,并监测患者平均动脉压（MAP）、心率（HR）。记录患者静脉PCA（PCIA）24 h内舒芬太尼的消耗量和药物不良反应（术后恶心、呕吐、呼吸抑制）。结果：1＊1G/＊1G组T1、T2和T3时的MAP、HR、Cor,Ang-I均低于＊1/＊1组和＊1/＊1G组（P〈0.05）;②3组患者术后VAS的比较差异无统计学意义（P〉0.05）,而达到相同的镇痛效果①＊1G/＊1G组患者消耗的PCIA舒芬太尼量为（49.8±10.2）μg,与＊1/＊1组（64.6±10.9）μg和＊1/＊1G组（62.5±12.7）μg相比均减少（P〈0.01）,＊1/＊1G组和＊1/＊1组该指标差异无统计学意义（P〉0.05）。结论：CYP3A4＊1G基因多态性是引起舒芬太尼药效学个体差异的遗传因素之一。
Objective： To investigate the effects of CYP3A4＊1G genetic polymorphism on analgesia with sufentanil in lower abdominal surgery. Methods： One hundred and twenty patients with ASA Ⅰ or Ⅱ, aged 20-65 years who underwent elective lower abdominal surgery under general anesthesia were recruited into this study. Patient-controlled analgesia（PCA） treatment was given after operation. Genotyping of CYP3A4＊1G was carried out by pyrosequencing. The patients were assigned into 3 groups according to their genotypes： group I wild homozygote, group Ⅱ mutation heterozygote and group Ⅲ mutation homozygote. MAP and HR were monitored before induction of general anesthesia（T0）, after intubation 1 min（T1）, at skin incision（T2） and extubation（T3）, and at 5 min after extubation（T4）. Plasma cortisol（Cor） and angiotension Ⅱ（Ang-Ⅱ） were measured as well. PCA sufentanil consumption and adverse effects were recorded during the fi rst 24 h after surgery. Results： 1MAP, HR, Cor and Ang-Ⅱ at T1, T2 and T3 were lower in group I than those in group Ⅱ and Ⅲ（P〈0.05）. 2No signifi cant differences in the scores of VAS were noted between the three groups（P〈0.05）. While similar degrees of pain control was achieved, patients in the ＊1G/＊1G group（49.8±10.2） μg consumed significantly less sufentanil than that in either the wild-type group（64.6±10.9） μg or the ＊1/＊1G group（62.5±12.7） μg（P〈0.01）. But there was no signifi cant difference in this index between group Ⅱ and Ⅲ（P〈0.05）. Conclusion： CYP3A4＊1G genetic polymorphism is one of the factors contributing to the individual variation in patient＇s response to analgesia with sufentanil.
出处
《温州医科大学学报》
CAS
2016年第4期258-262,共5页
Journal of Wenzhou Medical University
基金
温州市科技局科研基金资助项目(Y20140115)
