目前，舒芬太尼已逐步成为椎管内分娩镇痛的推荐药物，在国内外也得到了广泛的应用。但较多文献报道均认为，舒芬太尼在产妇中的应用中存在着较大的个体差异，它的常规应用剂量及浓度就能引起一些产妇出现恶心呕吐、胎心异常及宫缩亢奋等不良反应。有研究指出，芬太尼在产妇镇痛效果上的个体差异性与细胞色素P450 CYP3A4*1G的单核苷酸多态性(SNP)密切相关。舒芬太尼和芬太尼同为CYP3A4*1G酶N-去烃基代谢产物，所以，CYP3A4*1G的SNP也很有可能与舒芬太尼的量效个体差异性间存在着呼应关系。若能以CYP3A4*1G单核苷酸分型为依据，针对不同产妇个性化地应用舒芬太尼，就有可能在提高麻醉镇痛效果的同时，降低用药剂量与副作用，从而最终实现更好地保护新生儿与产妇健康的目的。本文结合近年来国内外已发表的相关文献，综合以上研究就细胞色素P450 CYP3A4*1G多态性对分娩镇痛舒芬太尼个体化用药的影响进行综述。%At present, Sufentanil has become the recommended medicine for labor analgesia and it has been more and more used at home and abroad. However, a number of reports show that there are individual differences of Sulfentanyl when it was used in maternal with concentration and common dosage. It can cause the different incidence of side ef-fects such as nausea, vomiting, fetal heart variability and uterine hyperfunction in different maternal. There is a study which find that single nucleotide polymorphism (SNP) of cytochrome P450 CYP3A4*1G is associated with individual differences of the fentanyl's analgesic effect. Sufentanil and Fentanyl were both metabolised by CYP3A4*1G enzyme with N-dealkylation, so there probably be a relationship between the SNP of CYP3A4*1G and Sufentanil's individual differences for labor analgesia. If it concludes that CYP3A4*1G SNP is associated with the dose-effect of Sufentanil, Sufentanil can be used personalized for different maternal. And then, it is possible to improve the effect of anesthesia analgesic and reduce the dosage and side effects, while finally achieve the purpose of better protection of infant and maternal health. This paper consults the related literatures published at home and abroad in recent years to summarize the effects of the cytochrome P450 enzymes CYP3A4*1G SNP on Sufentanil personalized medicine for labor analgesia.
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