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

摘要

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 car-ried 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 ifrst 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 signiifcant 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 signiifcant 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 re-sponse to analgesia with sufentanil.%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II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II（Ang-II）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-II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*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。