μ受体基因118A→G突变对芬太尼椎管内镇痛作用的影响  

Human μ-opioid receptor A118G polymorphism affects epidural patient-controlled analgesia with fentanyl

作　　者：张双全[1] 李少英[2] 谭秀华[1] 

机构地区：[1]广州医学院第三附属医院麻醉科,广东广州510150 [2]广州医学院第三附属医院妇产科研究所,广东广州510150

出　　处：《南方医科大学学报》2013年第2期309-311,共3页Journal of Southern Medical University

基　　金：广东省科技计划项目(2009B030801351)

摘　　要：目的研究μ受体基因(OPRM1)A118G单核苷酸多态对剖宫产术后硬膜外腔芬太尼镇痛作用的影响。方法选择广州医学院第三附属医院ASAⅠ-Ⅱ级,拟在腰硬联合麻醉下行剖宫产的孕产妇100例,术后行硬膜外腔芬太尼自控镇痛。抽取产妇静脉血,应用PCR-RFLP法,根据OPRM1外显子1第118位点处的碱基情况判定产妇基因型,AA型为野生型,GG型为突变型,AG型为杂合型,根据基因型将产妇分为3组即AA组、AG组、GG组。观察术后疼痛视觉模拟评分(VAS评分)、镇痛期间恶呕记录和48 h芬太尼总用量。结果最终96名产妇完成研究,各种基因型所占比例为GG(16,16.7%),AA(35,36.5%),AG(45,46.9%)。术后12、24 h两个时点的VAS评分,GG组要明显高于AA组和AG组(P<0.05);术后镇痛芬太尼总用量,GG组亦明显高于AA组和AG组(P<0.05)。结论 OPRM1 A118G单核苷酸多态影响芬太尼硬膜外腔镇痛效果,GG型镇痛效果明显弱于AA型和AG型;达到同样镇痛效果,GG型需要更大剂量的芬太尼。Objective To investigate whether A118G single nucleotide polymorphisms of the μ-opioid receptor （OPRM1） affects epidural patient-controlled analgesia with fentanyl after caesarian section. Methods A total of 100 pregnant women （ASA class Ⅰ or Ⅱ） scheduled for elective caesarian section were enrolled in this study. All the patients received spinal-epidural anesthesia and were screened for blood A118G polymorphism. Epidural patient-controlled analgesia with fentanyl was provided postoperatively. The pain scores, incidence of nausea and vomiting, and total self-administered epidural fentanyl dose within 48 h postoperatively were recorded. Results Ninety-six patients were finally included in this study. The percentages of the genotypes AA, AG, and GG were 36.5% （35 cases）, 46.9% （45 cases）, and 16.7% （16 cases）, respectively. At 12 and 24 h postoperatively, the pain scores and the total fentanyl dose administered were significantly higher in group GG than in groups AA and AG. Conclusion A118G single nucleotide polymorphism affects pain relief and total fentanyl dose administered in epidural patient-controlled analgesia after caesarian section. Gl18 homozygotes have a poorer response to fentanyl than Al18 homozygotes or heterzygotes.

关 键 词：芬太尼 Μ受体 单核苷酸多态性 

分 类 号：R614[医药卫生—麻醉学]