异丙酚复合麻醉致心室颤动的分子遗传学研究  

Molecular genetic study of ventricular fibrillation induced by propofol combined anesthesia in Chinese population

作　　者：俞建华[1] 胡金柱[1] 邵江华[2] 周慧[1] 刘欣[1] 熊琴梅[1] 周琼琼[1] 刘秀霞 曹青 陈琦[1] 鲍慧慧[1] 程晓曙[1] 洪葵[1,3] 

机构地区：[1]南昌大学第二附属医院心内科,南昌330006 [2]南昌大学第二附属医院普通外科 [3]江西省分子通医学重点实验室

出　　处：《临床心血管病杂志》2013年第11期823-827,共5页Journal of Clinical Cardiology

摘　　要：目的:探讨异丙酚复合麻醉药物致心室颤动(室颤)的分子遗传学机制。方法:收集异丙酚复合麻醉中发生室颤的患者临床资料和外周血标本并进行DNA提取。以DNA直接测序法筛查候选基因SCN5A、SCN1b、SCN3b和GPD1L,若发现基因变异,与200例正常人DNA序列对照以明确基因突变或单核苷酸多态性。分析麻醉药物致室颤的基因改变。结果:共收集到4例患者于应用异丙酚等药物复合麻醉后发生室速/室颤,均成功心肺复苏;其中2例使用利多卡因抢救患者反复除颤5次后才得以维持窦性节律。与基础心电图相比,心肺复苏后ECG表现出PR和QTc延长,其中2例患者表现出Brugada波,1例显示右束支阻滞图形。基因筛查未发现SCN5A、SCN1b、SCN3b和GPD1L基因发生突变;发现4个基因多态性:2个SCN5A基因多态性,为A29A(c.87A>G),exon24+53C>T;2个GPD1L基因多态性,为A155A(c.465C>T),V358V(c.1074G>T)。结论:异丙酚复合麻醉可能导致恶性心律失常,基因筛查未发现异丙酚复合麻醉诱发室颤与SCN5A、SCN1b、SCN3b和GPD1L基因突变有关。麻醉药物诱发室颤患者应慎用钠通道阻滞剂。Objective：To explore the molecular genetic mechanism of ventricular fibrillation induced by propofol combined anesthesia.Method：The clinical data and blood samples of patients experienced ventricular fibrillation during propofol combined anaesthesia were collected in the study.The direct sequencing was applied to screen the mutation of candidate genes including SCN5A,SCN1b,SCN3 band GPD1L.If any gene variation was found,it would be verified as a mutation or a polymorphism by comparison with control population.The clinical feature and association between genotype and phenotype were analyzed and the risk of ventricular fibrillation was evaluated.Result：Four patients occurred ventricular fibrillation during propofol combined anaesthesia,who survived after successful cardiopulmonary resuscitation;2 of them with lidocaine administration experienced five times electric defibrillation before sinus rhythm recovery.Shortly after recovery,EKG presented PR interval and QTc prolongation in four patients,newly Brugada type ECG in 2 and right branch block in 1.No mutation was found in SCN5A,SCN1b,SCN3 band GPD1L.Four gene polymorphisms were found：A29A（c.87AG）and exon 24＋53CT in SCN5A,A155A（c.465CT）and V358V（c.1074GT）in GPD1L.Conclusion：Propofol combined anesthesia may trigger ventricular fibrillation.The direct evidences of the relevance between ventricular fibrillation induced by propofol combined anesthesia and mutation in SCN5A,SCN1bSCN3band GPD1Lgenes are not proved in Chinese patients.Sodium channel blocker may be avoided in this situation.

关 键 词：心室颤动 全身麻醉 Brugada心电图 分子遗传 

分 类 号：R541.7[医药卫生—心血管疾病]