细胞色素P450 2D6＊10基因多态性对剖腹术后曲马多自控静脉镇痛的影响  

Effects of CYP2D6 * 10 gene polymorphism on the self-controlled analgesia effect of tramadol in abdominal surgery patients

作　　者：宋春雨[1] 芦树军[1] 常菲菲[1] 刘禹彤[1] 张延卓[1] 王楠[1] 于平[1] 董弘[1] 

机构地区：[1]150081哈尔滨医科大学附属第二医院麻醉科黑龙江省麻醉与危重病学研究重点实验室

出　　处：《临床麻醉学杂志》2014年第1期14-16,共3页Journal of Clinical Anesthesiology

基　　金：黑龙江省教育厅课题(12521271)

摘　　要：目的评价细胞色素P450 2D6*10(CYP2D6*10)基因多态性对剖腹术后曲马多自控静脉镇痛的影响。方法择期剖腹术患者100例,ASAⅠ或Ⅱ级,经肘正中静脉采血2 ml,采用PCR方法进行细胞色素P450 CYP2D6*10基因分型,分为野生型纯合子组(w/w组,n=28),杂合子组(m/w组,n=24)和突变型纯合子组(m/m组,n=42)。手术结束前30 min,静脉注射曲马多100mg、格拉司琼1 mg。清醒后VAS≤4分开始PCA,若VAS>4分追加曲马多50 mg,30 min后VAS≤4分,继续单纯行PCA,若VAS>4分则静脉注射芬太尼50μg,至VAS≤4分继续单纯行PCA,曲马多PCA背景输注速率12 mg/h,PCA剂量15 mg,锁定时间15 min,记录术后2、4、24、48和72 h曲马多累积用量及PCA次数,并行VAS评分。结果术后3 d w/w组、m/w组和m/m组曲马多用量分别为(130±26)mg,(147±44)mg,(157±34)mg,三组差异无统计学意义。与m/m组比较,术后2 h w/w组、m/w组患者VAS评分明显降低(P<0.05)。术后4 h w/w组、m/w组患者自控次数明显减少(P<0.05)。结论 CPY2D6*10基因多态性是影响剖腹术后曲马多自控静脉镇痛遗传因素之一。Objective To evaluate the effects of cytochrome P450 2D6 ＊ 10 （CYP2D6 ＊ 10） gene polymorphism on the self-controlled analgesia effect of tramadol in abdominal surgery patients.Methods One hundred patients undergoing abdominal surgery,ASA Ⅰ or Ⅱ,blood sampling 2 ml was collected from the elbow middle venous,and polymerase chain reaction （PCR） was used to type cytochrome P450 CYP2D6 ＊ 10 gene.Wild type homozygous group （group w/w,n =28）,heterozygote group （group m/w,n=24） and mutant homozygous group （group m/m,n =42） were divided.Tramadol 100 mg and granisetron 1 mg were intravenously given 30 min before the end of the surgery.PCA was performed postoperatively when VAS≤4.Additional tramadol 50 mg was given if VAS〉4 and PCA was performed if VAS≤4 30 min later.Fentanyl 50 μg was intravenously given if VAS〉4.Background infusion rate was 12 mg/h and PCA dose was 15 mg with the lock time of 15 min.The cumulative dose of tramadol and the automatic frequency were recorded 2,4,24,48 and 72 h after the operation.Results The dosages of tramadol in groups w/w,m/w and m/m 3 d after the operation were （130± 26） mg,（147±44） mg and （157± 34） mg,respectively,which was no statistical differences.Compared with group m/m,VAS scores decreased in groups w/w and m/w 2 h after the operation （P〈0.05）,and times of self-control decreased in groups w/w and m/w 4 h after the operation （P〈0.05）.Conclusion CPY2D6 ＊ 10 gene polymorphism is the one of genetic factors influencing the effect of self-controlled analgesia with tramadol in patients undergoing abdominal operation.

关 键 词：细胞色素P450 CYP2D6 基因多态性 曲马多 

分 类 号：R614[医药卫生—麻醉学]