CYP4A3基因多态性对舒芬太尼用于剖宫产术后镇痛药物用量的影响  

CYP4A3 gene polymorphism of sufentanil for the influence of the dosage of analgesic drugs after cesarean section

作　　者：张海青 刘勇波[2] 徐晓琳[2] 刘英志[2] 

机构地区：[1]青岛市妇女儿童医院麻醉科,山东青岛266000 [2]青岛大学附属医院,山东青岛266000

出　　处：《医药前沿》2015年第24期20-22,共3页Journal of Frontiers of Medicine

摘　　要：目的：评价CYP3A4基因的多态性对舒芬太尼用于中国汉族产妇剖宫产术后镇痛药物用量的影响。方法：选择孕38w～40w,择期行剖宫产，AsAI或II级汉族产妇60名，根据CYP3A4基因型将其分为三组，即突变型纯合子、突变型杂合子、野生型。术前禁饮食，采用硬腰联合麻醉，术后给予静脉舒芬太尼患者自控镇痛（PCIA）。舒芬太尼2．5μg／kg加生理盐水共150ml，负荷量0．1μg／kg，背景输注量2ml／小时，PCA2ml，锁定时间15分钟。记录患者48小时的舒芬太尼总用量、PCA次数及48小时内静息状态下的视觉模拟疼痛评分（VAS）、镇静评分以及恶心、呕吐、瘙痒等不良反应情况。采用双盲法，观察术后镇痛效果、舒芬太尼用药量及PCA次数后再与基因型进行对照，比较三组之间的差别。结果：三组48小时舒芬太尼的总用量以及PCA的次数有明显差异，其中基因型为突变纯合子的产妇舒芬太尼总用量及PCA的次数少于突变杂合子及野生型（P〈0．05），而突变杂合子和野生型之间无明显差异（P〉0．05）。产妇镇痛效果无明显差异。结论：舒芬太尼用于剖宫产产妇术后镇痛，基因型为突变纯合子的产妇总用药量要明显少于突变杂合子及野生型，而镇静及不良反应无明显区别。提示CYP3A4基因多态性可以指导舒芬太尼镇痛时的个体化用药。Objective Evaluation of CYP3A4 gene polymorphism ofsufentanil used in Chinese han nationality women in cesarean section the influence of the dosage of analgesic drugs. Methods Select pregnant 38 w - 40 w, elective cesarean delivery, ASAI or class II han Chinese women 60, according to its CYP3A4 genotype divided into three groups, namely the homozygous mutant, mutant heterozygote, wild type. By double blind method, observe the postoperative analgesic effect, sufentanil dose and number of PCA and genotype again after comparison, comparing the difference between three groups. Results The total amount of three groups of sufentani148 hours and the number of PCA have obvious difference, which the homozygous mutant genotype for maternal sufentanil total amount less than mutation frequency of PCA and heterozygous and wild type （P 〈 0.05）, and the mutant heterozygote and no obvious difference between wild type （P 〉 0.05）. Conclusion Sufentanil for analgesia after cesarean section ChanFuShu, homozygous mutant genotype for much less than maternal total dose of heterozygous mutations and wild type, and no obvious difference between calm and adverse reactions. Prompt CYP3A4 gene polymorphism can guide individualized medication of sufentanil analgesia.

关 键 词：CYP3A4基因 舒芬太尼 硬-腰联合麻醉 剖宫产术 术后镇痛 罗哌卡因 

分 类 号：R453[医药卫生—治疗学]