COMTVal158Met基因多态性对胃癌患者术前疼痛敏感性及术后芬太尼镇痛用量无影响  

No relationship of COMT Val 158 Met with pain sensitivity and fentanyl requirement after gastriccancer operation in humans

作　　者：文玲玲[1] 廖琴[2] 李莉[2] 王懿春[1] 

机构地区：[1]湖南省肿瘤医院重症监护室,长沙市410013 [2]中南大学湘雅第三医院麻醉科

出　　处：《实用疼痛学杂志》2015年第4期246-251,共6页Pain Clinic Journal

摘　　要：目的探讨儿茶酚-O-甲基转移酶（COMT）Val158Met对术前疼痛敏感性以及术后芬太尼镇痛剂量之间的关系。方法全麻下拟行胃癌根治术的患者130例，术前1h用电化学刺激和缺血刺激测量患者的痛阈和耐受阈；术中抽取患者静脉血检测COMTVal158Met基因型，术后使用芬太尼静脉自控镇痛（PCIA）控制术后视觉模拟评分（VAS）〈3。观察术后24、48h芬太尼的用量以及不良反应；按照COMTVal158Met基因型将患者分为Met／Met，Val／Met，Val／Val3组。结果术前的痛阈、耐受阈以及术后24、48h芬太尼用量3组间比较均无统计学差异；术前痛阈与术后24、48h芬太尼用量无相关性（P〉0．05）。结论COMTVal158Met多态性不能解释人体对电化学刺激和缺血刺激的疼痛敏感性及术后24、48h芬太尼镇痛用量的个体间的差异性；术前电化学刺激和缺血刺激的痛阈不能预测术后24、48h镇痛药芬太尼的用量。Objective To detect the relationship between COMT Val 158 Met and preoperative pain sensitivity and fentanyl requirement for postoperative analgesia. Methods Pain threshold and pain tolerance in one hundred and thirty patients scheduled for radical gastreetomy under general anesthesia were measured at one hour before surgery. Patientcontrolled intravenous analgesia was provided postoperatively and fentanyl con- sumption and side effects were observed. Subjects were divided into three groups according to the COMT Va｜ 158 Met genotype. Results There was no significant difference in pain threshold and tolerance before opera- tion and in fentanyl dose at the first 24 h and 48 h postoperatively among the different genotypes of COMT Val 158 Met （P〉 0.05）; there was no correlation between sensory threshold and pain threshold and fentanyl de- mand at the first 24 h and 48 h postoperatively for analgesia （P〉 0.05）. Conclusion The difference of pain sensitivity to ischemic and electro-chemical stimuli and fentanyl demand for postoperative analgesia could not be explained by COMT Val 158 Met genotype; both pain threshold to electrochemical stimuli and sensory threshold to ischemic stimuli could not predict fentanyl requirement at the first 24 h and 48 h postoperatively for analgesia.

关 键 词：儿茶酚-O-甲基转移酶 Val 158 MET 基因 疼痛敏感性 芬太尼 镇痛 

分 类 号：R644[医药卫生—外科学]