IL-1RN基因多态性对病人芬太尼术后静脉镇痛效力的影响  

Effect of IL-1RN genetic polymorphism on potency of fentanyl for postoperative intravenous analgesia

作　　者：李秀杰[1] 张卫[1] 

机构地区：[1]郑州大学第一附属医院麻醉科,450052

出　　处：《中华麻醉学杂志》2016年第8期961-964,共4页Chinese Journal of Anesthesiology

摘　　要：目的 探讨IL-1RN基因多态性对病人术后芬太尼静脉镇痛效力的影响.方法 择期全麻下行子宫全切术或子宫肌瘤剔除术的病人270例,河南籍,汉族,年龄20～50岁,ASA分级Ⅰ或Ⅱ级.采集外周静脉血样,采用苯酚-氯仿萃取法提取DNA,采用聚合酶链反应和琼脂糖凝胶电泳对IL-1RN基因多态性进行检验.根据基因型将病人分为5组：IL-1RN Ⅰ/Ⅰ野生纯合子组（Ⅰ/Ⅰ组）、IL-1RN Ⅰ/Ⅱ突变杂合子组（Ⅰ/Ⅱ组）、IL-1RN Ⅱ/Ⅱ突变纯合子组（Ⅱ/Ⅱ组）、IL-1RN Ⅰ/Ⅲ突变杂合子组（Ⅰ/Ⅲ组）和IL-1RN Ⅰ/Ⅳ突变杂合子组（Ⅰ/Ⅳ组）.病人苏醒后进行VAS评分,当VAS评分＞3分时,每隔5 min静脉注射芬太尼20 μg,直至VAS评分≤3分时开始PCIA,PCIA药物配方：芬太尼1.0 mg和氟哌利多5 mg,用生理盐水稀释至100 ml,背景输注速率0.5 ml/h,PCA剂量2 ml,锁定时间5 min,维持VAS评分≤3分;记录PCIA开始后24 h内芬太尼用量.结果 224例病人完成基因分型,Ⅰ/Ⅰ组210例,Ⅰ/Ⅱ组6例,Ⅱ/Ⅱ组4例,Ⅰ/Ⅲ组3例,Ⅰ/Ⅳ组1例（未纳入统计）.4组PCIA开始后24h内芬太尼用量差异无统计学意义（P＞0.05）.结论 IL-1RN基因多态性与病人芬太尼术后静脉镇痛效力个体差异的遗传因素无明显关系.Objective To investigate the effect of IL-1RN genetic polymorphism on the potency of fentanyl for postoperative intravenous analgesia.Methods Two hundred and seventy patients of Han nationality （native of Henan province）,aged 20-50 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective abdominal total hysterectomy or myomectomy under general anesthesia,were enrolled in this study.Blood samples were taken from the peripheral vein for DNA extraction using phenol chloroform extracting method,and polymerase chain reaction and agarose gel electrophoresis were used for IL-1RN genotying.The patients were assigned to one of 5 groups according to their genotypes：IL-1RN Ⅰ/Ⅰ wild homozygote group （group Ⅰ /Ⅰ）,IL-1RN Ⅰ/Ⅱ mutation heterozygote group （group Ⅰ /Ⅱ）,IL-1RN Ⅱ/Ⅱ mutation homozygote group （group Ⅱ /Ⅱ）,IL-1RN Ⅰ/Ⅲ mutation heterozygote group （group Ⅰ /Ⅲ）,and IL-1RN Ⅰ/Ⅳ mutation heterozygote group （group Ⅰ/Ⅳ）.Pain was assessed using visual analogue scale （VAS） score after the patients recovered from anesthesia.When VAS score〉3,the patients were given fentanyl 20 μg every 5 min until VAS score decreased to ≤ 3.Patient-controlled intravenous analgesia （PCIA） with fentanyl was then started.The PCIA solution contained fentanyl 1.0 mg and droperidol 5 mg in 100 ml of normal saline.The PCA pump was set to deliver a background infusion of 0.5 ml/h and a bolus dose of 2 ml at 5 min lockout interval.The VAS score was maintained ≤ 3.The amount of fentanyl consumed within 24 h of PCIA was recorded.Results A total of 224 patients were genotyped successfully.Among the 224 patients,there were 210 cases in group Ⅰ /Ⅰ,6 cases in group Ⅰ /Ⅱ,4 cases in group Ⅱ/Ⅱ,3 cases in group Ⅰ/Ⅲ,and 1 case in group Ⅰ/Ⅳ （excluded）.There was no significant difference in the amount of fentanyl consumed within 24 h of PCIA among the four groups （P〉0.05）.Conclusion IL-1RN genetic polymorphism is not related to

关 键 词：受体 白细胞介素1 多态性 单核苷酸 芬太尼 镇痛 剂量效应关系 药物 

分 类 号：R614[医药卫生—麻醉学]