ORM1基因多态性对罗库溴铵肌松时效的影响  

Effect of ORM1 genetic polymorphism on time-course of muscle relaxation induced by rocuronium

作　　者：王世萍[1] 郭小文[1] 章放香[2] 张伟晶[1] 

机构地区：[1]浙江省中医院麻醉科,杭州市310002 [2]贵州省人民医院麻醉科,贵阳市550002

出　　处：《中华麻醉学杂志》2016年第10期1236-1239,共4页Chinese Journal of Anesthesiology

基　　金：贵州省优秀省长基金项目（黔省专20100152号）

摘　　要：目的评价ORM1基因多态性对罗库溴铵肌松时效的影响。方法择期全麻妇科腔镜手术患者70例，ASA分级Ⅰ或Ⅱ级，年龄25～55岁，体重指数20～25kg／m2。静脉注射咪达唑仑和芬太尼，靶控输注丙泊酚行麻醉诱导，待患者意识消失后行肌松定标，采用单刺激模式，静脉注射罗库溴铵0．6mg／kg，肌颤搐达最大抑制程度时行气管插管后机械通气，维持PET CO235～45mmHg。记录罗库溴铵起效时间、无反应期、临床作用时间、75％恢复时间和恢复指数。术前采集外周静脉血标本，采用ELISA法测定血浆α1-酸性糖蛋白和C-反应蛋白的浓度，生化法测定白蛋白浓度，应用PCR—RFLP法行ORM1基因分型，根据基因型分为3组：野生纯合子组（AA组）基因型为ORM1＊E1/＊F1、突变杂合子组（AG组）基因型为ORM1＊F1／＊S和突变纯合子组（GG组）基因型为ORM1＊S／＊S。结果AA组40例，AG组25例和GG组5例。3组血浆α1-酸性糖蛋白、白蛋白和C-反应蛋白的浓度差异无统计学意义（P〉0．05）。与AA组比较，AG组和GG组罗库溴铵临床作用时间、75％恢复时间和恢复指数延长（P〈0．05），起效时间和无反应期差异无统计学意义（P〉0．05）。结论ORM1基因多态性是影响罗库溴铵时效个体差异的遗传因素之一。Objective To evaluate the effect of ORM1 genetic polymorphism on the time-course of muscle relaxation induced by rocuronium. Methods Seventy American Society of Anesthesiologists physi- cal status Ⅰ or Ⅱ patients, aged 25-55 yr, scheduled for elective gynecological laparoscopic surgery, with body mass index of 20-25 kg/m2 , were enrolled in this study. Anesthesia was induced with iv midazolam and fentanyl and target-controlled infusion of propofol. After the patients lost consciousness, neuromuscular block was assessed with TOF Wateh-SX using single stimulation of the ulnar nerve. When the maximal twitch depression was achieved, tracheal intubation was facilitated with roeuronium 0.6 mg/kg. The patients were mechanically ventilated. End-tidal carbon dioxide partial pressure was maintained at 35-45 mmHg. The onset time, nonresponse time, clinical duration, 75% recovery time and recovery index of roeuronium were recorded. Peripheral venous blood samples were collected before surgery for determination of concen- trations of plasma alphal acid glycoprotein, C-reactive protein （by enzyme-linked immunosorbent assay） and albumin （by biochemical method）. ORM1 genotypes were detected by polymerase chain reaction-re- striction fragment length polymorphism. The patients were divided into 3 groups according to the ORM1 gen-otypes： wild homozygote （ ORM1＊F1/＊F1 ） group （ AA group）, mutation heterozygote （ORM1＊F1/＊S） group （AG group） and mutation homozygote （ORM1＊S/＊S） group （GG group）. Results There were 40 cases in group AA, 25 cases in group AG, and 5 cases in group GG. There were no significant differences in plasma alphal acid glycoprotein, albumin and C-reactive protein concentrations between the three groups （P〉0.05）. Compared with group AA, the clinical duration, 75% recovery time and recovery index of rocuronium were significantly prolonged （P〈0.05）, and no significant change was found in the onset time and nonresponse time in AG and GG groups （P〉0.05�

关 键 词：血清类黏蛋白 多态性 单核苷酸 雄甾烷醇类 神经肌肉阻滞 剂量效应关系 药物 

分 类 号：R614[医药卫生—麻醉学]