MDR1基因多态性对罗库溴铵肌松效应的影响  

Effect of MDR1 gene polymorphisms on neuromuscular block of rocuronium

作　　者：梅杨[1] 何才 李有长[1] 段开明[2] 汪赛赢[2] 

机构地区：[1]重庆市妇幼保健院手术麻醉科,400000 [2]中南大学湘雅三医院麻醉科,长沙市410013

出　　处：《中华麻醉学杂志》2017年第10期1243-1246,共4页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金（81302852）

摘　　要：目的 评价MDR1基因多态性对罗库溴铵肌松效应的影响.方法 择期全麻妇科腹腔镜手术患者135例,年龄18～50岁,BMI 18～25 kg∕m^2,ASA分级Ⅰ或Ⅱ级.麻醉诱导：静脉注射咪达唑仑0.06 mg∕kg、舒芬太尼0.7 μg∕kg、丙泊酚（血浆靶浓度6 μg∕ml）和瑞芬太尼（血浆靶浓度6 ng∕ml）,意识消失后启用TOF-Watch SX型加速度肌松监测仪,静脉注射罗库溴铵0.6 mg∕kg.麻醉维持：靶控输注丙泊酚（血浆靶浓度3～5 μg∕ml）和瑞芬太尼（血浆靶浓度3～6 ng∕ml）.T1恢复至基础值的25%时追加罗库溴铵0.15 mg∕kg.记录罗库溴铵的起效时间、诱导剂量的维持时间、追加剂量的维持时间和恢复指数.诱导前采集外周静脉血2 ml,采用PCR-RFLP法进行MDR11236 C〉T和3435 C〉T基因型分析.结果 MDR11236 C〉T基因型中,MDR11236 CC基因型患者19例,MDR11236 TT基因型患者72例,MDR11236 CT基因型患者44例.与MDR11236 CC基因型患者相比,MDR11236 TT和CT基因型的患者罗库溴铵诱导剂量的维持时间、追加剂量的维持时间及恢复指数延长（P〈0.05）.MDR13435 C〉T基因型中,MDR13435 CC患者58例,MDR13435 TT患者55例,MDR13435 TC患者22例.MDR13435 C〉T不同基因型患者,罗库溴铵诱导剂量的维持时间、追加剂量的维持时间及恢复指数差异无统计学意义（P〉0.05）.结论 MDR11236 C〉T基因多态性可影响罗库溴铵的肌松效应,遗传因素可能是导致肌松药药效个体差异的原因之一.Objective To evaluate the effect of MDR1 gene polymorphisms on the neuromuscular block of rocuronium. Methods One hundred thirty-five patients, aged 18-50 yr, with body mass index of 18-25 kg∕m^2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing gynecologic laparoscopic operation under general anesthesia, were enrolled in the study. Anesthesia was induced with midazolam 006 mg∕kg, sufentanil 07 μg∕kg, propofol（target plasma concentration 6 μg∕ml）and remifentanil（target plasma concentration 6 ng∕ml）. After the patients lost consciousness, neuromuscular block was assessed with TOF-Watch SX accelerometer, and rocuronium 06 mg∕kg was intravenously injec-ted. Anesthesia was maintained by target-controlled infusion of propofol（target plasma concentration 3-5 μg∕ml）and remifentanil（target plasma concentration 3-6 ng∕ml）. Rocuronium 015 mg∕kg was added when T1reached 25% of control. The onset time of rocuronium, maintenance time of induction dose, main-tenance time of additional dose and recovery index were recorded. Peripheral venous blood samples were collected for MDR1 genotype（MDR1 1236 C〉T and 3435 C〉T）analysis using polymerase chain reaction-restriction fragment length polymorphism. Results For MDR1 1236 C〉T genotype, there were 19 cases of MDR1 1236 CC genotype, 72 cases of MDR1 1236 TT genotype, 44 cases of MDR1 1236 CT genotype. Compared with patients of MDR1 1236 CC, the maintenance time of induction dose, maintenance time of additional dose and recovery index were significantly prolonged in patients of MDR1 1236 TT and CT geno-types（P〈0.05）. For MDR1 3435 C〉T genotype, there were 58 cases of MDR1 3435 CC genotype, 55 cases of MDR1 3435 TT genotype, 22 cases of MDR1 3435 TC genotype. There was no significant differ-ence in maintenance time of induction dose, maintenance time of additional dose and recovery index among patients of different MDR1 3435 C〉T genotypes（P〉0.05）. Conclusion MDR1 1236 C〉T gene poly-morphisms

关 键 词：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]