ACE基因多态性对右美托咪定抑制高血压患者气管拔管反应的影响  

Effect of angiotension-converting enzyme gene polymorphism on dexmedetomidine-induced inhibition of responses to extubation in patients with hypertension

作　　者：查文华 王军[4] 丁留成[5] 史荣辉 张力 Zha Wenhua;Wang Jun;Ding Liucheng;Shi Ronghui;Zhang Li(Department of Anesthesiology, People′s Hospital of Lishui, Nanjing 211200, China;Department of Cardiology, People′s Hospital of Lishui, Nanjing 211200, China;Department of Laboratory, People′s Hospital of Lishui, Nanjing 211200, Chin;Department of Anesthesiology, People′s Hospital of Wuxi, Wuxi 214023, China;Department of Urology, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Chin)

机构地区：[1]南京市溧水区人民医院麻醉科,211200 [2]南京市溧水区人民医院心内科,211200 [3]南京市溧水区人民医院检验科,211200 [4]无锡市人民医院麻醉科,214023 [5]南京医科大学第二附属医院泌尿外科,210011

出　　处：《中华麻醉学杂志》2018年第3期312-315,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价血管紧张素转换酶（ACE）基因多态性对右美托咪定抑制高血压患者气管拔管反应的影响。方法选择全麻下行腹部手术的原发性高血压患者180例，年龄50-63岁，体重54-69 kg，ASA分级Ⅱ或Ⅲ级，术前采用RFLP-PCR法测定ACE基因型，并根据是否应用右美托咪定分为6组（n＝30）：DD基因型组（DD组）、ID基因型组（ID组）、Ⅱ基因型组（Ⅱ组）、右美托咪定＋DD基因型组（DEX＋DD组）、右美托咪定＋ID基因型组（DEX＋ID组）和右美托咪定＋Ⅱ基因型组（DEX＋Ⅱ组）。DEX＋DD组、DEX＋ID组和DEX＋Ⅱ组于手术结束前30 min静脉输注右美托咪定0.5 μg·kg^－1·h^－1，直至术毕。于给予右美托咪定前即刻（T1）、给予右美托咪定30 min（T2）、气管拔管后即刻（T3）、气管拔管后1.5、5和15 min（T4-6）时，记录SP、DP、HR和ECG，并计算心率收缩压乘积；记录气管拔管后15 min内心肌缺血和气管拔管反应的发生情况。结果与T1时比较，DD组、ID组和Ⅱ组T3-6时血流动力学各指标升高（P〈0.05），Dex＋DD组、Dex＋ID组和Dex＋Ⅱ组T2-6时血流动力学各指标差异无统计学意义（P〉0.05）；与DD组比较，Dex＋DD组T3-6时血流动力学各指标降低，心肌缺血和气管拔管反应发生率降低（P〈0.05）；与ID组比较，Dex＋ID组T3-6时血流动力学各指标降低，心肌缺血和气管拔管反应发生率降低（P〈0.05）；与II组比较，Dex＋Ⅱ组T3-6时血流动力学各指标和气管拔管反应发生率降低，DD组和ID组T3-6时血流动力学各指标升高，心肌缺血和气管拔管反应发生率升高（P〈0.05）；Dex＋DD组、Dex＋ID组和Dex＋I组间各时点血流动力学各指标、心肌缺血和气管拔管反应发生率比较差异无统计学意义（P〉0.05）。结论ACE基因多态性不会影响右美托咪定抑制高血压患者气管拔管反应。Objective To evaluate the effect of angiotension-converting enzyme （ACE） gene polymorphism on dexmedetomidine-induced inhibition of responses to extubation in the patients with hypertension.Methods A total of 180 patients with primary hypertension, aged 50-63 yr, weighing 54-69 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective abdominal surgery under general anesthesia, in whom ACE genotypes were detected using polymerase chain reaction-restriction fragment length polymorphism, were divided into 6 groups （n=30 each） according to whether dexmedetomidine was applied： DD genotype group （DD group）, ID genotype group （ID group）, Ⅱ genotype group （Ⅱ group）, dexmedetomidine ＋ DD genotype group （DEX＋ DD group）, dexmedetomidine ＋ ID genotype group （DEX＋ ID group） and dexmedetomidine＋ Ⅱ genotype group （DEX＋ Ⅱ group）. Dexmedetomidine 0.5 μg·kg-1·h-1 was intravenously infused starting from 30 min before the end of surgery until the end of surgery in DEX＋ DD, DEX＋ ID and DEX＋ Ⅱ groups.Immediately before infusing dexmedetomidine （T1）, at 30 min of dexmedetomidine infusion （T2）, immediately after extubation （T3） and at 1.5, 5 and 15 min after extubation （T4-6）, systolic blood pressure, diastolic blood pressure, heart rate and ECG were recorded, and rate-pressure product was calculated.The development of myocardial ischemia and responses to extubation was recorded within 15 min after extubation.Results Compared with the baseline at T1, each parameter of hemodynamics was significantly increased at T3-6 in DD, ID and Ⅱ groups （P〈0.05）, and no significant change was found in each parameter of hemodynamics at T2-6 in Dex＋ DD, Dex＋ ID and Dex＋ Ⅱ groups （P〉0.05）. Each parameter of hemodynamics was significantly lower at T3-6, and the incidence of myocardial ischemia and responses to extubation was decreased in group Dex＋ DD than in group DD and in group Dex＋ ID than in group ID （P�

关 键 词：右美托咪啶 肽基二肽酶A 多态性 单核甘酸 高血压 气管拔管反应 

分 类 号：R614[医药卫生—麻醉学]