摘要
目的:评估细胞色素P450 2D6*10基因多态性,对汉族人群术后吗啡自控镇痛效果的影响。方法:美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅰ～Ⅱ级患者共64名被纳入此实验,56名患者完成实验。根据CYP2D6基因型,患者分为3组:野生型纯合子组(w/w组,n=19),杂合子组(m/w组,n=21)和突变型纯合子组(m/m组,n=16)。在手术结束前10 min给予复合剂量吗啡(静脉注射,0.1 mg/kg)后,患者可通过吗啡(单次给药1 mg)自控输注泵进行自控镇痛(patient-controlled analgesia,PCA)。全身麻醉诱导后采集血样。采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)进行CYP2D6*10基因分型。记录并比较术后72 h各组间的吗啡用量及视觉模拟评分(visual analogue score,VAS)。结果:与m/m组相比,m/w组吗啡在T0.5～4 h的累积量显著升高(P<0.05)。3组中各时间段的VAS评分对比差异无统计学意义。结论:在全麻术后0.5 h至4 h急性疼痛治疗中,CYP2D6*10 m/w组所需吗啡的量比m/m组高,以此推测m/w组产生的内源性阿片肽比m/m组低。
Objective： To evaluate the effects of cytochrome P-450 2D6＊10 （CYP2D6＊10） genetic polymorphism on the postoperative patient-controlled analgesia with morphine in HAN population. Methods： Totally 64 patients in grades I - II by American Society of Anesthesiologists （ASA） grading were enrolled in this study, among which 56 patients completed the experiment. Patients were categorized into three groups according to the CYP2D6 genotype： wild homozygote （w/w group, n = 19）, heterozygote （m/ w group, n = 21） and mutation homozygote （m/m group, n = 16）. After receiving a loading dose （i.v. 0.1 mg/kg） in 10 min before the end of operation, patients could conduct patient-controlled analgesia （PCA） by self administration of morphine （ one time 1 mg ） via self-controlled infusion pump. Blood samples were collected after induction of general anesthesia. The CYP2D6＊10 genotyping was conducted by means of polymerase chain reaction-based restriction fragment length polymorphism （PCR-RFLP）. The total consumption of morphine and the visual analogue score （VAS） for the three genotype groups within 72 h after the operation were recorded and compared. Results： The cumulative dose of morphine in CYP2D6＊ 10 m/w group was significantly higher than that in the m/m group at T0.5 - 4 h （P 〈 0.05）. There was no significant difference of VAS among three groups within 72 h after the operation. Conclusion： The current results suggested that CYP2D6＊ 10 m/w group appeared to require more morphine in the acute operative period （0.5 - 4 h after operation） compared with CYP2D6＊10 m/m group. One possible mechanism for this observation is that CYP2D6＊10 m/w group may have lower efficiency in synthesizing endogenous opioid peptide compared with CYP2D6＊ 10 m/m group.
出处
《中国疼痛医学杂志》
CAS
CSCD
北大核心
2013年第9期540-544,共5页
Chinese Journal of Pain Medicine
