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OPRM1A118G多态性对喉癌患者术后舒芬太尼静脉自控镇痛效果的影响
陈思,刘瞾宇,曾毅,马锐,董海龙
0
(解放军第四军医大学西京医院麻醉科)
摘要:
目的 探讨μ阿片受体基因OPRM1A118G多态性对喉癌患者全麻术后舒芬太尼静脉自控镇痛效果的影响。方法 耳鼻喉科择期全麻下行喉癌根治术患者120例,年龄40~70岁,ASA Ⅱ~Ⅲ级。检测OPRM1A118G多态性,根据OPRM1A118G基因型将患者分为野生型纯合子(A/A)、突变型杂合子(A/G)和突变型纯合子(G/G)3组。全麻诱导:靶控输注丙泊酚,初始血浆靶浓度3.0 μg/ml,以0.2 μg/ml的浓度递增,直至患者意识消失。静脉注射舒芬太尼0.2 μg/kg、罗库溴铵0.6 mg/kg。麻醉维持:七氟烷吸入2%~3%,持续泵注瑞芬太尼0.1~0.2 μg/kg·min。通过监测NT值调节七氟烷吸入浓度,维持NT值在40~60之间。术后采用舒芬太尼行静脉自控镇痛,背景输注速率10 ml/h,PCA量04 ml/次,锁定时间15 min,维持VAS评分≤3分为镇痛有效。记录术后24、48 h舒芬太尼消耗量以及药物不良反应(恶心、呕吐、呼吸抑制)发生率。结果 3组患者一般情况差异无统计学意义(P>0.05);术后24、48 h舒芬太尼消耗量3组间差异有统计学意义(P<0.05),G/G组高于A/G组和A/A组,A/G组和A/A组之间差异无统计学意义P>0.05)。结论 OPR1A118G基因多态性是引起喉癌患者术后舒芬太尼静脉镇痛效果差异的遗传因素之一。
关键词:  基因多态性  OPRM1  舒芬太尼  术后镇痛
DOI:
基金项目:国家自然科学基金(81503373)
Effect of OPRM1A118G genetic polymorphism on the postoperative patientcontrolled analgesia with sulfentanil in laryngocarcinoma patients
CHEN Si,LIU Zhaoyu,ZENG Yi,MA Rui,DONG Hailong
(Department of Anesthesiology, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine)
Abstract:
Objective To observe the Effect of OPRM1, A11G genetic polymorphism on the postoperative patient controlled analgesia with sulfentanyl in laryngocarcinoma patients.Methods〓120 patients with American Society of Anesthesiologists (ASA) physical status of Ⅱ or Ⅲ were underwent selective laryngocarcinoma radical surgery with general anesthesia. According to the genotype of OPRM1A118G, the patients were divided into wild homozygote group, heterozygote group and mutation homozygote group. General anesthesia was induced with target controlled infusion of propofol, initial plasma target concentration of 3ug/ml, increased at 0.2ug/ml until the patient's unconscious, following intravenous injection of sulfentanyl 0.2 μg·kg1 and rocuronium 0.6 mg·kg1. Inhaled sevoflurane was at 2%~3%, remifentanil was continuously infused at 0.2 μg·kg1·min1 were used for maintenance of anesthesia. Inhalation concentration of sevoflurane was regulated by monitoring the Narco Trend (NT) value and kept this value between 40-60. Sulfentanyl patient controlled analgesia(PCA) was provided postoperatively for satisfactory anesthesia. The analgesic solution of PCA contained sulfentanyl 100ug and tropisetron 5mg in 100ml of normal saline was programmed to give a 04ml bolus does with a 15min lock out time and background infusion at a rate of 1.0 ml/h maintaining the visual analogue scale(VAS) less than or equal to 3 points is effective for analgesia treatment. The sulfentanyl consumption within 24 and 48 hours after operation and so as the incidence of any adverse reactions were recorded. Results-There was no significant difference in general condition among the three groups.Compared with A/A and A/G groups,the amount of sulfentanil consumed within 24 and 48 hours after operation was significantly increased in G/G group(P<0.05),but there was no significant difference in the amount of sulfentanil consumed within 24 and 48 h after operation between A/A and A/G groups.Conclusions OPRM1,A118G genetic polymorphism is one of the genetic factors contributing to individual variantion in patientcontrolled intravenous analgesia with sulfentanil in the patients undergoing laryngocarcinoma radical surgery.
Key words:  GeneticPolymorphism  OPRM1  Sufentanyl  Postoperativeanalgesia

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