中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2008年
5期
389-392
,共4页
虞建刚%王俊科%郭艳辉%孙新艳
虞建剛%王俊科%郭豔輝%孫新豔
우건강%왕준과%곽염휘%손신염
细胞色素 P450 CYP2D6%多态性,单核苷酸%曲马朵%镇痛,病人控制
細胞色素 P450 CYP2D6%多態性,單覈苷痠%麯馬朵%鎮痛,病人控製
세포색소 P450 CYP2D6%다태성,단핵감산%곡마타%진통,병인공제
Cytochrome P-450 CYP2D6%Polymorphism,singal nucleotide%Tramadol%Analgesia,patient-controlled%Pain,postoperative
目的 探讨细胞色素P450 2D6* 10(CYP2D6* 10)基因多态性对曲马多术后病人自控镇痛(PCA)效果的影响.方法 全麻病人212例,年龄20～64岁,ASA Ⅰ或Ⅱ级.按基因型分为野生型纯合子(w/w)组,杂合子(m/w)组和突变型纯合子(m/m)组.手术结束前30 min静脉注射曲马多1.5mg/kg.清醒时VAS评分＞4分则静脉注射曲马多,若用量超过3 mg/kg则静脉注射芬太尼,至VAS评分≤4分后开始PCA,记录曲马多负荷量.曲马多PCA背景输注速率18 mg/h、16 h后降为12 mg/h、32h后降为9mg/h,PCA剂量22.5mg.记录术后6、12、24及48 h(T1～4)时曲马多累积用量.分别于T1、T3和T4时采用视觉模拟评分法(VAS)评价疼痛程度.于T4后行PCA镇痛效果评价.结果 与w/w组相比,m/m组曲马多负荷量、T1～3时曲马多累积用量均升高,清醒和T1时VAS评分升高(P＜0.05);与m/w组相比,m/m组曲马多负荷量、T3时曲马多累积用量均升高,T1时VAS评分升高(P＜0.05).结论 C YP2D6* 10基因多态性为曲马多术后镇痛药效学个体差异的因素之一.
目的 探討細胞色素P450 2D6* 10(CYP2D6* 10)基因多態性對麯馬多術後病人自控鎮痛(PCA)效果的影響.方法 全痳病人212例,年齡20～64歲,ASA Ⅰ或Ⅱ級.按基因型分為野生型純閤子(w/w)組,雜閤子(m/w)組和突變型純閤子(m/m)組.手術結束前30 min靜脈註射麯馬多1.5mg/kg.清醒時VAS評分＞4分則靜脈註射麯馬多,若用量超過3 mg/kg則靜脈註射芬太尼,至VAS評分≤4分後開始PCA,記錄麯馬多負荷量.麯馬多PCA揹景輸註速率18 mg/h、16 h後降為12 mg/h、32h後降為9mg/h,PCA劑量22.5mg.記錄術後6、12、24及48 h(T1～4)時麯馬多纍積用量.分彆于T1、T3和T4時採用視覺模擬評分法(VAS)評價疼痛程度.于T4後行PCA鎮痛效果評價.結果 與w/w組相比,m/m組麯馬多負荷量、T1～3時麯馬多纍積用量均升高,清醒和T1時VAS評分升高(P＜0.05);與m/w組相比,m/m組麯馬多負荷量、T3時麯馬多纍積用量均升高,T1時VAS評分升高(P＜0.05).結論 C YP2D6* 10基因多態性為麯馬多術後鎮痛藥效學箇體差異的因素之一.
목적 탐토세포색소P450 2D6* 10(CYP2D6* 10)기인다태성대곡마다술후병인자공진통(PCA)효과적영향.방법 전마병인212례,년령20～64세,ASA Ⅰ혹Ⅱ급.안기인형분위야생형순합자(w/w)조,잡합자(m/w)조화돌변형순합자(m/m)조.수술결속전30 min정맥주사곡마다1.5mg/kg.청성시VAS평분＞4분칙정맥주사곡마다,약용량초과3 mg/kg칙정맥주사분태니,지VAS평분≤4분후개시PCA,기록곡마다부하량.곡마다PCA배경수주속솔18 mg/h、16 h후강위12 mg/h、32h후강위9mg/h,PCA제량22.5mg.기록술후6、12、24급48 h(T1～4)시곡마다루적용량.분별우T1、T3화T4시채용시각모의평분법(VAS)평개동통정도.우T4후행PCA진통효과평개.결과 여w/w조상비,m/m조곡마다부하량、T1～3시곡마다루적용량균승고,청성화T1시VAS평분승고(P＜0.05);여m/w조상비,m/m조곡마다부하량、T3시곡마다루적용량균승고,T1시VAS평분승고(P＜0.05).결론 C YP2D6* 10기인다태성위곡마다술후진통약효학개체차이적인소지일.
Objective To investigate the effects of cytochrome P-450 2D6*10 (CYP2D6 10) genetic polymorphism on the postoperative patient-controlled analgesia(PCA)with traraadol.Methods Two hundred and twelve ASA I or Ⅱ patients aged 20-64 yr undergoing elective operation under general anesthesia were assigned to one of 3 groups according to their genotypes:group I.wild homozygote (w/w);groupⅡheterozygote(m/w)and group Ⅱ mutation homozygate (m/m).The patients'pain Was assessed using visual analogue scale(VAS).Each patient received a loading dose of tramadol 1.5 mg/kg at 30 min before the end of surgery.In the recovery room when the patients were awake if VAS score was<4 the patients were given tramadol 30 mg every 10 min until VAS score was decreased to<4.If analgesia remained insufficient when the total dose of tramadol reached 3 mg/kg,fentanyl 50 ug Was administered every 10 min until VAS SCOre≤4.PCA with tramadol Was then started.The background infusion rate of tramadol was 18 mg/h for the 1st 16h,12mg/h for the 2nd 16h and 9mg/h for the 3rd 16 h.The PCA device Was programmed to deliver a bolus dose of tramedol 22.5 mg.The cumulative dose of tramadol was recorded at 6 h(T1),12 h(T2),24 h(T3)and 48 h(T4) after operation.VAS scores were recorded at T1,T3 and T4.The patients were asked to filled in a questionnaire on the patients'evaluation of the effectiveness of PCA they received.Results Two hundred and seven patients completed the study.Their genotypes were w/w 44:m/w 112;m/m 51.The loading dose and the cumulative dose at T1-3 and the VAS seoreg rigt after emergence from general anesthesia and at T1 were significantly higer in m/m group than in w/w group.The loading dose and the cumulative dose at T3 and the VAS scores at Tl were significantly higher in m/m group than in m/w group(P<0.05).There was no significant difference in the VAS seores,at T3 and T4 among the 3 groups.There were no significant differences in the ratio of the patients who were satisfied with the postoperative PCA they received.Conclusion CYP2D6*10 genetic polymorphism is one of the factors contributing to the individual variation in patient's response to postoperative PCA with tramadol.
