CAJ | 학술논문

目的探讨CYP3A5~*3基因多态性对病人芬太尼镇痛效应的影响.方法择期全麻下行腹式子宫全切术或子宫肌瘤剔除术的病人180例,河南籍,汉族,年龄20～50岁,ASA Ⅰ或Ⅱ级.采用聚合酶链反应-限制性片断长度多态性技术进行CYP3A5~*3多态性位点检测,根据基因型将病人分为野生型纯合子组、突变型杂合子组和突变型纯合子组.病人清醒后行视觉模拟评分(VAS),当VAS评分>3分时,则间断静脉注射芬太尼20 μg,直至VAS评分≤3分时开始病人自控静脉镇痛,维持VAS不超过3分.记录病人自控静脉镇痛24 h内芬太尼的用量.结果 3组病人自控静脉镇痛24 h内芬太尼用量比较差异无统计学意义(P>0.05).结论 CYP3A5~*3基因多态性不是芬太尼静脉镇痛效应个体差异的遗传因素.
목적 탐토CYP3A5~*3기인다태성대병인분태니진통효응적영향.방법 택기전마하행복식자궁전절술혹자궁기류척제술적병인180례,하남적,한족,년령20～50세,ASA Ⅰ혹Ⅱ급.채용취합매련반응-한제성편단장도다태성기술진행CYP3A5~*3다태성위점검측,근거기인형장병인분위야생형순합자조、돌변형잡합자조화돌변형순합자조.병인청성후행시각모의평분(VAS),당VAS평분>3분시,칙간단정맥주사분태니20 μg,직지VAS평분≤3분시개시병인자공정맥진통,유지VAS불초과3분.기록병인자공정맥진통24 h내분태니적용량.결과 3조병인자공정맥진통24 h내분태니용량비교차이무통계학의의(P>0.05).결론 CYP3A5~*3기인다태성불시분태니정맥진통효응개체차이적유전인소.
Objective To investigate the effects of CYP3A5~* 3 genetic polymorphism on analgesia with fentanyl. Methods One hundred and eighty ASA Ⅰ or Ⅱ patients, aged 20-50 yr, Hart nationality, Henan province, scheduled for elective abdominal total hysterectomy or myomectomy under general anesthesia, were enrolled in this study. The polymorphic sites of the CYP3A5~* 3 allele were analyzed by polymerase chain reaction-restriction fragment length polymorphism. The patients were assigned to one of 3 groups according to their genotypes: wild homozygote group, mutation heterozygote group and mutation homozygote group. Midazolam, remifentanyl, propofol and succinylcholine were used for induction of anesthesia. The patients were mechanically ventilated after tracheal intubation. Remifentanyl, propofol and atracurium were given iv for maintenance of anesthesia. The pain was assessed with visual analog scale (VAS) after consciousness was regained. When VAS score > 3, the patients were given fentanyl 20 μg every 5 min until VAS score was decreased to ≤3 and then patient-controlled intravenous analgesia (PCIA) with fentanyl was started. The background infusion rate of fentanyl 1.0 mg and droperidol 5 mg (in 100 ml normal saline) was 0.5 ml/h. The PCIA pump was programmed to give a 2 ml bolus of fentanyl solution with a 5 min lockout interval, 7 time successful delivery per hour and maximum dosage 145 μg/h, and VAS score was maintained less than 3. The amount of fentanyl used within 24 h after surgery was recorded. Results No significant difference was detected in the fentanyl consumption in the 24 h during PCIA among the 3 groups (P> 0.05). Conclusion The genetic polymorphism CYP3 A5~* 3 is not the factor contributing to the individual variation in the patient's response to analgesia with fentanyl.