CAJ | 학술논문

目的评价血管紧张素转换酶多态性对高血压患者气管插管心血管反应的影响.方法择期全麻手术的原发性高血压患者,体重50～ 70 kg,ASA分级Ⅱ或Ⅲ级.根据血管紧张素转换酶(ACE)基因型进行分组:DD基因型组(DD组)、ID基因型组(ID组)和Ⅱ基因型组(Ⅱ组).于诱导前(T0)、气管插管前即刻(T1)、气管插管后即刻(T2)、1.5 min(T3)和5.0 min(T4)时,测定SP、DP和HR,并计算心率收缩压乘积(RPP)；记录心血管事件的发生情况.结果 DD组与ID组各时点SP、DP、HR和RPP差异无统计学意义(P＞0.05)；与DD组及ID组比较,Ⅱ组T2、T3时SP、DP、HR及RPP降低,T4时SP、HR和RPP降低(P ＜0.05),心肌缺血和气管插管心血管反应发生率降低(P＜0.05).结论血管紧张素转换酶基因多态性可影响高血压患者气管插管心血管反应,其中DD基因型和ID基因型影响最大.
목적 평개혈관긴장소전환매다태성대고혈압환자기관삽관심혈관반응적영향.방법 택기전마수술적원발성고혈압환자,체중50～ 70 kg,ASA분급Ⅱ혹Ⅲ급.근거혈관긴장소전환매(ACE)기인형진행분조:DD기인형조(DD조)、ID기인형조(ID조)화Ⅱ기인형조(Ⅱ조).우유도전(T0)、기관삽관전즉각(T1)、기관삽관후즉각(T2)、1.5 min(T3)화5.0 min(T4)시,측정SP、DP화HR,병계산심솔수축압승적(RPP)；기록심혈관사건적발생정황.결과 DD조여ID조각시점SP、DP、HR화RPP차이무통계학의의(P＞0.05)；여DD조급ID조비교,Ⅱ조T2、T3시SP、DP、HR급RPP강저,T4시SP、HR화RPP강저(P ＜0.05),심기결혈화기관삽관심혈관반응발생솔강저(P＜0.05).결론 혈관긴장소전환매기인다태성가영향고혈압환자기관삽관심혈관반응,기중DD기인형화ID기인형영향최대.
Objective To investigate the effect of angiotensin converting enzyme (ACE) genetic polymorphism on the cardiovascular response to endotracheal intubation in patients with hypertension.Methods The patients with primary hypertension,ASA Ⅱ or Ⅲ,aged 54-64 yr,weighing 50-70 kg,scheduled for elective operation under general anesthesia,were enrolled in this study.Polymerase chain reaction-restriction fragment length polymorphism was used to detect the polymorphism of ACE gene.The patients were assigned into 3 groups according to their genotypes:homozygote DD group (group DD),heterozygote ID group (group ID),and homozygote Ⅱ group (group Ⅱ).Systolic blood pressure (SBP),diastolic blood pressure (DBP) and heart rate (HR) were recorded before and after induction of anesthesia,and at 0,1.5 and 5.0 min after intubation (T0-4).The rate-pressure product (RPP) was calculated.The cardiovascular events were recorded.Results In groups DD,ID and Ⅱ,40,39 and 40 cases were included in the analysis respectively.Compared with group ID,there was no significant difference in SBP,DBP,HR and RPP at T0-4 in group DD (P ＞ 0.05).Compared with groups DD and ID,SBP,DBP,HR and RPP were significantly deceased at T2,3,and SBP,HR and RPP were significantly deceased at T4 in group Ⅱ (P ＜ 0.05).The incidences of the myocardial ischemia during intubation and cardiovascular response to intubation were significantly lower in group C than in groups DD and ID (P ＜ 0.05).Conclusion ACE genetic polymorphism exerts an effect on the cardiovascular response to endotracheal intubation in patients with hypertension,and homozygote DD and heterozygote ID have the most influence.