CAJ | 학술논문

目的：评价C Y P3A4基因的多态性对舒芬太尼用于中国汉族产妇剖宫产术后镇痛药物用量的影响。方法：选择孕38w-40w,择期行剖宫产，ASAI或II级汉族产妇60名，根据CYP3A4基因型将其分为三组，即突变型纯合子、突变型杂合子、野生型。术前禁饮食，采用硬腰联合麻醉，术后给予静脉舒芬太尼患者自控镇痛（PCIA）。舒芬太尼2.5μg/kg加生理盐水共150ml,负荷量0.1μg/kg,背景输注量2ml/小时,PCA2ml,锁定时间15分钟。记录患者48小时的舒芬太尼总用量、PCA次数及48小时内静息状态下的视觉模拟疼痛评分（VAS）、镇静评分以及恶心、呕吐、瘙痒等不良反应情况。采用双盲法，观察术后镇痛效果、舒芬太尼用药量及PCA次数后再与基因型进行对照，比较三组之间的差别。结果：三组48小时舒芬太尼的总用量以及P C A的次数有明显差异，其中基因型为突变纯合子的产妇舒芬太尼总用量及PCA的次数少于突变杂合子及野生型（P＜0.05），而突变杂合子和野生型之间无明显差异（P＞0.05）。产妇镇痛效果无明显差异。结论：舒芬太尼用于剖宫产产妇术后镇痛，基因型为突变纯合子的产妇总用药量要明显少于突变杂合子及野生型，而镇静及不良反应无明显区别。提示CYP3A4基因多态性可以指导舒芬太尼镇痛时的个体化用药。
목적：평개C Y P3A4기인적다태성대서분태니용우중국한족산부부궁산술후진통약물용량적영향。방법：선택잉38w-40w,택기행부궁산，ASAI혹II급한족산부60명，근거CYP3A4기인형장기분위삼조，즉돌변형순합자、돌변형잡합자、야생형。술전금음식，채용경요연합마취，술후급여정맥서분태니환자자공진통（PCIA）。서분태니2.5μg/kg가생리염수공150ml,부하량0.1μg/kg,배경수주량2ml/소시,PCA2ml,쇄정시간15분종。기록환자48소시적서분태니총용량、PCA차수급48소시내정식상태하적시각모의동통평분（VAS）、진정평분이급악심、구토、소양등불량반응정황。채용쌍맹법，관찰술후진통효과、서분태니용약량급PCA차수후재여기인형진행대조，비교삼조지간적차별。결과：삼조48소시서분태니적총용량이급P C A적차수유명현차이，기중기인형위돌변순합자적산부서분태니총용량급PCA적차수소우돌변잡합자급야생형（P＜0.05），이돌변잡합자화야생형지간무명현차이（P＞0.05）。산부진통효과무명현차이。결론：서분태니용우부궁산산부술후진통，기인형위돌변순합자적산부총용약량요명현소우돌변잡합자급야생형，이진정급불량반응무명현구별。제시CYP3A4기인다태성가이지도서분태니진통시적개체화용약。
ObjectiveEvaluation of CYP3A4 gene polymorphism of sufentanil used in Chinese han nationality women in cesarean section the influence of the dosage of analgesic drugs.MethodsSelect pregnant 38 w - 40 w, elective cesarean delivery, ASAI or class II han Chinese women 60, according to its CYP3A4 genotype divided into three groups, namely the homozygous mutant, mutant heterozygote, wild type. By double blind method, observe the postoperative analgesic effect, sufentanil dose and number of PCA and genotype again after comparison, comparing the difference between three groups. Results The total amount of three groups of sufentanil 48 hours and the number of PCA have obvious difference, which the homozygous mutant genotype for maternal sufentanil total amount less than mutation frequency of PCA and heterozygous and wild type (P < 0.05), and the mutant heterozygote and no obvious difference between wild type (P> 0.05).ConclusionSufentanil for analgesia after cesarean section ChanFuShu, homozygous mutant genotype for much less than maternal total dose of heterozygous mutations and wild type, and no obvious difference between calm and adverse reactions. Prompt CYP3A4 gene polymorphism can guide individualized medication of sufentanil analgesia.