CAJ | 학술논문

目的：探究CYP3A4基因多态性对芬太尼药效的影响及基因检测在大面积烧伤患者应用芬太尼镇痛个体化用药的应用价值。方法本研究为临床前瞻随机对照研究，选取第四军医大学西京医院2015年2月～7月就诊大面积烧伤患者149例，将患者随机分为对照组（n＝56）和试验组（n＝93），对照组患者均采用芬太尼5μg／kg进行麻醉诱导，试验组患者结合基因检测结果予以芬太尼6、5、4μg／kg。对比观察试验组和对照组患者术后不同时刻VAS评分，术中芬太尼用量；对VAS评分＞7分患者肌注哌替啶100 mg，记录所有患者哌替啶追加例数及次数。同时记录2组患者术后出院前各项不良反应发生情况。结果术后清醒即刻VAS评分差异无统计学意义，术后6 h、12 h试验组患者VAS评分明显较低（P＜0．05）。试验组芬太尼用量及术后哌替啶追加例数及次数明显减少（P＜0．05）。术后试验组恶心、呕吐、瘙痒、嗜睡等不良反应及不良反应总数明显较少（P＜0．05）。结论 CYP3A4基因检测对大面积烧伤患者的个体化用药具有重要意义，通过结合患者基因型调整芬太尼药量，可明显增强镇痛效果，减少患者药物使用量，有效减少患者不良反应。
목적：탐구CYP3A4기인다태성대분태니약효적영향급기인검측재대면적소상환자응용분태니진통개체화용약적응용개치。방법본연구위림상전첨수궤대조연구，선취제사군의대학서경의원2015년2월～7월취진대면적소상환자149례，장환자수궤분위대조조（n＝56）화시험조（n＝93），대조조환자균채용분태니5μg／kg진행마취유도，시험조환자결합기인검측결과여이분태니6、5、4μg／kg。대비관찰시험조화대조조환자술후불동시각VAS평분，술중분태니용량；대VAS평분＞7분환자기주고체정100 mg，기록소유환자고체정추가례수급차수。동시기록2조환자술후출원전각항불량반응발생정황。결과술후청성즉각VAS평분차이무통계학의의，술후6 h、12 h시험조환자VAS평분명현교저（P＜0．05）。시험조분태니용량급술후고체정추가례수급차수명현감소（P＜0．05）。술후시험조악심、구토、소양、기수등불량반응급불량반응총수명현교소（P＜0．05）。결론 CYP3A4기인검측대대면적소상환자적개체화용약구유중요의의，통과결합환자기인형조정분태니약량，가명현증강진통효과，감소환자약물사용량，유효감소환자불량반응。
Objective To explore effect of CYP3A4 gene polymorphism and genetic testing on the efficacy of fentanyl in patients with extensive burns.Methods A prospective randomized controlled study, 149 patients with extensive burns were picked from Feburary to July in 2015.Patients were randomly divided into matched group ( n=56 ) and experimental group ( n=93 ) . The matched group was treated with fentanyl 5 g/kg to finish implementation of anesthesia induction.Depends on the gene detection results, the patients in experimental group were treated with 6 g/kg, 5 g/kg or 4 g/kg fentanyl.The VAS score at different time after operation in the experimental group and the control group were compared , and the dosage of fentanyl was observed.Patients whose VAS score was greater than 7 should treated with intramuscular injection of pethidine 100 mg, recorded all patients with pethidine,s additional cases and the times.At the same time, the adverse reactions of the two groups were recorded before and after hospital discharge. ResuIts The score of VAS was not significantly different after wake up immediatly after the surgery , and the score of VAS was significantly lower in the experimental group patients in 6h,12h after the surgery (P<0.05).The dosage of fentanyl in the experimental group and the number of the cases and the times were significantly decreased (P<0.05).The adverse reactions after the surgery such as nausea, vomiting, itching, drowsiness, and adverse reactions were significantly lower in the experimental group (P<0.05).ConcIusion CYP3A4 gene detection in patients with large area of burn in the individual drug use is important, because of patients’ genotype adjusting fentanyl dosagecan, it enhances significantly the analgesic effect, reduces the amount of drug use, and effectively reduces the adverse reactions.