μ阿片受体A118G基因多态性对芬太尼静脉镇痛恶心呕吐的影响.docVIP

μ阿片受体A118G基因多态性对芬太尼静脉镇痛恶心呕吐的影响 袁静静 张卫 郑州大学第一附属医院麻醉科 【摘要】目的 观察μ阿片受体A118G基因多态性对妇科患者全麻术后芬太尼静脉镇痛恶心、呕吐的影响。方法 165例妇科全麻下行择期腹式子宫全切术或子宫肌瘤剔除术后行芬太尼静脉自控镇痛的患者，年龄20～50岁，ASAⅠ或Ⅱ级。静脉注射咪达唑仑、瑞芬太尼、异丙酚和琥珀胆碱麻醉诱导；静脉输注瑞芬太尼和异丙酚，静脉注射阿曲库铵维持麻醉；术后采用芬太尼行病人静脉自控镇痛。记录术后24 h恶心、呕吐发生情况、术后24 hVAS评分和术后24 h芬太尼消耗量。采用聚合酶链反应-限制性片断长度多态性(PCR-RFLP)技术检测A118G基因多态性，根据基因型将病人分为野生纯合子(A/A)，突变杂合子(A/G)，突变纯合子(G/G)三组。结果　165例患者中OPRM1 118G等位基因频率为32.4%。术后24小时G/G组比A/A和A/G组消耗了更多的芬太尼以达到满意的镇痛效果，但A/A、A/G和G/G三组术后24小时恶心、呕吐发生率及评分差异无统计学意义。结论　A118G基因多态性对芬太尼术后静脉镇痛恶心、呕吐无影响。 【关键词】基因多态性；A118G；芬太尼；术后镇痛；术后恶心呕吐 Association study of OPRM1 A118G Genetic Polymorphism with Postoperative Nausea and Vomiting induced by Fentanyl intravenous Analgesia ZHANG Wei, YUAN Jing-jing，KAN Quan-cheng, et al. Department of Anesthesiology，First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052,China 【Abstract】Objective: To evaluate the impact of OPRM1 A118G genetic polymorphism on postoperative nausea and vomiting induced by fentanyl intravenous analgesia in Chinese gynaecologic patients. Method: One hundred and sixty-five patients, aged 20-50 yr, ASAⅠorⅡ, scheduled for elective abdominal total hysterectomy or myomectomy with general anesthesia were enrolled. Anesthesia was induced with iv midazolam，remifentanil，propofol and succinylcholine. Remifentanyl 0.1～0.2 μg·kg-1·min-1, propofol 6～8 mg·kg-1·h-1 and iv atracurium were used for maintenance of anesthesia． Intravenous fentanyl patient-controlled analgesia was provided postoperatively for satisfactory analgesia.The presence and scores of nausea and vomiting at 24h postoperatively were recorded and measured with rating scales.Pain and fentanyl consumption in the first 24 hours were measured with visual analog scale and recorded respectively.Genotyping of the A118G allele was conducted by polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP). Patients were divided into three groups according to genotype. Results: Among the 165subjects, 80 women were wild homozygous (A/A)