SCN9A基因多态性和罗哌卡因对术后疼痛的影响
发布时间：2018-11-12 06:43
【摘要】：目的：腹腔镜手术虽然具有切口小、创伤小、疼痛轻等优点,但仍有许多患者在术后早期会出现不同程度的疼痛,需接受麻醉性镇痛药来缓解,腹腔镜手术后急性疼痛是一个值得重视的问题。本实验选择择期行腹腔镜下妇科手术治疗的患者,观察罗哌卡因局部浸润对腹腔镜妇科手术后镇痛的应用效果,并进一步分析疼痛相关的SCN9A基因单核苷酸多态性对腹腔镜手术后患者疼痛敏感性的影响。 方法：1选择200例行择期腹腔镜下妇科手术患者,采用随机,对照和双盲的研究方法将患者分为实验组(R组)和对照组(N组),分别于手术开始切皮前5min在切口部位局部浸润0.75%罗哌卡因12ml和生理盐水12ml,记录术前,术中,术后的血流动力学指标,麻醉后苏醒情况以及术中麻醉药物的用量,通过视觉模拟评分法(VAS)对术后1h,6h,12h,24h,48h切口部位进行疼痛程度评估,记录两组患者术后恶性呕吐等不良反应的发生情况。2每位患者抽取外周静脉血2ml提取DNA,应用PCR技术结合DNA直接测序方法对患者SCNA9基因进行单核苷酸多态性分析及其与术后疼痛的相关性。 结果：1一般资料比较：两组患者年龄、体重、手术时间、麻醉时间及麻醉药用量差异无统计学意义(P0.05)。2两组患者各时间点无创血压、心率差异无统计学意义(P0.05)。3两组患者麻醉后恢复指标自主呼吸恢复时间、清醒时间、拔管时间差异无统计学意义(P0.05)。4两组患者的静息VAS在术后1h、6h、12h比较有显著性差异(P0.05),两组患者的运动VAS在术后1h、6h、12h、24h、48h比较均有显著性差异(P0.05)。5两组患者术后不良反应恶心呕吐等无统计学意义(P0.05)。6SCN9A基因第15号外显子2794(A/C)基因突变与术后疼痛无相关性(P0.05);SCN9A基因第18号外显子3448(C/T)基因突变与术后疼痛存在相关性(P0.05),等位基因T的存在可能使痛阈下降。 结论：1罗哌卡因局部浸润能够显著减轻妇科腹腔镜手术患者术后切口部位的疼痛。2SCN9A基因第18外显子3448(C/T)的杂合突变与术后疼痛的发生发展具有相关性,等位基因T使痛阈下降。3SCN9A基因3448(C／T)的突变与罗哌卡因对疼痛的影响无明显相关性。
[Abstract]:Objective: although laparoscopic surgery has the advantages of less incision, less trauma and less pain, there are still many patients who have different degrees of pain in the early postoperative period, and need to receive anaesthetic analgesics to alleviate the pain. Acute pain after laparoscopic surgery is an important problem. Patients undergoing laparoscopic gynecologic surgery were selected to observe the effect of ropivacaine local infiltration on analgesia after laparoscopic gynecological surgery. The effects of single nucleotide polymorphisms of SCN9A gene associated with pain on the pain sensitivity of patients undergoing laparoscopic surgery were analyzed. Methods: (1) 200 patients undergoing laparoscopic gynecological surgery were divided into two groups: experimental group (group R) and control group (group N). 5min infiltrated 0.75% ropivacaine 12ml and 12 ml saline at the incision site before the operation, respectively. The hemodynamic indexes before, during and after operation, the recovery after anesthesia and the dosage of anesthetic during the operation were recorded. Visual analogue score (VAS) was used to evaluate the pain degree of incision at 1 hour, 6 h, 12 h, 24 h and 48 h after operation, and to record the occurrence of malignant vomiting and other adverse reactions in both groups. 2 the peripheral venous blood 2ml was extracted from each patient to extract DNA,. Single nucleotide polymorphism (SNP) of SCNA9 gene and its association with postoperative pain were analyzed by PCR and DNA sequencing. Results: 1 comparison of general data: there was no significant difference in age, body weight, operation time, anesthetic time and anesthetic dosage between the two groups (P0.05). There was no significant difference in heart rate between the two groups (P0.05). 3 there was no significant difference in the recovery time of spontaneous respiration, waking time and extubation time between the two groups (P0.05). 4 the resting VAS of the two groups was 6 hours after operation. There was a significant difference in 12h (P0.05). The exercise VAS of the two groups was 24 hours after 1 hour, 6 hours after operation and 12 hours after operation. There was no significant difference in postoperative adverse reactions, nausea and vomiting between the two groups (P0.05). The mutation of exon 2794 (A / C) of 6SCN9A gene was not related to postoperative pain (P0.05). Relevance (P0.05); The mutation of exon 3448 (C / T) in exon 18 of SCN9A gene was correlated with postoperative pain (P0.05). The presence of allele T might decrease the pain threshold. Conclusion: 1 Local infiltration of ropivacaine can significantly relieve the pain of incision in patients undergoing gynecological laparoscopic surgery. The heterozygosity mutation in exon 3448 (C / T) of 2SCN9A gene is associated with the occurrence and development of postoperative pain. Allele T decreased the pain threshold. The mutation of 3SCN9A gene 3448 (C / T) was not correlated with the effect of ropivacaine on pain.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
本文编号：2326345
[Abstract]:Objective: although laparoscopic surgery has the advantages of less incision, less trauma and less pain, there are still many patients who have different degrees of pain in the early postoperative period, and need to receive anaesthetic analgesics to alleviate the pain. Acute pain after laparoscopic surgery is an important problem. Patients undergoing laparoscopic gynecologic surgery were selected to observe the effect of ropivacaine local infiltration on analgesia after laparoscopic gynecological surgery. The effects of single nucleotide polymorphisms of SCN9A gene associated with pain on the pain sensitivity of patients undergoing laparoscopic surgery were analyzed. Methods: (1) 200 patients undergoing laparoscopic gynecological surgery were divided into two groups: experimental group (group R) and control group (group N). 5min infiltrated 0.75% ropivacaine 12ml and 12 ml saline at the incision site before the operation, respectively. The hemodynamic indexes before, during and after operation, the recovery after anesthesia and the dosage of anesthetic during the operation were recorded. Visual analogue score (VAS) was used to evaluate the pain degree of incision at 1 hour, 6 h, 12 h, 24 h and 48 h after operation, and to record the occurrence of malignant vomiting and other adverse reactions in both groups. 2 the peripheral venous blood 2ml was extracted from each patient to extract DNA,. Single nucleotide polymorphism (SNP) of SCNA9 gene and its association with postoperative pain were analyzed by PCR and DNA sequencing. Results: 1 comparison of general data: there was no significant difference in age, body weight, operation time, anesthetic time and anesthetic dosage between the two groups (P0.05). There was no significant difference in heart rate between the two groups (P0.05). 3 there was no significant difference in the recovery time of spontaneous respiration, waking time and extubation time between the two groups (P0.05). 4 the resting VAS of the two groups was 6 hours after operation. There was a significant difference in 12h (P0.05). The exercise VAS of the two groups was 24 hours after 1 hour, 6 hours after operation and 12 hours after operation. There was no significant difference in postoperative adverse reactions, nausea and vomiting between the two groups (P0.05). The mutation of exon 2794 (A / C) of 6SCN9A gene was not related to postoperative pain (P0.05). Relevance (P0.05); The mutation of exon 3448 (C / T) in exon 18 of SCN9A gene was correlated with postoperative pain (P0.05). The presence of allele T might decrease the pain threshold. Conclusion: 1 Local infiltration of ropivacaine can significantly relieve the pain of incision in patients undergoing gynecological laparoscopic surgery. The heterozygosity mutation in exon 3448 (C / T) of 2SCN9A gene is associated with the occurrence and development of postoperative pain. Allele T decreased the pain threshold. The mutation of 3SCN9A gene 3448 (C / T) was not correlated with the effect of ropivacaine on pain.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
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