MDR1 C3435T多态性对关节置换术后镇痛药物使用量的影响

发布时间：2018-10-17 21:43

【摘要】：目的:探讨多药耐药基因1(MDR1)C3435T多态性对关节置换术后镇痛药物(地佐辛联合舒芬太尼)使用量的影响。方法:选取2014年1月-2016年2月在天津市人民医院和天津港口医院行关节置换术的患者300例,术后给予地佐辛+舒芬太尼联合镇痛。采用聚合酶链反应-限制性片段长度多态性分析法测定其MDR1 C3435T多态性,比较不同基因型患者术后视觉模拟量表(VAS)评分、镇静程度(Ramesy)评分、地佐辛+舒芬太尼的使用量,以及不良反应发生情况。结果:300例患者中,MDR1C3435T CC、CT和TT基因型分别有100例(33.3%)、102例(34.0%)和98例(32.7%),各基因型频率均符合Hardy-Weinberg平衡(P0.05)。各基因型患者术后0、24、48 h VAS评分、Ramesy评分比较,差异均无统计学意义(P0.05),且未见镇静过度者。CT、TT基因型患者术后0~24、24~48 h地佐辛+舒芬太尼的使用量均显著低于CC基因型患者,差异均有统计学意义(P0.05);而CT与TT基因型上述各时间段药物使用量比较,差异均无统计学意义(P0.05)。TT基因型患者术后恶心呕吐(PONV)及总体不良反应发生率均显著低于CC、CT基因型患者,差异均有统计学意义(P0.05);而CC与CT基因型患者PONV及总体不良反应发生率,以及各基因型患者瘙痒的发生率比较,差异均无统计学意义(P0.05)。结论:在达到相似镇痛、镇静效果的前提下,MDR1C3435T突变型患者对地佐辛+舒芬太尼的耐受性更低,所需剂量更少,且不良反应发生率更低。该基因型可作为临床个体化治疗的参考指标。
[Abstract]:Aim: to investigate the effect of multidrug resistance gene 1 (MDR1) C3435T polymorphism on the dosage of analgesic drugs (dizosin combined with sufentanil) after arthroplasty. Methods: from January 2014 to February 2016, 300 patients underwent arthroplasty in Tianjin people's Hospital and Tianjin Port Hospital. The MDR1 C3435T polymorphism was measured by polymerase chain reaction-restriction fragment length polymorphism (PCR). The (VAS) score, sedation (Ramesy) score and the amount of dizosin sufentanil were compared among the patients with different genotypes. And the occurrence of adverse reactions. Results: the genotypes of MDR1C3435T CC,CT and TT were 100 cases (33.3%), 102 cases (34.0%) and 98 cases (32.7%), respectively. The frequencies of all genotypes were in accordance with Hardy-Weinberg equilibrium (P0.05). There was no significant difference in VAS score and Ramesy score between 0 and 24 hours postoperatively in all genotypes (P0.05), and there was no oversedation. The use of dizosin sufentanil in patients with CT,TT genotype was significantly lower than that in patients with CC genotype. The difference was statistically significant (P0.05), but there was no significant difference in drug use between CT and TT genotypes (P0.05) the incidence of nausea and vomiting (PONV) and overall adverse reactions in patients with). TT genotype were significantly lower than those in patients with CC,CT genotype. The difference was statistically significant (P0.05), while the incidence of PONV and total adverse reactions in patients with CC and CT genotype, as well as the incidence of pruritus in all genotypes, had no statistical significance (P0.05). Conclusion: on the premise of similar analgesia and sedative effect, the patients with MDR1C3435T mutant have lower tolerance, less dosage and lower incidence of adverse reactions to dizosin sufentanil. The genotype can be used as a reference index for individual clinical therapy.
【作者单位】：天津港口医院麻醉科;天津市人民医院病案室;
【分类号】：R614

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