IL－1β—511基因多态性对病人芬太尼术后镇痛效应的影响

Effect of IL-1β-511 genetic polymorphism on postoperative analgesia with fentanyl

目的 探讨IL-1β-511基因多态性对病人芬太尼术后镇痛效应的影响.方法 择期全麻下行子宫全切术或子宫肌瘤剔除术的病人250例,河南籍,汉族,年龄20～50岁,ASA分级Ⅰ或Ⅱ级.采用聚合酶链反应-限制性片断长度多态性技术进行IL-1β-511基因多态性位点检测,根据基因型将病人分为野生型纯合子组、突变型杂合子组和突变型纯合子组.病人清醒后行VAS评分,当VAS评分＞3分时,间断静脉注射芬太尼20μg,直至VAS评分≤3分时开始PCIA,维持VAS≤3分.记录PCIA 24 h内芬太尼的用量.结果 三组PCIA 24 h内芬太尼用量差异无统计学意义（P＞0.05）.结论 IL-1β-511基因多态性不是芬太尼术后静脉镇痛效应个体差异的遗传因素,提示术后24 h内的疼痛与炎性因子无关.

Objective To investigate the effect of IL-1β-511 genetic polymorphism on postoperative analgesia with fentanyl. Methods Two hundred and fifty ASA Ⅰ or Ⅱ patients of Han nationality （native of Henan province） aged 20-50 yr undergoing elective abdominal total hysterectomy or myomectomy under general anesthesia were enrolled in this study. The polymorphic sites of the IL-1β-511 allele were analyzed by polymerase chain reaction-restriction fragment length polymorphism. The patients were assigned into 3 groups according to their genotypes： group wild homozygote; group mutation hetorozygote and group mutation homozygote. Anesthesia was induced with midazolam, remifentanil, propofol and succinylcholine and maintained with propofol, remifentanil and atracurium. The patients were mechanically ventilated after tracheal intubation. The pain was assessed using VAS score after the patients recovered from anesthesia. When VAS score was 〉 3 the patients were given fentany120 μg every 5 min until VAS score decreased to ≤ 3. PCIA with fentanyl was then started. The PCIA solution contained fentanyl 1.0 mg and droperidol 5mg in 100 ml of normal saline. The PCA pump was set to deliver a background infusion of 0.5 ml/h and a bolus dose of 2 ml at 5 min lockout interval. The VAS score was maintained at ≤3.The amount of fentanyl consumed during 24 h of PCIA was recorded. Results There was no significant difference in the amount of fentanyl consumed during the 24 h PCIA among the 3 groups. Conclusion IL-1β-511 genetic polymorphism is not the factor contributing to the individual variation in the patient＇ s response to postopertive analgesia with fentanyl, indicating that the pain within 24 h after operation is not related to the inflammatory factors.