CYP2D6*10基因多态性对曲马多与托烷司琼术后镇痛的影响

CYP2D6*10 gene polymorphism in the influence of tramadol and tropisetron postoperative analgesia

目的 观察CYP2D6＊10基因多态性对曲马多与托烷司琼术后镇痛的影响.方法 120例ASA Ⅰ～Ⅱ级择期手术患者,手术部位限于下腹部及下肢,手术时间少于3h.术前静脉采血4 mL,采用等位基因特异扩增法（ASA-PCR）进行CYP2D6＊10基因分型.术后采用曲马多和托烷司琼静脉镇痛,采用视觉模拟评分（VAS）、曲马多负荷量、曲马多总用量评价术后镇痛效果,并统计术后恶心呕吐发生率.结果 按基因型分为三组：19例野生型纯合子（wt/w t）,55例杂合子（Ⅱm/w t）,46例突变型纯合子（m/m）.m/m组术后VAS评分及恶心呕吐发生率明显高于（w[/wt）组和（Ⅱm/w t）组（P＜0.05）.结论 CYP2D6＊10基因多态性使个体对曲马多与托烷司琼的药代动力学产生差异,影响术后镇痛止吐效果.

Objective To observe CYP2D6＊10 gene polymorphism in the influence of tramadol and tropisetron postoperative analgesia. Methods 120 patients of ASA level Ⅰ - Ⅱsuffered operation limited hypogastric zone or the lower limbs under the combined spinal and epidural anesthesta within 3 hours. Preoperative venous blood sampling was 4 mL, used allele specific amplification method （ASA-PCR） for CYP2D6＊10 genotyping. Used tramadol and tropisetron intra- venous analgesia after operation, used the visual analogue scale （VAS）, tramadol load and the total dosage of tramadol evaluation to postoperative analgesia effect, the incidence of postoperative nausea and vomiting were counted. Results They were divided into three groups by gene types： 19 cases of wild type homozygote（wt/wt）, 55 cases of heterozygote （m/wt）, 46 cases of homozygous mutant （m/m）. （m/m） group of postoperative VAS score and the incidence of nausea and vom- iting were obviously higher than those of（wt/wt） group and（m/wt） group（P〈0.05）. Conclusion CYP2D6＊10 gene poly- morphisms make individuals produce the differences to the tramadol and tropisetron pharmaeokinetic, and influence the postoperative analgesia anti-nausea effect.