ACE基因多态性对右美托咪定抑制高血压患者气管插管反应的影响

Effect of ACE gene polymorphism on dexmedetomidine-induced inhibition of responses to endotracheal intubation in patients with hypertension

目的评价紧张素转换酶(ACE)基因多态性对右美托咪定抑制高血压患者气管插管反应的影响。方法选择全麻下行腹部手术的原发性高血压患者180例,年龄48~61岁,体重51~66 kg,ASA分级Ⅱ或Ⅲ级,术前采用RFLP-PCR法测定ACE基因型,并根据是否应用右美托咪定分为6组(n=30):DD基因型组(DD组)、ID基因型组(ID组)、II基因型组(II组)、右美托咪定+DD基因型组(DEX+DD组)、右美托咪定+ID基因型组(DEX+ID组)和右美托咪定+II基因型组(DEX+II组)。DEX+DD组、DEX+ID组和DEX+II组于麻醉诱导前经15 min静脉输注右美托咪定0.8μg/kg。分别于给右美托咪定前(T0)、气管插管前即刻(T1)、气管插管后即刻(T2)、气管插管后1.5 min(T3)和5.0 min(T4)时,测定SP、DP和HR,并计算心率收缩压乘积(RPP);记录气管插管后5 min内心肌缺血和心血管反应的发生情况。分别于T0和T2-4时抽取颈内静脉血标本,采用高效液相色谱-电化学法检测血浆肾上腺素(E)和去甲肾上腺素(NE)浓度。结果与DD组比较,Dex+DD组T2-4时SP、DP、HR和RPP降低,T2,3时血浆NE和E浓度降低,心肌缺血和心血管反应发生率降低(P<0.05);与ID组比较,Dex+DD组T2-4时SP、DP、HR和RPP降低,T2,3时血浆NE和E浓度降低,心肌缺血和心血管反应反应发生率降低(P<0.05);与II组比较,Dex+II组T2,3时SP、DP、HR和RPP降低,血浆NE和E浓度降低,T4时HR和RPP降低,心肌缺血和心血管反应发生率降低(P<0.05);Dex+DD组、Dex+ID组和Dex+II组间上述各指标比较差异无统计学意义(P>0.05)。结论ACE基因多态性不会影响右美托咪定抑制高血压患者气管插管反应。

Objective To evaluate the effect of angiotensin-converting enzyme(ACE)gene polymorphism on dexmedetomidine-induced inhibition of responses to endotracheal intubation in the patients with hypertension.Methods One hundred and eighty patients with essential hypertension,aged 48-61 yr,weighing 51-66 kg,of American Society of Anesthesiologists physical statusⅡorⅢ,in whom ACE genotype was determined using polymerase chain reaction-restriction fragment length polymorphisms method before operation,were divided into 6 groups(n=30 each)according to whether dexmedetomidine was applied:DD genotype group(DD group),ID genotype group(ID group),II genotype group(II group),dexmedetomidine plus DD genotype group(DEX+DD group),dexmedetomidine plus ID genotype group(DEX+ID group),and dexmedetomidine plus II genotype group(DEX+II group).Dexmedetomidine 0.8μg/kg was intravenously infused over 15 min before induction of anesthesia in DEX+DD group,DEX+ID group and DEX+II group.Systolic and diastolic pressure(SP,DP)and heart rate(HR)were measured before dexmedetomidine(T0),immediately before tracheal intubation(T1),immediately after tracheal intubation(T2),and at 1.5 and 5.0 min after tracheal intubation(T3,4).The rate-pressure product(RPP)was calculated.The occurrence of myocardial ischemia and cardiovascular responses within 5 min after tracheal intubation was recorded.Blood samples from the internal jugular vein were collected at T0 and T2-4,and plasma concentrations of epinephrine(E)and norepinephrine(NE)were determined by high performance liquid chromatography-electrochemical detection assay.Results Compared with group DD,the SP,DP,HR and RPP were significantly decreased at T2-4,plasma NE and E concentrations were decreased at T2,3,and the incidence of myocardial ischemia and cardiovascular reactions was decreased in group Dex+DD(P<0.05).Compared with group ID,SP,DP,HR and RPP were significantly decreased at T2-4,plasma NE and E concentrations were decreased at T2,3,and the incidence of myocardial ischemia and cardiovascular responses were decreased in group Dex+DD(P<0.05).Compared with group II,SP,DP,HR and RPP were significantly decreased at T2,3,plasma NE and E concentrations were decreased,HR and RPP were decreased at T4,and the incidence of myocardial ischemia and cardiovascular reactions was decreased in group Dex+II(P<0.05).There was no significant difference in the above parameters among group Dex+DD,group Dex+ID and group Dex+II(P>0.05).Conclusion ACE gene polymorphism does not affect dexmedetomidine-induced inhibition of responses to endotracheal intubation in the patients with hypertension.