OPRM1 118G基因多态性对剖宫产鞘内注射吗啡术后镇痛的影响

Effect of OPRM1118G gene polymorphism on postoperative analgesia after intrathecal morphine injection in cesarean section

目的探讨OPRM1 118G基因多态性对剖宫产鞘内注射吗啡术后镇痛的影响。方法选取2017年1月~2018年1月我院收治的194例足月妊娠择期行剖宫产手术的产妇为研究对象,患者行吗啡鞘内注射麻醉,分别在4、12和24 h记录患者疼痛视觉模拟评分(VAS评分)和舒适程度评级布氏评分(BCS评分)。记录术后24 h内患者恶心呕吐、呼吸抑制和皮肤瘙痒等不良反应。聚合酶链反应-限制性片段长度多态性技术(PCR-RFLP)进行OPRM1 118G基因多态性检测,并比较不同基因型对吗啡镇痛效果和不良反应的影响。结果 OPRM1等位基因的野生型纯合子、杂合子和突变型纯合子的分布符合Hardy-Weinberg平衡,具有群体代表性;GG基因型4、12 h VAS评分显著高于A/A基因型和A/G基因型(t=16.146,P<0.05;t=13.269,P<0.05;t=14.197,P<0.05;t=11.502,P<0.05);GG基因型12、24 h BCS评分显著低于A/A基因型(t=2.639,P=0.095;t=2.33,P=0.0214);GG基因型皮肤瘙痒率显著高于A/A基因型和A/G基因型(χ^2=53.152,P<0.05;χ^2=33.512,P<0.05)。结论 OPRM1 118G基因多态性可影响剖宫产鞘内注射吗啡术后的镇痛效果和皮肤瘙痒的发生。

Objective To investigate the effect of OPRM1 118 G gene polymorphism on postoperative analgesia after intrasheath morphine injection in cesarean section. Methods From January 2017 to January 2018, 194 cases of women underwent elective cesarean section during term pregnancy in our hospital were randomly selected. Patients were given morphine intrathecal injection anesthesia. Visual analogue scale(VAS) and comfort rating(BCS) were recorded at 4 h, 12 h and 24 h, respectively. Adverse reactions including nausea, vomiting, respiratory depression and pruritus were recorded within 24 h after surgery. Polymerase chain reaction-restricted fragment length polymorphism was used to detect OPRM1 118 G gene polymorphism and compare the effects of different genotypes on morphine analgesia and adverse reactions. Results The distribution of wild homozygote, heterozygote and mutant homozygote of OPRM1 allele was in line with Hardy-Weinberg equilibrium and was representative of the population. VAS scores at 12 h and 4 h of GG genotype were significantly higher than A/A genotype and A/G genotype(t=14.197,P<0.05;t=11.502,P<0.05;t=16.146,P<0.05;t=13.269,P<0.05). GG genotype BCS score at 12 h and BCS score at 24 h were significantly lower than A/A genotype(t=2.639,P=0.095;t=2.33,P=0.0214). The skin pruritus rate of GG genotype was significantly higher than that of A/A genotype and A/G genotype(χ^2=53.152,P<0.05;χ~2=33.512,P<0.05). Conclusion OPRM1 118 G gene polymorphism can affect the analgesic effect and skin pruritus rate after intrathecal morphine injection in cesarean section.