基因多态性对老年妇科手术患者舒芬太尼术后镇痛效果的影响

Effect of genetic polymorphism on postoperative analgesia of sufentanil in elderly patients undergoing gynecological surgery

目的探讨基因多态性对老年妇科手术患者舒芬太尼术后镇痛效果的影响。方法回顾性选取2018年1月至2019年12月张家港市中医医院收治的老年妇科手术患者80例,入院后均进行OPRMI A118G基因型和等位基因频率检测,根据基因型分为野生型纯合子AA组23例,突变型杂合子AG组28例,突变型纯合子GG组29例。以舒芬太尼作为镇痛药物,记录患者术后不同时间点的舒芬太尼用量及疼痛数字模拟评分(NRS)评分。比较3组患者不同时间点NRS评分、舒芬太尼用量以及不良反应的发生情况。结果3组患者年龄、体重、手术时间、术中舒芬太尼消耗量基本情况相当,差异无统计学意义(P>0.05)。至术后8、24、48 h,AA组舒芬太尼用量分别为(20.12±5.69)μg、(50.17±9.65)μg、(92.58±24.16)μg,均低于AG组[(25.61±7.62)μg、(64.35±11.28)μg、(110.32±26.59)μg]和GG组[(30.31±6.95)μg、(80.35±16.47)μg、(135.41±30.58)μg],差异均有统计学意义(P<0.05)。术后即刻3组患者NRS评分相当,差异无统计学意义(P>0.05);术后8、24、48 h,AA组NRS评分分别为(0.44±0.42)分、(0.24±0.20)分、(0.23±0.11)分,低于AG组[(1.05±1.02)、(0.87±0.84)、(0.95±0.91)分]和GG组[(1.59±1.31)、(2.09±1.95)、(1.17±1.05)分],差异均有统计学意义(P<0.05)。3组患者的术后不良反应均以恶心、呕吐、瘙痒为主,均为轻中度,不良反应总发生率比较差异无统计学意义(P>0.05)。结论OPRMI A118G基因型多态性会对老年妇科手术患者舒芬太尼术后镇痛效果造成影响,其中AA基因型患者的舒芬太尼消耗量少于AG与GG基因型患者,NRS评分也低于AG与GG基因型患者,携带A等位基因患者的镇痛效果更佳,有助于为个体化镇痛提供参考。

Objective To investigate the effect of genetic polymorphism on postoperative analgesia of sufentanil in elderly patients undergoing gynecological surgery.Methods Eighty elderly patients with gynecologic surgery admitted to Zhangjiagang Hospital of Traditional Chinese Medicine from January 2018 to December 2019 were retrospectively enrolled.All patients were tested for OPRMI A118G genotype and allele frequency after admission.According to genotype,23 cases were classified as wild-type homozygous AA group.There were 28 cases of mutant heterozygous AG group and 29 cases of mutant homozygous GG group.Sufentanil was used as analgesic drug to record the dose of sufentanil and numerical rating scale(NRS)score at different time points after operation.The NRS scores,the dose of sufentanil,and the incidence of adverse reactions were compared between the three groups.Results The age,weight,operation time,and intraoperative sufentanil consumption in the three groups were basically the same(P>0.05).At 8,24 and 48 hours after operation,the dosage of sufentanil in AA group was(20.12±5.69)μg,(50.17±9.65)μg,(92.58±24.16)μg,respectively,which was lower than that in AG group[(25.61±7.62)μg,(64.35±11.28)μg,(110.32±26.59)μg]and GG group[(30.31±6.95)μg,(80.35±16.47)μg、(135.41±30.58)μg],the differences were statistically significant(P<0.05).The NRS scores of the three groups were comparable immediately after surgery(P>0.05).At 8,24 and 48 hours after operation,the NRS scores of AA group were(0.44±0.42),(0.24±0.20),(0.23±0.11)pionts,which were lower than those of AG group[(1.05±1.02),(0.87±0.84),(0.95±0.91)pionts]and GG group[(1.59±1.31),(2.09±1.95)and(1.17±1.05)pionts],respectively,the differences were statistically significant(P<0.05).The postoperative adverse reactions of the three groups were mainly nausea,vomiting and itching,all of which were mild to moderate,and the total incidence of adverse reactions was not statistically significant(P>0.05).Conclusion OPRMI A118G genotype polymorphism affects the postoperative analgesia of sufentanil in elderly patients undergoing gynecologic surgery.Among them,the AA genotype patients have less sufentanil consumption than the AG and GG genotypes,and the NRS score is also low.In patients with AG and GG genotypes,patients with A allele have better analgesic effect and help to provide reference for individualized analgesia.