多药耐药蛋白1 C1236T基因多态性对股骨骨折患者术后舒芬太尼镇痛效应的影响

Effect of ATP binding cassette,sub⁃family B(MDR/TAP),member 1 C1236T gene polymorphism on postoperative sufent⁃anil analgesic effect in patients with femoral fracture

目的评价多药耐药蛋白1(ABCB1)C1236T基因多态性对股骨骨折患者术后舒芬太尼镇痛效应的影响。方法选择椎管内麻醉下行股骨骨折手术的372例患者,术前采集静脉血进行ABCB1基因多态性检测,根据基因型分为野生型纯合子组(CC组,172例)、杂合子组(CT组,152例)、突变型纯合子组(TT组,48例),手术结束后连接并使用静脉镇痛泵。观察记录各组患者一般资料,术后1、3、7 d数字分级评分法(NRS)评分,患者自控镇痛(PCA)泵按压次数,镇痛泵舒芬太尼消耗量,患者术后回病房后开始出现疼痛的时间,术后不良反应(恶心、呕吐和过度镇静)的发生情况。结果372例患者中,基因型频率符合Hardy⁃Weinberg遗传平衡定律。各组患者一般资料差异均无统计学意义(均P>0.05)。与CC组和CT组比较,TT组患者术后1 d NRS评分、PCA泵按压次数、镇痛泵舒芬太尼消耗量和过度镇静发生率均较高(均P<0.05),患者术后回病房后开始出现疼痛的时间更早(P<0.05)。与CC组比较,CT组患者PCA泵按压次数、镇痛泵舒芬太尼消耗量均较高(均P<0.05);各组患者术后3 d NRS评分、术后7 d NRS评分及术后恶心、呕吐发生率差异均无统计学意义(均P>0.05)。结论ABCB1 C1236T基因多态性是影响患者术后早期舒芬太尼镇痛效应个体化差异的遗传因素之一。

Objective To evaluate the effect of ATP binding cassette,sub⁃family B(MDR/TAP),member 1(ABCB1)C1236T gene polymorphism on the analgesic effect of sufentanil in patients with femoral fracture.Methods This article selected 372 pa⁃tients who underwent femoral fracture surgery under intrathecal anaesthesia,and collected venous blood for ABCB1 gene polymorphism testing before surgery.The patients were divided into wild⁃type(CC)group,heterozygous(CT)group,and mutant homozygous(TT)group according to their genotypes.The patients were placed intravenous analgesic pumps at the end of the surgery.Observe and record the pa⁃tients'information including general information,the Numerical Rating Scale(NRS)scores on day 1,3 and 7 postoperatively,the num⁃ber of presses by the patient controlled analgesia(PCA)pump,the amount of sufentanil consumed by the analgesic pump,the time when the patients began to experience pain after returning to the ward postoperatively and the postoperative adverse event(nausea,vomiting and excessive sedation).Results Among the 372 patients,genotype ratios were complied with the Hardy⁃Weinberg law of genetic equilibrium.There was no statistical difference in the general information(all P>0.05).Compared to the patients CC and CT groups,pa⁃tients in the TT group had high postoperative 1 d NRS scores,high numbers of PCA presses,high analgesic pump sufentanil consumption,and high incidence of over⁃sedation(all P<0.05).The patients in the TT group began to experience pain earlier after returning to the wards(P<0.05).In the meantime,the patients in the CT group had higher number of PCA presses,and analgesic pump sufentanil con⁃sumption than the patients in CC group(all P<0.05).There was no statistical difference among the groups in the incidences of postoper⁃ative 3 d NRS,7 d NRS,and postoperative nausea and vomiting(all P>0.05)Conclusion The ABCB1 C1236T gene polymorphism is one of the genetic factors affecting the individual differences in the analgesic effect of sufentanil in the early postoperative period.