细胞色素酶P450 3A4基因多态性对舒芬太尼与罗哌卡因联合用药方案的影响

Effects of cytochrome P450 3A4 gene polymorphism on the treatment programs of sufentanyl combined with ropivacaine

目的研究细胞色素酶P450 3A4基因多态性影响舒芬太尼与罗哌卡因联合用药的给药方案。方法将400例足月单胎头位产妇随机分成2组(每组200例):对照组(A组)按照常规剂量给予0.5mg·L-1舒芬太尼和0.15%盐酸罗哌卡因混合液10mL。观察组(B组)根据基因型给药:GA/AA基因型组(B1组)根据临床常规剂量的87.6%给予舒芬太尼,盐酸罗哌卡因的给药量不变(0.438mg·L-1舒芬太尼和0.15%盐酸罗哌卡因混合液10mL);GG基因型组(B2组)给药量同A组。记录各组镇痛前与镇痛后1h视觉模拟评分(VAS),监测镇痛过程中产妇的生命体征、分娩方式、产程、不良反应与新生儿Apgar评分。结果各组镇痛后VAS评分与镇痛前相比均有显著性差异,镇痛效果满意。B1组不良反应发生率比A组和B2组低,差异有统计学意义。每组各时间点的VAS评分、产程、剖宫产率、顺产率及新生儿产后1、5min Apgar评分差异均无统计学意义。结论根据临床常规剂量的87.6%给予舒芬太尼(0.438mg·L-1)联合0.15%盐酸罗哌卡因应用于GA/AA基因型孕妇分娩镇痛效果确切,用药后恶心、皮肤瘙痒等不良反应发生率降低。

AIM To study the effects of enzyme cytochrome P450 3A4 gene polymorphism on the treatment programs of sufentanyl combined with ropivacaine in labor analgesia.METHODS Four hundred full-term singleton pregnancy cephalic presentation parturients were divided into control group(group A)with 200 cases and treatment group(group B)with 200 cases randomly.Group A was injected sufentanyl 0.5mg·L-1 combined with ropivacaine 0.15%(10mL)according to the conventional doses.Group B were divided into 2groups based on the results of genotyping:GA/AA genotype group(group B1)was given the 87.6% conventional dose of sufentanil and the same dose of ropivacaine(0.438mg·L-1 sufentanil and 0.15%ropivacaine 10mL),GG group(group B2)was the same as group A.Visual analog scale(VAS,0-10)were recorded respectively before labor analgesia and 1hafter analgesia.Maternal vital signs,mode of delivery,duration of labor,incidence of subsequent adverse drug reactions and Apgar score(1min and 5min)were recorded.RESULTS VAS scores in groups of epidural analgesia decreased significantly,the analgesia was good.The incidences of pruritus and nausea were significantly lower in group B1 than in group A and in group B2.There were no significant differences in other indexes between the 3groups.CONCLUSION The 87.6% conventional dose of sufentanil(0.438 mg·L-1)combined with ropivacaine 0.15% on GA/AA genotype group provided good and safe labor analgesia and can reduce the incidence rate of nausea and pruritus.