[1]胡玉皎a,张莹a,周铁成a,等.胃肠手术患者瑞芬太尼相关基因位点检测在术中麻醉药物剂量评估中的应用[J].现代检验医学杂志,2020,35(05):20-23，158.[doi:10.3969/j.issn.1671-7414.2020.05.006]
　HU Yu-jiaoa,ZHANG Yinga,Zhou Tie-chenga,et al.Application of Remifentanil Related Genes Detection in Anesthetic Dose Assessment of Patients Undergoing Gastrointestinal Surgery[J].Journal of Modern Laboratory Medicine,2020,35(05):20-23，158.[doi:10.3969/j.issn.1671-7414.2020.05.006]
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胃肠手术患者瑞芬太尼相关基因位点检测在术中麻醉药物剂量评估中的应用()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第35卷
期数:
2020年05期
页码:
20-23，158
栏目:
论著
出版日期:
2020-11-01

文章信息/Info

Title:
Application of Remifentanil Related Genes Detection in Anesthetic Dose Assessment of Patients Undergoing Gastrointestinal Surgery
文章编号:
1671-7414（2020）05-020-05
作者:
胡玉皎a; 张莹a; 周铁成a; 王昊a; 成丹丹b; 郝晓柯a; 刘家云a
空军军医大学西京医院a. 全军临床检验中心；b. 麻醉科, 西安710032
Author(s):
HU Yu-jiaoa;  ZHANG Yinga;  Zhou Tie-chenga;  WANG Haoa;  CHENG Dan-danb;  HAO Xiao-kea;  LIU Jia-yuna
a.Center of Clinical Laboratory for People’s Liberation Army Medicine;b.Department of Anesthesiology, Xijing Hospital of Air Force Medical University, Xi’an 710032, China
关键词:
瑞芬太尼; 胃肠手术; 基因检测; 个体化用药
分类号:
R656.6；R614
DOI:
10.3969/j.issn.1671-7414.2020.05.006
文献标志码:
A
摘要:
目的　通过检测麻醉药物瑞芬太尼（remifentanil，REM）体内代谢和转运相关基因位点，探讨其与术中瑞芬太 尼使用剂量的关系，为患者提供精准的麻醉药物个体化用药指导。方法　收集5 249 例胃肠手术患者血液样本，应用荧 光探针原位杂交技术检测瑞芬太尼相关基因位点OPRM1(118A ＞ G)，CYP3A4*1G(25343C ＞ T)，ABCB1(3435T>C)， CYP3A4*18B(A>G) 并进行分析，评估不同基因型患者麻醉药物的使用剂量。结果　OPRM1(118A ＞ G) 位点AA/AG 基因型4 636 例（88.32%），GG基因型613 例（11.68%），CYP3A4*1G( 25343C ＞ T) 位点CC/CT 基因型4 922 例（93.77%）， TT 基因型327 例（6.23%），ABCB1(3435T>C) 位点TT 基因型1 842 例（35.09%），TC/CC 基因型3 407 例（64.91%）， CYP3A4*18B(A>G) 位点AA 基因型5 149 例（98.09%），AG/GG 基因型100 例（1.91%）。54 例OPRM1 AA/AG， CYP3A4*1G TT，ABCB1 TT 基因型患者麻醉诱导及术中维持中应减低瑞芬太尼剂量，严格控制静脉泵注速度；118 例 OPRM1 GG，CYP3A4*1G CC 和ABCB1 CC 基因型患者，术中麻醉维持应根据其麻醉程度适当提高瑞芬太尼剂量和泵 注速度；100 例CYP3A4*18B AG/GG 基因型患者适当减少瑞芬太尼剂量，降低静脉泵注速度。结论　不同患者应根据 其瑞芬太尼基因型别合理用药，为麻醉药物使用的患者提供精准的用药指导。
Abstract:
Objective　By detecting the metabolism and transportation of remifentanil related genes, the relationship between the genes and the dosage was discussed, so as to provide accurate guidance for the individual use of anesthetic drugs. Methods　 Collected blood samples of 5 249 patients undergoing gastrointestinal surgery,detected remifentanil related genes OPRM1(118A ＞ G), CYP3A4*1G(25343C ＞ T), ABCB1(3435T>C) and CYP3A4*18B(A>G) by fluorescence probe in situ hybridization, ssessed the dosage of anesthetic drugs used in patients with different enotypes. Results　The cases of OPRM1(118A ＞ G) AA/ AG were 4 636（88.32%）， GG were 613（11.68%）,and the cases of CYP3A4*1G( 25343C ＞ T) CC/CT were 4 922（93.77%）， TT were 327（6.23%）.The cases of ABCB1(3435T>C) TT were 1 842（35.09%），TC/CC were 3 407（64.91%）,and the cases of CYP3A4*18B(A>G) AA were 5 149（98.09%），AG/GG were 100（1.91%）. The dosage of remifentanil should be reduced and the speed of intravenous pump should be strictly controlled during anesthesia maintenance in 54 patients with OPRM1 AA/AG, CYP3A4*1G TT and ABCB1 TT genotype. In 757 patients with OPRM1 AA/AG, CYP3A4*1G CC/CT and ABCB1 TT genotype, remifentanil dosage and intravenous pump speed should be reduced appropriately according to the response during anesthesia maintenance. In 100 CYP3A4*18B AG/GG genotype patients, the dosage of remifentanil and the speed of intravenous pump should be properly reduced. Conclusion　Different patients should use remifentanil reasonably according to their genotype, so as to provide accurate medication guidance for patients who use anesthetic drugs.

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备注/Memo

备注/Memo:
作者简介：胡玉皎（1988-），女，医学学士学位，主管技师/ 执业医师，从事临床生化工作，研究方向：临床生物化学在疾病、诊断和治疗的应用， E-mail hyjshine@163.com。
通讯作者：刘家云，男，博士。
更新日期/Last Update: 2020-10-30