CYP3A4*1G基因多态性对胃肠外科老年患者舒芬太尼全麻诱导中应激反应的影响

目的： 研究胃肠外科手术老年患者CYP3A4*1G基因多态性与舒芬太尼对应激反应抑制作用的相关性。方法： 择期全麻胃肠外科手术老年患者119例，以焦磷酸测序法检测CYP3A4*1G基因多态性，根据基因型进行分组，比较不同基因型患者插管前后及切皮前后应激反应（收缩压、舒张压和心率）的变化。麻醉诱导方法为依次给予咪达唑仑、舒芬太尼、维库溴铵、依托咪酯。结果： CYP3A4*1G等位基因突变率为20.17%，符合Hardy-Weinberg平衡。将患者分为野生型组、突变型杂合子组和突变型纯合子组，三组患者插管前后的收缩压、舒张压和心率的波动及切皮前后的舒张压的波动的差别无统计学意义（P>0.05），而野生型组与突变型杂合子组患者切皮前后的收缩压和心率的波动的差别有统计学意义（P<0.05）。结论： CYP3A4*1G基因多态性与舒芬太尼抑制切皮引起的应激反应的强弱有关。

Impact of CYP3A4*1G genetic polymorphism on stress reaction during induction of general anesthesia with sufentanil in elderly patients receiving gastrointestinal surgery

OBJECTIVE To study relationship between CYP3A4*1G genetic polymorphism and stress reaction during induction of general anesthesia with sufentanil in elderly patients receiving gastrointestinal surgery.METHODS A total of 119 elderly patients received elective gastrointestinal surgery under general anesthesia were recruited into this study. CYP3A4*1G genetic polymorphism was analyzed in pyrosequencing method, and patients were grouped according to their genotypes. Stress reaction parameters, including systolic blood pressure, diastolic blood pressure and heart rate, were recorded prior to anesthesia induction (T₀), before and instantly after intubation (T₁ and T₂) and skin cut (T₃ and T₄), and were analyzed by different genotypes. During anesthesia induction, midazolam, sufentanil, vecuronium bromide and etomidate were given in orders.RESULTS CYP3A4*1G allele rate was 20.17%, in accordant with Hardy-Weinberg equilibrium. Patients were divided into 3 groups, wild-type group, mutant-heterozygous group and mutant-homozygous group. No significant difference was noted between each two groups (P>0.05) in fluctuations of systolic blood pressure, diastolic blood pressure, heart rate before and instantly after intubation (T₂-T₁) and in fluctuations of diastolic blood pressure before and instantly after skin cut (T₄-T₃). Meanwhile, between wild-type and mutant-heterozygote group, a significant difference appeared in fluctuations of systolic blood pressure and heart rate before and instantly after skin cut (P<0.05).CONCLUSION CYP3A4*1G genetic polymorphism is associated with strength of stress reaction of skin cutting inhibited by sufentanil.