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Anesth Analg:ADRB2基因型可影响剖宫产术对去氧肾上腺素的需求量

2015-07-09 嗷大森 MedSci原创

背景:低血压是椎管内麻醉(尤其是腰麻)剖宫产手术中最常见的并发症之一,以往麻黄碱是处理产科手术麻醉时低血压的首选血管收缩药。纯α受体激动药去氧肾上腺素,可通过直接收缩血管起到升高血压作用,对防治腰麻低血压比麻黄碱更具有针对性且起效快,作用时间短,更适合微量静脉泵。 β2-肾上腺素能受体(ADRB2基因)具有数个具备生理学或药理学意义的多态性位点。前期的工作已经阐明ADRB2基因型可影响腰


背景:低血压是椎管内麻醉(尤其是腰麻)剖宫产手术中最常见的并发症之一,以往麻黄碱是处理产科手术麻醉时低血压的首选血管收缩药。纯α受体激动药去氧肾上腺素,可通过直接收缩血管起到升高血压作用,对防治腰麻低血压比麻黄碱更具有针对性且起效快,作用时间短,更适合微量静脉泵。

β2-肾上腺素能受体(ADRB2基因)具有数个具备生理学或药理学意义的多态性位点。前期的工作已经阐明ADRB2基因型可影响腰麻剖宫产术中用于维持血压的麻黄碱的泵注量。本研究探讨ADRB2基因型是否会影响剖宫产期间去氧肾上腺素的给药量。如果去氧肾上腺素不是因为通过作用于β2-肾上腺素能受体而作为用于维持血压的血管升压药,我们就不应该假设ADRB2基因型改变了麻黄碱的剂量反应。

方法:本研究的试验对象是择期在腰麻下行剖宫产术的产妇。收缩压基础值是确定的,在腰麻开始时给予高比重布比卡因12mg,芬太尼20ug,吗啡200ug。在腰麻开始后使用一种标准公式(如果SBP介于基础值的90%-99%,则去氧肾上腺素的泵注速度为50μg/min,如果SBP介于基础值的80%-89%,则去氧肾上腺素的泵注速度为100μg/min,如果SBP低于基础值的80%则去氧肾上腺素的泵注速度为200μg/min)泵注去氧肾上腺素15分钟以处理术中低血压。ADRB2的基因型由16及27位的密码子所决定,通过方差分析和线性回归来比较基因型对去氧肾上腺素泵注量的影响。



结果:我们收集了本实验中96位产妇的完整数据并进行分析。采用非标准化变量分析,在16及27密码子决定的不同基因型患者之间,泵注的去氧肾上腺素量的剂量没有显著差异。当调整协变量(母亲体重指数,收缩压与舒张压基础值,新生儿重量及种族)时,16位精氨酸纯合子基因亚型相比16位谷氨酸纯合子基因亚型患者,其所需要泵注的去氧肾上腺素量增加了200μg(95%置信区间,4-396;P =0.04)。

结论:腰麻后用于维持收缩压的去氧肾上腺素的需求量受ADRB2基因型的影响,但是这种影响不如麻黄碱显著。这表明前期的工作阐明通过一个微分对基于ADRB2基因型的麻黄碱的反应剂,至少部分解释ADRB2基因型对麻黄碱需求量的显著影响。这也表明去氧肾上腺素对腰麻的反应存在ADRB2基因亚型的治疗差异。

原始出处:

Odekon L1, Landau R, Blouin JL, Brodow D, Wang S, Smiley RM.The Effect of β2-Adrenoceptor Genotype on Phenylephrine Dose Administered During Spinal Anesthesia for Cesarean Delivery.Anesth Analg. 2015 Jun;120(6):1309-16. doi: 10.1213/ANE.0000000000000675.

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    2016-09-15 1e10c84am36(暂无匿称)

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    2015-08-09 AspirantSuo
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    2015-12-23 经常头晕
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    2015-07-09 huaxipanxing

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