约旦产妇剖宫产脊髓麻醉期间麻黄碱的需求量：与β2肾上腺素能受体基因变异的关联

Ephedrine requirements during spinal anesthesia for cesarean delivery in Jordanian parturients: association with b2 adrenoceptor gene variants.

作者信息

Almustafa Mahmoud M, Al-Oweidi Abdelkareem S, Al-Zaben Khaled R, Qudaisat Ibraheem Y, Abu-Halaweh Sami, Alghanem Subhi M, Massad Islam M, Samarah Walid, Al-Shaer Reem A, Ismail Said, Khazawla Fawaz

机构信息

Associate Professor Mahmoud Mansour Almustafa, King Faisal Specialist Hospital and Research Center,, Anesthesia Department MBC 22, PO Box 3354 Riyadh,11211,, Saudi Arabia, T: 966 146 47272 Ext: 32700,

出版信息

Ann Saudi Med. 2016 Jan-Feb;36(1):29-36. doi: 10.5144/0256-4947.2016.29.

DOI:10.5144/0256-4947.2016.29

PMID:26922685

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6074272/

Abstract

BACKGROUND

Maternal hypotension after spinal anesthesia for cesarean delivery is common. Many studies performed on the b2-adrenoceptor (b2AR) gene variants and their association with vasopressor requirements during and after neuroaxial block have contradictory conclusions.

OBJECTIVES

The aim of the study was to evaluate the influence of the b2AR in codons 16 and 27 on the incidence of maternal hypotension and ephedrine consumption after spinal anesthesia for cesarean delivery in an Arab ethnic group.

DESIGN

A prospective gene association study.

SETTING

Jordan University Hospital from 1 July 2013 to 31 January 2014.

PATIENTS AND METHODS

We enrolled parturients who underwent cesarean delivery under spinal anesthesia. Spinal anesthesia was performed with 10 mg plain bupivacaine along with 25 micro g fentanyl. Hypotension was treated with ephedrine and the amount consumed in the first 30 minutes after spinal anesthesia was calculated. The b2AR genotype at codons 16 and 27 was determined. We studied the correlation between the b2AR genotype and the amount of ephedrine consumption after spinal anesthesia.

MAIN OUTCOME MEASURES

Amount of ephedrine used.

RESULTS

Of 250 patients enrolled in the study, genotype and clinical data were available for 234 cases. Ephedrine was used in 94% of patients. There was a significant effect of b2AR genotype on ephedrine dose in the first 30 minutes after spinal anesthesia in codon 16 and 27. Arg16 homozygotes received less ephedrine (14.0 [11.2] mg) than Gly16 homozygotes (38.6 [25.7] mg) and Arg16Gly heterozygotes (33.42 [22.70] mg) (P < .0001). Gln27 homozygotes received less ephedrine (18.2 [12.8] mg) than Glu 27 homozygotes (47.5 [27.0] mg) and Gln27Glu heterozygotes (48.2 [23.7] mg). (P < .0001).

CONCLUSION

In an Arab ethnic group, the b2AR gene has a role in maternal hypotension after spinal anesthesia. The Gly16 and Glu27 alleles have a higher incidence of arterial hypotension and required a greater amount of vasopressor to treat hypotension compared with homozygous Arg16 and Gln27 carriers.

LIMITATIONS

Fasting time and hydration protocol, the use of a fixed dose of ephedrine, and relatively small sample size.

摘要

背景

剖宫产脊髓麻醉后产妇低血压很常见。许多关于β2 -肾上腺素能受体（β2AR）基因变异及其与神经轴阻滞期间及之后血管升压药需求相关性的研究得出了相互矛盾的结论。

目的

本研究旨在评估密码子16和27处的β2AR对阿拉伯族裔剖宫产脊髓麻醉后产妇低血压发生率及麻黄碱用量的影响。

设计

一项前瞻性基因关联研究。

地点

2013年7月1日至2014年1月31日期间的约旦大学医院。

患者与方法

我们纳入了接受脊髓麻醉下剖宫产的产妇。脊髓麻醉采用10mg普通布比卡因加25μg芬太尼。低血压用麻黄碱治疗，并计算脊髓麻醉后前30分钟的用量。测定密码子16和27处的β2AR基因型。我们研究了β2AR基因型与脊髓麻醉后麻黄碱用量之间的相关性。

主要观察指标

麻黄碱用量。

结果

在纳入研究的250例患者中，234例有基因型和临床数据。94%的患者使用了麻黄碱。密码子16和27处的β2AR基因型对脊髓麻醉后前30分钟麻黄碱剂量有显著影响。精氨酸（Arg）16纯合子接受的麻黄碱（14.0[11.2]mg）少于甘氨酸（Gly）16纯合子（38.6[25.7]mg）和Arg16Gly杂合子（33.42[22.70]mg）（P <.0001）。谷氨酰胺（Gln）27纯合子接受的麻黄碱（18.2[12.8]mg）少于谷氨酸（Glu）27纯合子（47.5[27.0]mg）和Gln27Glu杂合子（48.2[23.7]mg）（P <.0001）。