Shi Nian-Jun, Zhang Wei-Xia, Zhang Ning, Zhong Li-Na, Wang Ling-Ping
Department of Anesthesiology, Linyi People's Hospital, Linyi, People's Republic of China.
Medicine (Baltimore). 2017 Jun;96(24):e7002. doi: 10.1097/MD.0000000000007002.
The motive of this study was to investigate the collaboration between MDR1 gene polymorphisms and anesthetic effects following pediatric tonsillectomy.
All together 178 children undergoing tonsillectomy with preoperative sevoflurane-remifentanil anesthesia were selected. In order to determine MDR1 gene polymorphisms of 3435C > T, 1236C > T, and 2677G > T/A, polymerase chain reaction-restriction fragment length polymorphism was used. Mean arterial pressure (MAP), diastolic blood pressure (DBP), systolic blood pressure (SBP), and heart rate (HR) at T0 (5 mins after the repose), T1 (0 min after tracheal intubation), T2 (5 mins after the tracheal intubation), T3 (0 min after the tonsillectomy), T4 (0 min after removal of the mouth-gag) and T5 (5 min after the extubation) were observed. The visual analog scale (VAS), the face, legs, activity, cry, and consolability (FLACC) pain assessment, and Ramsay sedation score were recorded after the patients gained consciousness. The adverse reactions were also observed.
As compared to the CT + TT genotype of MDR1 1236C > T, the time of induction, respiration recovery, eye-opening, and extubation of children with the CC genotype was found to be shorter (all P <.05); the MAP, SBP, DBP, and HR were significantly reduced at T5 in children that possessed the CC genotype (all P <.05), the VAS at postoperative 1, 2, 4, and 8 hours and Ramsay sedation score were decreased, while the FLACC score increased (all P <.05). It was found that the adverse reaction rate was lower in children bearing the CC genotype (P <.05).
It could be concluded that anesthetic effect in patients with the MDR1 1236C > T CC genotype was found to be superior to those carrying the CT + TT genotype.
本研究旨在探讨多药耐药基因1（MDR1）基因多态性与小儿扁桃体切除术后麻醉效果之间的关系。
选取178例行扁桃体切除术且术前采用七氟醚-瑞芬太尼麻醉的儿童。采用聚合酶链反应-限制性片段长度多态性方法检测MDR1基因3435C>T、1236C>T和2677G>T/A位点的基因多态性。观察T0（静息5分钟后）、T1（气管插管后0分钟）、T2（气管插管后5分钟）、T3（扁桃体切除术后0分钟）、T4（取出开口器后0分钟）和T5（拔管后5分钟）时的平均动脉压（MAP）、舒张压（DBP）、收缩压（SBP）和心率（HR）。患者清醒后记录视觉模拟评分（VAS）、面部、腿部、活动、哭闹及安慰度（FLACC）疼痛评估和Ramsay镇静评分。同时观察不良反应。
与MDR1 1236C>T的CT+TT基因型相比，CC基因型儿童的诱导时间、呼吸恢复时间、睁眼时间和拔管时间均较短（均P<.05）；CC基因型儿童在T5时MAP、SBP、DBP和HR显著降低（均P<.05），术后1、2、4和8小时的VAS评分降低，Ramsay镇静评分降低，而FLACC评分升高（均P<.05）。发现CC基因型儿童的不良反应发生率较低（P<.05）。
可以得出结论，MDR1 1236C>T CC基因型患者的麻醉效果优于携带CT+TT基因型的患者。
