SCN9A基因多態(tài)性和羅哌卡因?qū)πg后疼痛的影響
發(fā)布時間：2018-11-12 06:43
【摘要】：目的：腹腔鏡手術雖然具有切口小、創(chuàng)傷小、疼痛輕等優(yōu)點,但仍有許多患者在術后早期會出現(xiàn)不同程度的疼痛,需接受麻醉性鎮(zhèn)痛藥來緩解,腹腔鏡手術后急性疼痛是一個值得重視的問題。本實驗選擇擇期行腹腔鏡下婦科手術治療的患者,觀察羅哌卡因局部浸潤對腹腔鏡婦科手術后鎮(zhèn)痛的應用效果,并進一步分析疼痛相關的SCN9A基因單核苷酸多態(tài)性對腹腔鏡手術后患者疼痛敏感性的影響。 方法：1選擇200例行擇期腹腔鏡下婦科手術患者,采用隨機,對照和雙盲的研究方法將患者分為實驗組(R組)和對照組(N組),分別于手術開始切皮前5min在切口部位局部浸潤0.75%羅哌卡因12ml和生理鹽水12ml,記錄術前,術中,術后的血流動力學指標,麻醉后蘇醒情況以及術中麻醉藥物的用量,通過視覺模擬評分法(VAS)對術后1h,6h,12h,24h,48h切口部位進行疼痛程度評估,記錄兩組患者術后惡性嘔吐等不良反應的發(fā)生情況。2每位患者抽取外周靜脈血2ml提取DNA,應用PCR技術結(jié)合DNA直接測序方法對患者SCNA9基因進行單核苷酸多態(tài)性分析及其與術后疼痛的相關性。 結(jié)果：1一般資料比較：兩組患者年齡、體重、手術時間、麻醉時間及麻醉藥用量差異無統(tǒng)計學意義(P0.05)。2兩組患者各時間點無創(chuàng)血壓、心率差異無統(tǒng)計學意義(P0.05)。3兩組患者麻醉后恢復指標自主呼吸恢復時間、清醒時間、拔管時間差異無統(tǒng)計學意義(P0.05)。4兩組患者的靜息VAS在術后1h、6h、12h比較有顯著性差異(P0.05),兩組患者的運動VAS在術后1h、6h、12h、24h、48h比較均有顯著性差異(P0.05)。5兩組患者術后不良反應惡心嘔吐等無統(tǒng)計學意義(P0.05)。6SCN9A基因第15號外顯子2794(A/C)基因突變與術后疼痛無相關性(P0.05);SCN9A基因第18號外顯子3448(C/T)基因突變與術后疼痛存在相關性(P0.05),等位基因T的存在可能使痛閾下降。 結(jié)論：1羅哌卡因局部浸潤能夠顯著減輕婦科腹腔鏡手術患者術后切口部位的疼痛。2SCN9A基因第18外顯子3448(C/T)的雜合突變與術后疼痛的發(fā)生發(fā)展具有相關性,等位基因T使痛閾下降。3SCN9A基因3448(C／T)的突變與羅哌卡因?qū)μ弁吹挠绊憻o明顯相關性。
[Abstract]:Objective: although laparoscopic surgery has the advantages of less incision, less trauma and less pain, there are still many patients who have different degrees of pain in the early postoperative period, and need to receive anaesthetic analgesics to alleviate the pain. Acute pain after laparoscopic surgery is an important problem. Patients undergoing laparoscopic gynecologic surgery were selected to observe the effect of ropivacaine local infiltration on analgesia after laparoscopic gynecological surgery. The effects of single nucleotide polymorphisms of SCN9A gene associated with pain on the pain sensitivity of patients undergoing laparoscopic surgery were analyzed. Methods: (1) 200 patients undergoing laparoscopic gynecological surgery were divided into two groups: experimental group (group R) and control group (group N). 5min infiltrated 0.75% ropivacaine 12ml and 12 ml saline at the incision site before the operation, respectively. The hemodynamic indexes before, during and after operation, the recovery after anesthesia and the dosage of anesthetic during the operation were recorded. Visual analogue score (VAS) was used to evaluate the pain degree of incision at 1 hour, 6 h, 12 h, 24 h and 48 h after operation, and to record the occurrence of malignant vomiting and other adverse reactions in both groups. 2 the peripheral venous blood 2ml was extracted from each patient to extract DNA,. Single nucleotide polymorphism (SNP) of SCNA9 gene and its association with postoperative pain were analyzed by PCR and DNA sequencing. Results: 1 comparison of general data: there was no significant difference in age, body weight, operation time, anesthetic time and anesthetic dosage between the two groups (P0.05). There was no significant difference in heart rate between the two groups (P0.05). 3 there was no significant difference in the recovery time of spontaneous respiration, waking time and extubation time between the two groups (P0.05). 4 the resting VAS of the two groups was 6 hours after operation. There was a significant difference in 12h (P0.05). The exercise VAS of the two groups was 24 hours after 1 hour, 6 hours after operation and 12 hours after operation. There was no significant difference in postoperative adverse reactions, nausea and vomiting between the two groups (P0.05). The mutation of exon 2794 (A / C) of 6SCN9A gene was not related to postoperative pain (P0.05). Relevance (P0.05); The mutation of exon 3448 (C / T) in exon 18 of SCN9A gene was correlated with postoperative pain (P0.05). The presence of allele T might decrease the pain threshold. Conclusion: 1 Local infiltration of ropivacaine can significantly relieve the pain of incision in patients undergoing gynecological laparoscopic surgery. The heterozygosity mutation in exon 3448 (C / T) of 2SCN9A gene is associated with the occurrence and development of postoperative pain. Allele T decreased the pain threshold. The mutation of 3SCN9A gene 3448 (C / T) was not correlated with the effect of ropivacaine on pain.
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614
本文編號：2326345
[Abstract]:Objective: although laparoscopic surgery has the advantages of less incision, less trauma and less pain, there are still many patients who have different degrees of pain in the early postoperative period, and need to receive anaesthetic analgesics to alleviate the pain. Acute pain after laparoscopic surgery is an important problem. Patients undergoing laparoscopic gynecologic surgery were selected to observe the effect of ropivacaine local infiltration on analgesia after laparoscopic gynecological surgery. The effects of single nucleotide polymorphisms of SCN9A gene associated with pain on the pain sensitivity of patients undergoing laparoscopic surgery were analyzed. Methods: (1) 200 patients undergoing laparoscopic gynecological surgery were divided into two groups: experimental group (group R) and control group (group N). 5min infiltrated 0.75% ropivacaine 12ml and 12 ml saline at the incision site before the operation, respectively. The hemodynamic indexes before, during and after operation, the recovery after anesthesia and the dosage of anesthetic during the operation were recorded. Visual analogue score (VAS) was used to evaluate the pain degree of incision at 1 hour, 6 h, 12 h, 24 h and 48 h after operation, and to record the occurrence of malignant vomiting and other adverse reactions in both groups. 2 the peripheral venous blood 2ml was extracted from each patient to extract DNA,. Single nucleotide polymorphism (SNP) of SCNA9 gene and its association with postoperative pain were analyzed by PCR and DNA sequencing. Results: 1 comparison of general data: there was no significant difference in age, body weight, operation time, anesthetic time and anesthetic dosage between the two groups (P0.05). There was no significant difference in heart rate between the two groups (P0.05). 3 there was no significant difference in the recovery time of spontaneous respiration, waking time and extubation time between the two groups (P0.05). 4 the resting VAS of the two groups was 6 hours after operation. There was a significant difference in 12h (P0.05). The exercise VAS of the two groups was 24 hours after 1 hour, 6 hours after operation and 12 hours after operation. There was no significant difference in postoperative adverse reactions, nausea and vomiting between the two groups (P0.05). The mutation of exon 2794 (A / C) of 6SCN9A gene was not related to postoperative pain (P0.05). Relevance (P0.05); The mutation of exon 3448 (C / T) in exon 18 of SCN9A gene was correlated with postoperative pain (P0.05). The presence of allele T might decrease the pain threshold. Conclusion: 1 Local infiltration of ropivacaine can significantly relieve the pain of incision in patients undergoing gynecological laparoscopic surgery. The heterozygosity mutation in exon 3448 (C / T) of 2SCN9A gene is associated with the occurrence and development of postoperative pain. Allele T decreased the pain threshold. The mutation of 3SCN9A gene 3448 (C / T) was not correlated with the effect of ropivacaine on pain.
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614
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