HCRTR1/2基因变异和非遗传因素对异丙酚、右美托咪定和瑞芬太尼麻醉时睡眠-觉醒转换和血流动力学稳定性的联合影响

IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY
Zhuoling Zheng, Faling Xue, Haini Wang, Qingling Gu, Rong Hu, Xiaoyan Li, Min Huang, Wenqi Huang, Zhongxing Wang, Jiali Li
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引用次数: 0

摘要

背景:异丙酚-瑞芬太尼-右美托咪定为基础的全静脉麻醉在临床中应用广泛。然而,维持睡眠-觉醒转换期间的安全性和确保血流动力学稳定性仍然构成重大挑战。本研究旨在探讨在食欲能神经元中特异性表达的基因对意识丧失时间(LOC)、苏醒时间和心血管波动等个体间变异的影响。方法:共纳入250例患者。基因多态性检测采用Agena Bioscience MassARRAY系统。麻醉诱导以异丙酚开始,并以异丙酚和瑞芬太尼维持。麻醉诱导前给予右美托咪定。记录LOC时间、苏醒时间、心率(HR)和平均动脉压(MAP)。结果:HCRTR2(下丘脑分泌素受体2)rs2292040和rs76380807与LOC时间显著相关,HCRTR2 rs7774031与醒来时间显著相关。HCRTR2 rs3122162、rs3122169和rs74296544与HR波动相关,HCRTR1(下丘脑分泌素受体1)rs2176807、rs2271933、rs871634和HCRTR2 rs74296544与MAP波动相关。多元线性回归分析显示,LOC时异丙酚> 4µg ml- 1的靶控输注(TCI)血浆浓度(Cp)和右美托咪定是LOC时间的影响因素,而HCRTR2 rs7774031影响苏醒时间。基线HR、基线MAP、右美托咪定、HCRTR2 rs3122162和HCRTR1 rs2176807是心血管易感性的预测因素。LOC时间、wake - up时间、平均HR和平均MAP波动的预测模型分别占变化的41.89%、3.36%、35.56%和47.41%。结论:HCRTR1和HCRTR2基因变异可能影响异丙酚、右美托咪定和瑞芬太尼麻醉时的睡眠-觉醒转换和血流动力学稳定性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Combined effects of HCRTR1/2 gene variants and non-genetic factors on sleep-wake transition and hemodynamic stability during propofol, dexmedetomidine, and remifentanil anesthesia.

Background: Propofol-remifentanil-dexmedetomidine-based total intravenous anesthesia is widely utilized in clinical practice. However, maintaining safety during the sleep-wake transition and ensuring hemodynamic stability continues to pose significant challenges. This study aimed to investigate the impact of genes that are expressed specifically in orexinergic neurons on interindividual variability in the time to loss of consciousness (LOC), time to wake, and cardiovascular fluctuations.

Methods: A total of 250 patients were included in the study. Gene polymorphisms were detected using the Agena Bioscience MassARRAY system. Anesthesia induction began with propofol and was maintained with propofol and remifentanil. Dexmedetomidine was administered before anesthesia induction. The time to LOC, time to wake, heart rate (HR), and mean arterial pressure (MAP) were documented.

Results: HCRTR2 (Hypocretin receptor 2) rs2292040 and rs76380807 were significantly associated with the time to LOC, and HCRTR2 rs7774031 was correlated with the time to wake. HCRTR2 rs3122162, rs3122169, and rs74296544 were correlated with HR fluctuations, and HCRTR1 (Hypocretin receptor 1) rs2176807, rs2271933, rs871634, and HCRTR2 rs74296544 were associated with MAP fluctuations. Multiple linear regression analysis revealed that the Target-controlled infusion (TCI) plasma concentration (Cp) of propofol > 4 µg ml- 1 at the time of LOC and dexmedetomidine were influencing factors for the time to LOC, whereas HCRTR2 rs7774031 influenced the time to wake. Baseline HR, baseline MAP, dexmedetomidine, HCRTR2 rs3122162, and HCRTR1 rs2176807 were predictive factors for cardiovascular susceptibility. The predictive models for the time to LOC, time to wake, mean HR, and mean MAP fluctuations accounted for 41.89%, 3.36%, 35.56%, and 47.41% of variations, respectively.

Conclusions: Genetic variants of HCRTR1 and HCRTR2 may affect sleep-wake transition and hemodynamic stability during propofol, dexmedetomidine, and remifentanil anesthesia.

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来源期刊
Pharmacological Reports
Pharmacological Reports 医学-药学
CiteScore
8.40
自引率
0.00%
发文量
91
审稿时长
6 months
期刊介绍: Pharmacological Reports publishes articles concerning all aspects of pharmacology, dealing with the action of drugs at a cellular and molecular level, and papers on the relationship between molecular structure and biological activity as well as reports on compounds with well-defined chemical structures. Pharmacological Reports is an open forum to disseminate recent developments in: pharmacology, behavioural brain research, evidence-based complementary biochemical pharmacology, medicinal chemistry and biochemistry, drug discovery, neuro-psychopharmacology and biological psychiatry, neuroscience and neuropharmacology, cellular and molecular neuroscience, molecular biology, cell biology, toxicology. Studies of plant extracts are not suitable for Pharmacological Reports.
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