国际麻醉学与复苏杂志   2017, Issue (5): 9-9
    
吸烟患者细胞色素P450酶2E1的表达与七氟醚阻断肾上腺素能反应最低肺泡气浓度的相关性研究
徐永生1()
1.哈尔滨市第五医院
Association between cytochrome P450 family 2 subfamily E member 1 levels and minimum alveolar concentrations of sevoflurane that block adrenergic responses to pneumoperitoneum stimulation in smokers receiving laparoscopic cholecystectomy
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摘要:

目的 通过检测吸烟患者细胞色素P450酶2E1(cytochrome P450 family 2 subfamily E member 1, CYP2E1)含量变化,分析其与七氟醚阻断肾上腺素能反应的最低肺泡气浓度 (minimum alveolar concentration to block the adrenergic response, MACBAR)值的相关性,探讨吸烟对七氟醚MACBAR值的影响及机制。 方法 选择ASA分级Ⅰ、Ⅱ级,年龄30~50岁,择期拟在全身麻醉下行腹腔镜胆囊切除术的患者90例。通过询问患者本人及其家属评估两组患者吸烟情况,同时结合血清可替宁含量,将其分为吸烟组(A组,49例)和非吸烟组(B组,41例)。采用快诱导气管内插管静吸复合麻醉,两组患者七氟醚目标呼气末浓度平衡时间>20 min,使用气腹刺激,观察MAP和HR变化,采用单次刺激法测定七氟醚MACBAR。手术前1 d抽取患者晨起静脉血5 ml,离心收集血清,检测可替宁和CYP2E1含量。 结果 A组、B组诱导前HR和MAP组间比较,差异无统计学意义(P>0.05);组内HR和MAP基础值(气腹针穿刺前3 min、1 min的平均值)比诱导前明显下降(P<0.05);气腹后HR和MAP明显上升,其中MAP在 A组升高幅度大于B组(P<0.05),HR组间比较差异无统计学意义(P>0.05)。A组七氟醚MACBAR、CYP2E1和可替宁水平均高于B组(P<0.05)。A组CYP2E1含量与MACBAR有相关性,且呈正相关(r=0.51,P<0.05)。 结论 吸烟患者CYP2E1含量与七氟醚MACBAR值有一定相关性,提示吸烟者血清中CYP2E1可能对七氟醚MACBAR值有影响。

关键词: 吸烟; 七氟醚; 阻断肾上腺素能反应的最低肺泡气浓度值; 可替宁; 细胞色素P4
Abstract:

Objective To determine whether smoking affects minimum alveolar concentrations of sevoflurane that block adrenergic responses(MACBAR) in patients receiving laparoscopic cholecystectomy. Methods A total of 90 ASA grade Ⅰ or Ⅱ patients(30-50 years old) receiving laparoscopic cholecystectomy were enrolled in this study, and the patients had 49 smokers and 41 non-smokers. The levels of cytochrome P450 family 2 subfamily E member 1(CYP2E1, a principal enzyme metabolizes sevoflurane) and cotinine (a metabolite of nicotine, a bioactive component in cigarettes) in serum were measured one day before the operation. The patients received similar procedures for the induction of general anesthesia, thereafter, the anesthesia was maintained with sevoflurane. Pneumoperitoneum stimulation was applied to trigger adrenergic responses that were assessed by changes in MAP and HR. Meanwhile, MACBAR was recorded. Results HR and MAP were at the same levels between smokers and non-smokers(P>0.05). As expected, the levels of CYP2E1 and cotinine in serum were significantly higher in smokers than non-smokers(P<0.05). After general anesthesia was induced, HR and MAP were significantly decreased in both smokers and non-smokers(P<0.05). Pneumoperitoneum stimulation elevated these parameters more robustly in smokers than non-smokers(P<0.05). Moreover, MACBAR of sevoflurane and levels of CYP2E1 showed a significant correlation(r=0.51,P<0.05), and both were higher in smokers than non-smokers(P<0.05). Conclusions Smoking patients had higher levels of CYP2E1, which may accelerate the metabolism of sevoflurance and increase MACBAR.

Key words: Smoking; Sevoflurane; Minimum alveolar concentration to block the adrenergic response; Cotinine; Cytochrome P450 family 2 subfamily E member 1