Effect Of CYP3A4*1g Polymorphism On Pharmacodynamics Of Analgesic Sufentanil After Ciesarean Section

[Objective]To investigate the effect of CYP3A4*1G polymorphism on the pharmacodynamics of sufentanil after cesarean section.Postoperative pain after cesarean section not only causes maternal physical pain and mental discomfort,but also delays the breastfeeding of infants.However,if the dose of postoperative analgesics is increased,the side effects of drugs may also follow,nausea,vomiting,dizziness and other discomfort symptoms,which cannot improve the quality of life of mothers and infants.The genotype of puerpera was analyzed preoperatively,and then the optimal dosage of sufentanil was adjusted according to the genotype can give patients,adequate analgesia adequately,and to reduce doses caused by inappropriate because of side effects,improve the analgesic effect of anesthesia,to better protect the health of mothers and newborns,reduce the dosage of anesthetic drugs,patients to reduce the economic burden,reduce the occurrence of adverse reactions.[Methods]From February 2016 to June 2017,208 patients receiving CS treatment in qianfoshan hospital affiliated to medical college of shandong university were selected,and postoperative PCIA was performed.Pyrosequencing was used to detect the polymorphisms of CYP3A4*1G,including 117 wild homozygous(CYP3A4*1/*1),66 heterozygous(CYP3A4*1/*1G)and 25 mutant homozygous(CYP3A4a*1G/*1G).The distribution of CYP3A4*1g allele was consistent with Hardy Weinberg equilibrium(2 = 0.337,p>0.05),the gene distribution has reached the genetic balance and is representative of the population.The concentrations of sufentanil in plasma of CYP3A4*1/*1,CYP3A4*1/*1G and CYP3A4*1G/*1G genotypes were detected 1 min,10min after PCA initiation.The consumption of sufentanil at each postoperative time point(0 h,8 h,24 h,48 h)was compared between CYP3A4*1/*1,CYP3A4*1/*1G and CYP3A4*1G/*1G genotypes.The postoperative NRS score and PCIA frequency of the CYP3A4*1/*1,CYP3A4*1/*1G,CYP3A4*1 g/*1G genotype group at each time point(0 h,8 h,24 h,48 h)after surgery were recorded and compared.[Results]There was no statistically signifi cant difference in VAS at 0,8,24 and 48 h after surgery in the three groups(F = 0.907,0.192,0.757 and 0.256,all P<0.05).In the GG group with the same analgesic effect,the consumption of sufentanil[(89.8 ± 0.8)、(95.8 ± 0.5)、(96.0 ± 0· 4)μ g,F = 25.113,P<0.001]and the frequency of PCIA[(10.9 ± 2.0)、(17.4 ± 4.5)、(18.3 ± 3.7)number of times,F = 35.227,P<0.001]were significantly less than those in the AA group and GA group 48 h after surgery.However,there was no significant difference in the consumption of sufentanil and PCIA times between the GA group and the AA group 48 h after surgery(P =>0.05).[Conclusions]The drug dosage of sufentanil can be adjusted in combination with t.he genotype of the patients to reduce the drug dosage of the patients after cesarean section.