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目的:评价n OPRMn 1A118Gn 和n CYP3A5n *3n 基因多态性对患者术后氢吗啡酮镇痛效应的影响。n 方法:择期全麻下行单侧锁骨骨折切开复位内固定术患者120例，ASA分级Ⅰ或Ⅱ级，年龄20～64岁。采集外周静脉血作为样本，使用血液/细胞/组织基因组DNA提取试剂盒处理血标本，多重PCR法检测n OPRMn 1A118Gn 和n CYP3A5n *3n 位点的基因多态性。分别根据n OPRMn 1A118Gn 和n CYP3A5n *3n 基因型将患者分为野生型纯合子组[AA组(n n＝64)，n *1/n *1组(n n＝17)]、杂合子组[AG组(n n＝41)，n *1/n *3组(n n＝45)]和突变型纯合子组[GG组(n n＝15)，n *3/n *3组(n n＝58)]。术后接PCA泵：盐酸氢吗啡酮8 mg与生理盐水配至100 ml，负荷剂量2 ml，背景剂量：1 ml/h，按压1次2 ml，锁定时间10 min。于术后1、6、12、24和36 h时氢吗啡酮累积用量，观察恶心呕吐的发生情况。n 结果:AA组、AG组和GG组术后1、6、12、24和36 h时氢吗啡酮累积用量和恶心呕吐发生率比较差异无统计学意义(n P>0.05)。与n *1/n *1组比较，n *1/n *3组和n *3/n *3组术后12、24和36 h时氢吗啡酮累积用量降低(n P0.05)。n 结论:CYP3A5n *3n 基因多态性是引起患者术后氢吗啡酮药效学个体差异的遗传因素之一。n “,”Objective:To evaluate the effect of n OPRMn 1A118Gn and n CYP3A5n *3n gene polymorphisms on postoperative analgesic effect of hydromorphone after surgery.n Methods:One hundred and twenty patients, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, aged 20-64 yr, scheduled for elective open reduction and internal fixation after unilateral clavicle fracture under general anesthesia, were enrolled in this study.Peripheral venous blood samples were collected, blood/cell/tissue genomic DNA extraction kit was used to treat blood samples, and multiplex polymerase chain reaction was used to detect the genetic polymorphisms at n OPRMn 1A118Gn and n CYP3A5n *3n sites.According to n OPRMn 1A118Gn and n CYP3A5n *3n genotypes, patients were divided into wild-type homozygous group [AA group (n n=64), n *1/n *1 group (n n=17)], heterozygous group [AG group (n n=41), n *1/n *3 group (n n=45)] and mutant homozygous group [GG group (n n=15), n *3/n *3 group (n n=58)]. Patient-controlled intravenous analgesia solution contained hydromorphone hydrochloride 8 mg in 100 ml of normal saline, and patient-controlled analgesia pump was connected after operation.The patient-controlled analgesia pump was set up with a 2 ml loading dose, 2 ml for each pressing, a 10 min lockout interval and background infusion at a rate of 1 ml/h.The cumulative dose of hydromorphone was recorded at 1, 6, 12, 24 and 36 h after operation, and the occurrence of nausea and vomiting was observed.n Results:There was no significant difference in the cumulative dose of hydromorphone and incidence of nausea and vomiting at 1, 6, 12, 24 and 36 h after operation among AA group, AG group and GG group (n P>0.05). Compared with groupn *1/n *1, the cumulative consumption of hydromorphone was significantly decreased at 12, 24 and 36 h after operation (n P0.05).n Conclusion:CYP3A5n *3n gene polymorphism is one of the genetic factors causing individual differences in the pharmacodynamics of hydromorphone after surgery.n