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目的 研究老年肥胖患者脑血管介入手术中基因多态性对减少舒芬太尼术后并发症的指导意义.方法 选择择期全身麻醉下老年肥胖患者脑血管介入手术160例,年龄55～75岁,BMI指数:28 ～ 32kg/m2,ASA分级:2级～3级,随机分为两组:A组采用焦磷酸测序法检测CYP3A4* 1G基因多态性,根据基因型将患者分成突变型纯合子(* 1G/* 1G)TC组、野生型纯合子(*1/*1)YC组和突变型杂合子(*1/* 1G)TZ组,根据基因不同指导患者舒芬太尼用量,TC组舒芬太尼0.16μg/kg,YC组、TZ组舒芬太尼0.2μg/kg,B组患者舒芬太尼常规剂量0.2μg/kg,记录两组患者麻醉诱导前、喉罩置入后、手术开始后1分钟、喉罩拔出时及离开手术室时的血压心率;记录离开手术室前,术后12h、24h的VAS疼痛评分及术后24h恶心呕吐(PONV,postoperative nausea and vomiting)和呼吸抑制等并发症.结果 A组和B组患者各时间点血压心率变化无统计学差异(P＞0.05);A组和B组患者各时间点VAS评分差异无统计学意义(P＞0.05);B组术后并发症的发生频率高于A组,差异有统计学意义(P＜0.05).结论 基因多态性在老年肥胖患者脑血管介入手术中可以指导舒芬太尼的用量,对减少术后并发症有临床意义.“,”Objective To study the significance of genetic polymorphism in elderly patients with obesity after cerebral vascular intervention (PCI) in reducing the complications of sufentanil.Methods Totally 160 elderly patients accepting general anesthesia undergo elective cerebrovascular intervention,aged 55 ～ 75 years,with BMI index of 28 ～ 32 and ASA grading of Ⅱ-Ⅲ.They were randomly divided into two groups:The polymorphism of CYP3A4 * 1G gene was detected by pyrosequencing,group A were divided into(* 1 / * 1G) TC group,wild type homozygous (* 1/ * 1) YC group and mutant heterozygote (* 1/* 1G) TZ group according to the genotype;Sufentanil was administered according to different gene,sufentanil dosage was 0.16μg / kg in the TC group,0.2 μg / kg in the YC group,and 0.2 μg / kg in the TZ group.Group B were conventional dose of sufentanil 0.2μg / kg.The blood pressure and heart rate at the time of anesthesia induction,laryngeal mask implantation,1 minute after the start of operation,pull-out of the laryngeal mask and left the operating room were recorded;Before the operation,Postoperative 12 h and 24 h VAS pain scores and 24 h postoperative nausea,vomiting (PO NV) and respiratory depression and other complicationswere recorded.Results There was no significant difference in heart rate and blood pressure between the two groups (P ＞ 0.05).There was no significant difference in VAS scores between group A and group B at all time points (P ＞ 0.05).The frequency of postoperative complications in group B was significantly higher than that in group A (P ＜ 0.05).Conclusion Gene polymorphism can be used to guide the dosage of sufentanil in elderly patients with obesity.It is of clinical significance in reducing postoperative complications.