文章摘要
围手术期精准医疗有助于麻醉医师改善患者预后：β受体阻滞剂与阿片类药物的遗传变异性（英文）
Precision medicine is ammunition for anesthesiologists to improve patient outcomes during the perioperative period: genetic variability of beta-blockers and opioids
  
DOI：
中文关键词: 精准医疗  围手术期  β受体阻滞剂  阿片类药物
英文关键词: Precision medicine  Perioperative period  Beta blockers  Opioids
基金项目:
作者单位E-mail
克里斯托弗·斯宾塞 Department of Anesthesiology, University of Virginia, Charlottesville, VA 22901, U.S.A.  
杨建军 Department of Anesthesiology, Zhongda Hospital, Medical School, Southeast University, 210009 Nanjing, China.  
左志义 Department of Anesthesiology, University of Virginia, Charlottesville, VA 22901, U.S.A. zz3c@virginia.edu 
摘要点击次数: 2754
全文下载次数: 2430
中文摘要:
      随着精准医疗的不断发展，医师能够根据患者的个体遗传和分特征制定疾病的治疗和预防策略。近年来，基因测序及其相关技术在医疗机构中变得更加经济和便捷，其在各种医疗领域中的应用范围也在不断扩大。特别是在围手术期，有很多使用精准医疗的机会。例如，α和β肾上腺素能受体的个体多态性可提高β受体阻滞剂的疗效，同时也使患者容易出现药物不良反应，包括低血压和心动过缓等。同样，阿片受体的个体多态性可以使阿片类药物在术后镇痛中的有效性提高或者降低。此外，细胞色素P450 2D6(CYP2D6)酶基因的突变可以通过加速或减缓β受体阻滞剂和阿片类药物的代谢和清除，大大影响到二者的临床反应。术前基因测序可使麻醉医师识别患者上述以及其他相关的分子特征，并相应地选择适当的围手术期治疗策略，从而最大限度地提高临床疗效，减少不良事件的发生率。当下正是麻醉医师和围手术期医务人员实践精准医疗的时候。
英文摘要:
      The evolving practice of precision medicine allows physicians to make disease treatments and prevention decisions based on a patient’s individual genetic and molecular profile. In recent years, gene sequencing and related techniques are becoming more affordable and more accessible to healthcare providers, and their use in various medical fields continues to expand. In particular, there are numerous opportunities for the use of precision medicine in the perioperative setting. For example, individual polymorphisms in alpha and beta adrenergic receptors can improve the efficacy of beta blockade, or predispose apatientto adverse drug reactions including hypotension and bradycardia. Likewise, particular polymorphisms in opioid receptors can increase or decrease the effectiveness of various opioid medications for achieving adequate postoperative analgesia. In addition, mutations in the cytochrome P4502D6 (CYP2D6) enzyme can drastically affect the clinical response to a particular subset of beta blockers and opioids by accelerating or decelerating their metabolism and clearance. Preoperative genetic testing would allow anesthesiologists to identify these and other relevant molecular characteristics in their patients, and choose appropriate perioperative therapies accordingly in order to maximize clinical outcomes while minimizing the incidence of adverse events. It is the time for anesthesiologists and perioperative care providers to practice precision medicine.
查看全文   查看/发表评论  下载PDF阅读器
关闭