中国人扩张型心肌病与受磷蛋白基因关系的研究

受磷蛋白（phospholamban）是心肌收缩的一个重要调节因子,可抑制心肌肌浆网钙ATPase的活性、降低其对钙的亲和力。正常情况下,受磷蛋白可被不同的蛋白激酶磷酸化从而解除其肌浆网钙ATPase的抑制作用。国外两个DCM家系研究发现受磷蛋白基因突变与DCM的发生有关,研究目的旨在探讨中国人群心肌特异性受磷蛋白基因突变与特发性扩张型心肌病发病的关系。收集60例确诊的特发性扩张型心肌病患者临床资料,采集血样本并分离白细胞和提取基因组DNA。应用PCR扩增肌特异性受磷蛋白基因片段,经测序检测基因突变的存在。结果显示60例扩张型心肌病人受磷蛋白基因开放阅读框未发现突变,仅有两例患者出现阅读框3′部分非翻译区分别离终止密码153和173位单个碱基T的缺失。两例患者终止密码后非翻译区单个碱基T的缺失据分析并无实际意义。因此我们认为绝大部分中国人扩张型心肌病的发病可能与受磷蛋白基因突变无关。Abstract: Phospholamban (PLB) is a prominent regulator of myocardial contractility and a reversible inhibitor of the cardiac sarcoplasmic reticulum Ca2+ ATPase activity. In normal cardiac muscles, phospholamban can be phosphorylated at distinct sites by various protein kinases and release its inhibition to sarcoplasmic reticulum Ca2+ ATPase. The studies of pedigrees have shown dilated cardiomyopathy (DCM) is related with mutation of PLB. The aim of present study is to investigate the relationship between mutation of PLB gene and DCM. Sixty patients with idiotic DCM were enrolled in present study. The clinical data were collected, including clinical symptoms, ECG and echocardiography. Peripheral blood samples of all these subjects were collected to extract genome DNA. The fragments of PLB gene were amplified by PCR and PCR fragment sequencing was performed to study weather mutation of phospholamban gene exists. phospholamban gene did not show any mutation in these patients. Most Chinese DCM patients may not be related with mutation of PLB gene.     

ALI/ARDS患者使用保护性通气策略对于肺部损伤的影响

急性肺损伤(ALI)和急性呼吸窘迫综合征(ARDS)是常见的临床综合征,绝大多数ALI/ARDS患者需机械通气治疗,机械通气在提供可接受的肺部气体交换的同时治疗基础疾病,但机械通气本身也会引起肺部损伤,即机械通气性肺损伤(VILI)。而通过调整机械通气参数的设置,使用保护性通气策略可显著减低ALI/ARDS患者机械通气性肺损伤程度,从而减少肺部感染,缩短机械通气时间和住院时间,降低28天死亡率,明显改善ALI/ARDS患者的生存质量,起到最大程度地肺保护作用。本文从气道平台压,通气容积,呼气末正压等几个不同通气参数方面分别进行综述,讨论ALI/ARDS患者机械通气时使用保护性通气策略对于肺部损伤的影响。     

麻醉蒸发器输出浓度的影响因素与蒸发器校准研究进展

麻醉蒸发器是麻醉呼吸机的核心部件。它能够体现麻醉呼吸机的品质水平,直接影响吸入麻醉的临床效果,并进而关乎接受麻醉的患者的安全。随着现今临床患者周转率提高、手术量增大,应用到全麻手术中的吸入麻醉技术也占了更大比重,蒸发器临床使用频率也因此不断提高,蒸发器本身使用年限也在逐年增大--这些因素皆可能会引起蒸发器实际输出浓度的偏差,继而或对临床麻醉的实施和患者麻醉效果造成影响。本文立足于对麻醉蒸发器结构及相关原理的综述,着眼于不同条件对挥发效率的影响和输出浓度的检测校准的最新标准与进展;为指导临床麻醉过程中蒸发器更为科学精准的应用提供科学理论依据。