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Safety and validity of the small heparin-bonded artificial membrance lung for neonatal extracorporeal lung assist.

小型肝素人工膜肺用于新生儿体外肺辅助的安全性和有效性。

基本信息

批准号：
03454378
负责人：
TERASAKI Hidenori
金额：
$ 3.78万
依托单位：
KUMAMOTO UNIVERSITY
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (B)
财政年份：
1991
资助国家：
日本
起止时间：
1991 至 1992
项目状态：
已结题

项目摘要

We present the results of our fundamental animal studies and clinical experiences in extracorporeal lung assist (ECLA) with the artificial membrane lung. A new type of heparin-bonded dense membrane lung, which we constructed, reduced the systemic requirement of heparin to less than half of the conventional dose in ECLA on goats. This heparin-bonded circuit was applied to ECLA for patients with active bleeding sites, and could save them from severe cardio-pulmonary failure refractory to conventional treatments. As another approach to prevent bleeding attributable to impaired blood coagulation with heparin, we administered Nafamostat mesilate (FUT) as a substitute for heparin during ECLA on dogs. A large amount of FUT, 7.3*0.8 mg/kg/hr (mean * SD, n = 7), enabled safer ECLA. To simplify the ECLA maneuver in emergency, we devised a pre-primed ECLA circuit that was manually driven without using electric power. A pre-primed lung, stored for one year, provided a good function of gas exchange. The total number of ECLA patients in Kumamoto University Hospital has been 52 up to March 1993. Of the 52 patients who underwent ECLA, 29 patients underwent respiratory support, and 23 patients circulatory support. The survival rate on two months after weaning from ECLA was 46%. ECLA will become a new promising method in critical care medicine.

我们提出了我们的基础动物研究的结果和临床经验，在体外肺辅助（ECLA）与人工膜肺。我们构建的一种新型肝素结合致密膜肺，使山羊ECLA中肝素的全身需要量减少到传统剂量的一半以下。这种肝素结合回路应用于活动性出血部位患者的ECLA，可以挽救常规治疗难治的严重心肺功能衰竭。作为另一种方法，以防止出血归因于受损的血液凝固与肝素，我们给予萘莫司他甲磺酸盐（FUT）作为替代肝素在ECLA犬。大量FUT，7.3*0.8 mg/kg/hr（平均值 * SD，n = 7），使ECLA更安全。为了简化紧急情况下的ECLA操作，我们设计了一种预充的ECLA电路，该电路在不使用电力的情况下由手动驱动。预充肺保存一年后，可提供良好的气体交换功能。截至1993年3月，熊本大学医院的ECLA患者总数为52例。在52例接受ECLA的患者中，29例患者接受呼吸支持，23例患者接受循环支持。脱离ECLA后2个月的存活率为46%。ECLA将成为一种新的有前途的方法在危重病医学。