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

我们介绍了我们的基础动物研究的结果和临床经验，体外肺辅助(ECLA)与人工膜肺。我们构建的一种新型肝素结合型致密膜肺，使山羊ECLA对肝素的全身需要量减少到常规剂量的一半以下。这种肝素结合回路应用于活动性出血部位患者的ECLA，可使他们免于常规治疗难以治愈的严重心肺衰竭。作为预防肝素凝血功能受损所致出血的另一种方法，我们在犬的ECLA期间使用甲磺酸那法莫司他(FUT)作为肝素的替代品。大量的FUT，7.3×0.8 mg/kg/小时(平均值*SD，n=7)，使ECLA更安全。为了简化紧急情况下的ECLA动作，我们设计了一种预先启动的ECLA电路，无需使用电力就可以手动驱动。预充肺保存1年后，气体交换功能良好。截至1993年3月，熊本大学医院的ECLA患者总数为52人。在52例接受ECLA的患者中，29例接受了呼吸支持，23例接受了循环支持。ECLA脱机后两个月存活率为46%。ECLA将成为重症监护医学中一种很有前途的新方法。

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.