Total pulmonary liquid instillation under extracorporeal lung assist in dogs

体外循环心肺转流(ECLHA)是一种人工膜肺体外循环，是治疗传统治疗方法难以治愈的严重呼吸衰竭患者最有效的生命支持手段之一。探讨ECLHA能否支持麻醉犬全肺灌洗，为急性呼吸窘迫综合征(ARDS)肺泡腔内积聚的炎性物质的清除开辟一条新的治疗途径。在16只狗(体重8-13公斤)上，静脉-动脉ECLHA提供的旁路血流量为1,206？B1198毫升/分钟(平均值？B1SD)，然后在压力控制在30 cm H_2O的情况下，向狗的肺内注入500~700ml的乳酸林格液。然而，在一半的狗，旁路血流速度逐渐下降，血流动力学恶化了一段时间…更多的24小时肺灌注，因为在动物研究中，没有最佳的输血来恢复血量。在其余8只动物中，ECLHA可维持良好的气体交换和循环，24小时内不参与正常肺的呼吸。尸检发现所有动物都有大量胸腔积液和腹水，这可能是无水ECLHA中不可避免的低蛋白血症所致。这项研究表明，如果能够保持正常的血管通透性，新的肺灌洗联合ECLHA是可行的。因此，在下一项研究中，我们通过测量ECLHA后24小时动物体重的变化来测试前列腺素(PCE_1)对血管通透性的影响。PCE_1组的体重、尿量和血浆蛋白含量与对照组无显著差异。肺内滴注联合ECLHA作为一种新的呼吸系统治疗方法尚需进一步研究。较少

Extracorporporeal lung and heart assist (ECLHA) , which is prolonged cardiopulmonary bypass with an artifiaial membrane lung, is one of most effective life support means for patients with severe respiratory failure refractory to the conventional therapy. We examined if ECLHA could support the total pulmonary liquid instillation and lavage in anesthetized dogs, to open a new therapeutic modality to wash out wash out inflammatory substances accumulated in the alveolar space of acute respiratory distress syndrome (ARDS). In sixteen dogs (8 to 13 kg of body weight) , a veno-arterial ECLHA provided a bypass blood flow rate of 1,206? B1198 ml/min (mean? B1SD) through the peripheral blood accesses placed into the carotid artey and jugular vein, then we filled the lungs of dogs with the lactate Ringer's solution of 500 to 700 ml under a pressure controlled less than 30 cm H_2O.In a half of the dogs, however, the bypass blood flow rate decreased gradually, hemodynamics deterioreted for a period … More of 24 hours of the lung instillation because in animal study optimal blood transfusion was not available to restore the blood volume. In the remaining 8 animals, ECLHA could sustain the good gas exchange and circulation without particpating in respiration of the normal lungs for 24 hours. Autopsy revealed massive pleural effusion and ascites in all animals that might result from unavoidable hypoproteinemia in no-dlood ECLHA.This study suggested feasibility of the new pulmonary lavage combined with ECLHA,if normal vascular permeability could maintained. Therefore, in the next study we tested effects of prostaglandin (PCE_1) on vascular permeability by measuring the changes in the body weigth of animals undergone ECLHA of 24 hours. We found no singificant difference between the PCE_1 group and control group with regard to body weight, urine output and plasmaprotein. Further studies have to be carried out to establish the pulmonary instillation combined with ECLHA as a new respiratory treatment. Less