SAFETY AND EFFICACY OF A PROLONGED EXTRACORPOREAL LUNG ASSIST WITH A HEPARIN BONDED ARTIFICIAL MEMBRANE LUNG.

动物研究：我们在18只山羊身上研究了长期静脉-静脉体外肺辅助(ECLA)与肝素结合的人工膜肺和回路(CARMEDA，瑞典)的安全性和血液相容性。组I为非肝素结合型肺，II组为环氧乙烷气体消毒的肝素结合型肺，III组为肝素结合型肺。持续输注少量肝素溶液，激活凝血时间I组为200秒，II组为120-130秒，平均旁路血流量和转流时间分别为46.0ml/kg/min、6.7天、36.5ml/kg/min、7.8天、41.3ml/kg/min、7.8天。I组，17U/kg/min。II组，14U/kg/h。组III。II、III组肝素用量明显低于I组(p&lt；0.05)。在三组中，除纤维蛋白A在n组较III组显著升高(p&lt；0.05)外，其余三组间的血小板-凝血系统无显著差异(p&lt；0.05)。再次将肝素结合的膜肺暴露于环氧乙烷气体中可能会降低抗血栓形成能力，但肝素结合的表面在长时间的ECLA中具有良好的血液相容性。临床研究：我们对6例心内直视手术后严重心肺衰竭患者应用了长时间体外循环心肺辅助(ECLHA)。失血量减少到以前非肝素结合肺患者的1/10以下。其中3例患者分别于第5、6、2天成功脱机。人工膜肺和环路的肝素结合将为患者提供更安全的ECLA(ECLHA)，即使是新鲜的和多个伤口。

ANIMAL STUDY: We investigated safety and blood compatibility of a prolonged veno-venous extracorporeal lung assist (ECLA) with a heparin bonded artificial membrane lung and circuit (CARMEDA, SWEDEN ) in 18 goats. ECLA was performed with a non-heparin bonded lung in group I , a heparin bonded lung resterilized by ethylene oxide gas in group II, a heparin bonded lung in groupIII . Activated coagulation time was maintained about 200 seconds in group I , 120- 130 seconds in group II, III by continuous infusion of a small amount of heparin solution.An average of bypass blood flow and bypass duration were 46.0ml/Kg/min., 6.7 days in group I, 36.5ml/Kg/min., 7.8 days in group II, 41.3ml/Kg/min., 7.8 days in group III. A mean dose of heparin administered was 26 units /Kg/hr. in group I, 17 units/Kg/min. in group II, 14 units/Kg/hr. in group III . The dose of heparin in group II , III were less significantly ( p < 0.05) than in group I. Among three groups, there were no large difference in platelet-coagulation system except fibrionpeptide A which increased significantly ( p < 0.05) in group n compared with group III. A reexposure of a heparin bonded membrane lung to ethylene oxide gas may decrease antithrombogenecity, however, the heparin bonded surface provides excellent blood compatibility during a prolonged ECLA.CLINICAL STUDY :We applied prolonged extra corporeal lung and heart assist (ECLHA ) with a heparin bonded membrane lung for six patients with severe cardiopulmonary failure following an open heart surgery. Blood loss decreased to less than 1/10 of that in our previous cases with a non-heparin bonded lung. Three of these patients were successfully weaned from ECLHA on the 5th, 6th, and 2nd day. The heparin bonding of an artificial membrane lung and a circuit will afford a safer ECLA (ECLHA ) for a patient even with fresh and multiple wounds.