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时间静脉-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。采用非肝素结合肺（I组）、经环氧乙烷气体再灭菌的肝素结合肺（II组）和肝素结合肺（piii组）进行ECLA。持续滴注少量肝素溶液，ⅰ组维持激活凝血时间约200秒，ⅱ、ⅲ组维持激活凝血时间120 ~ 130秒。搭桥血流量和搭桥时间平均为46.0ml/Kg/min。， I组6.7 d, 36.5ml/Kg/min。II组7.8 d, 41.3ml/Kg/min。第三组7.8天。给予肝素的平均剂量为26单位/Kg/hr。I组17单位/Kg/min。II组14单位/Kg/hr。第三组。两组患者肝素剂量均显著低于ⅰ组（p < 0.05）。三组间除纤维肽A显著高于ⅲ组（p < 0.05）外，其余各组血小板凝血系统均无显著差异。肝素结合膜肺再次暴露于环氧乙烷气体中可能会降低抗血栓形成性，然而，肝素结合表面在延长的ECLA期间提供了良好的血液相容性。临床研究：我们应用肝素结合膜肺延长体外肺和心脏辅助（ECLHA）治疗6例心内直视手术后严重心肺衰竭患者。失血量减少到我们以前无肝素结合肺病例的1/10以下。其中3例患者于第5、6、2天成功脱离ECLHA。肝素结合的人工膜肺和电路将提供一个更安全的ECLA (ECLHA)，即使是新的和多处伤口的病人。

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.