Treatment of acute lung injury by the combination of total fluid filling of the lungs and continuous hemodiafiltration under extracorporeal lung assist.

我们研究了在体外肺辅助（ECLA）联合连续半滤（CHDF）下，用林格液完全填充双侧肺对损伤犬肺的影响。麻醉后气管插管机械通气，然后静脉滴注油酸0.15 ml/kg。急性肺损伤后开始静脉旁路ECLA。用15 cmH2O的林格氏液充肺4小时，然后将液体排出，重新进行机械通气。这些动物被分成两组；充液组（F组）和充液CHDF组（FC组）。在FC组，CHDF在肺充液后开始，并在整个实验期间持续。所有犬均可在肺液引流后从ECLA断奶至常规机械通气。然而，尽管液体引流后肺氧合短暂改善，但V-A旁路ECLA脱机后气道渗出物增加，肺氧合恶化，这可能是由于肺血流增加和肺泡毛细血管压力增加导致肺泡毛细血管血浆渗漏增加。没有狗能从机械通气断奶到自主呼吸。然而，FC组在ECLA脱机后的静态肺依从性仍高于f组。与f组相比，FC组在充液4小时和ECLA脱机后的胸部x线片也显示出比f组更好的恢复。这些结果表明，在油酸诱导的肺损伤中，肺充液4小时仅能短暂改善肺氧合，但联合CHDF可改善ECLA脱机后的肺功能。

We examined the effects on injured dog lungs of total filling of the bilateral lungs with Ringer's solution under extracorporeal lung assist (ECLA) in combination with continuous hemidiafiltration (CHDF). After anesthesia, dogs were endotracheally intubated and mechanically ventilated, then oleic acid 0.15 ml/kg i.v. was administered. Venoarterial bypass ECLA was started after acute lung injury was induced. The lungs were filled with Ringer's solution at 15 cmH2O for 4 hrs, then the fluid was drained and mechanical ventilation was re-instituted. The animals were divided in two groups ; fluid filled group (group F) and fluid filled with CHDF group (group FC). In group FC, CHDF was initiated just after fluid filling of the lungs and continued throughout the experimental period. All dogs could be weaned from ECLA to conventional mechanical ventilation after fluid drainage from the lungs. However, although lung oxygenation transiently ameliorated after fluid drainage, airway exudates increased and pulmonary oxygenation deteriorated after weaning from V-A bypass ECLA, probably because of increased plasma leakage from the alveolar capillaries due to increased pulmonary blood flow and alveolar capillary pressure. No dog could be weaned from mechanical ventilation to spontaneous respiration. In group FC, however, static lung compliance after weaning from ECLA remained higher compared to those in group F.Chest x-rays in group FC also showed better recovery after 4-hr of fluid filling and weaning from ECLA compared to group F.These results suggest that in oleic acid-induced lung injury, fluid filling of the lungs for 4 hr produced only transiently amelioration in pulmonary oxygenation but combination with CHDF could improve lung function after weaning from respiratory support by ECLA.