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）联合连续半透析滤过（CHDF）下，用林格氏液完全填充双侧肺对损伤犬肺的影响。麻醉后，对犬进行气管插管和机械通气，然后静脉注射油酸0.15 ml/kg。建立急性肺损伤模型后，开始静脉动脉转流ECLA。用15 cmH 2 O的林格氏溶液填充肺4小时，然后排出液体并重新开始机械通气。动物分为两组：液体填充组（F组）和液体填充CHDF组（FC组）。FC组在肺充满液体后立即开始CHDF，并持续整个实验期间。所有犬在从肺部引流液体后均可从ECLA脱机至常规机械通气。然而，尽管液体引流后肺氧合短暂改善，但在脱离V-A旁路ECLA后，气道渗出物增加，肺氧合恶化，这可能是由于肺血流量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。无犬可从机械通气转为自主呼吸。然而，在FC组中，脱离ECLA后的静态肺顺应性仍高于F组。FC组中的胸部X线也显示，与F组相比，在液体填充和脱离ECLA 4小时后恢复更好。这些结果表明，在油酸诱导的肺损伤中，充液4小时仅能短暂改善肺氧合，但与CHDF合用可改善撤机后的肺功能由ECLA提供呼吸支持。

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.