Safety and validity of the small heparin-bonded artificial membrance lung for neonatal extracorporeal lung assist.

我们介绍了体外肺辅助（ECLA）人工膜肺的基础动物研究和临床经验的结果。我们构建了一种新型肝素结合致密膜肺，将肝素的全身需取量降低到ECLA山羊常规剂量的一半以下。这种肝素结合电路应用于活动性出血部位患者的ECLA，可以避免常规治疗难以治愈的严重心肺衰竭。作为另一种预防肝素凝血功能受损引起出血的方法，我们在狗的ECLA期间给予甲磺酸纳莫他酯（FUT）作为肝素的替代品。大量FUT， 7.3*0.8 mg/kg/hr (mean * SD, n = 7)，使ECLA更安全。为了简化紧急情况下的ECLA操作，我们设计了一种不使用电力手动驱动的预启动ECLA电路。一个预充气的肺，储存一年，提供了良好的气体交换功能。截至1993年3月，熊本大学医院的ECLA患者总数为52人。在接受ECLA的52例患者中，29例患者接受呼吸支持，23例患者接受循环支持。断奶后2个月生存率为46%。ECLA将成为危重医学中一种很有前途的新方法。

We present the results of our fundamental animal studies and clinical experiences in extracorporeal lung assist (ECLA) with the artificial membrane lung. A new type of heparin-bonded dense membrane lung, which we constructed, reduced the systemic requirement of heparin to less than half of the conventional dose in ECLA on goats. This heparin-bonded circuit was applied to ECLA for patients with active bleeding sites, and could save them from severe cardio-pulmonary failure refractory to conventional treatments. As another approach to prevent bleeding attributable to impaired blood coagulation with heparin, we administered Nafamostat mesilate (FUT) as a substitute for heparin during ECLA on dogs. A large amount of FUT, 7.3*0.8 mg/kg/hr (mean * SD, n = 7), enabled safer ECLA. To simplify the ECLA maneuver in emergency, we devised a pre-primed ECLA circuit that was manually driven without using electric power. A pre-primed lung, stored for one year, provided a good function of gas exchange. The total number of ECLA patients in Kumamoto University Hospital has been 52 up to March 1993. Of the 52 patients who underwent ECLA, 29 patients underwent respiratory support, and 23 patients circulatory support. The survival rate on two months after weaning from ECLA was 46%. ECLA will become a new promising method in critical care medicine.