体外循環の応用による術後急性肺水腫治療の実験的研究
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The author investigated the application of extracorporeal circulation as treatment for the circulatory failure in the experimentally induced acute pulmonary edema.Method : 33 dogs were used for the present study. After pneumonectomy, the dogs were made to breath room air and were given plasma expander (50 cc/kg) intravenously to induce acute pulmonary edema, Jordan's grade IV. Then one of the 4 types of extracorporeal circulasion, i.e. 1) cardiopulmonary by-pass method (Fig. 1), 2) pulmonary by-pass method (Fig. 2), 3) simple oxygenation of the venous blood (Fig. 3), and 4) oxygenation of the venous blood of the inferior vena cave (Fig. 4) was started to treat the edema. Simultaneously positive pressure breathing with oxygen was started. Among these four methods, satisfactory result was obtained only by the cardiopulmonary by-pass method.The cardiopulmonary by-pass method was done by the following procedure. The venesection on the superior- and inferior venae cavae were performed. The venous blood was oxygenated by the bubble oxygenator of Lillehei-DeWall type, and then, the oxygenated venous blood was infused into both femoral arteries by the Sigma motor-pump.Results : In each method, results of treatment of pulmonary edema were as follows (Table I). 1) Cardiopulmonary by-pass method-Among 19 dogs treated 20-90 minutes by this method, 11 dogs recovered, 6 dogs improved and 2 dogs did not improve. 2) The pulmonary by-pass method-In this type of circulation one improved out of 5 dogs, 2 were not improved and died during the perfusion. None was cured by this method. 3) Simple oxygenation of the venous blood-Among 5 dogs, one cured, one improved, one not improved and 2 died immediately after the onset of the perfusion.4) Simple oxygenation of the venous blood of the inferior vena cava-Among 4 dogs, one improved, one not improved and 2 died during the course of the perfusion.To determine the optimum rate of perfusion in cardiopulmonary by-pass method, the clinical effectiveness of the treatment, changes in the arterial oxygen saturation and changes in the pulmonary arterial pressure were studied under various flow rates. Of the 4 dogs using the low flow rate, 35 cc/kg/min, 2 were improved and the other 2 were unchanged. In contrast, with the medium rate of perfusion, 40-65 cc/kg/min, 6 were recovered from the pulmonary edema and 2 were improved. Good results were obtained with the rate of perfusion over 70 cc/kg/min ; among 7 dogs, 5 were cured and 2 were improved.Immediate improvement of the arterial oxygen saturation was observed with any rate of perfusion (Fig. 5). Under the low perfusion rate the depressed arterial oxygen saturation showed steep elevation immediately after the beginning of the extracorporeal circulation, however, in this rate of perfusion, no significant improvement was obtained and the oxygen saturation remained below 90% even after 60 minutes' perfusion. The oxygen saturation rate in the 2 dogs not cured was 85 and 87% respectively, and it tended to decrease after 30 minutes' perfusion. Under the medium or the high rate of perfusion the arterial oxygen saturation was elevated up to the normal range (over 90%) within 5 minutes of perfusion. The maximum arterial oxygen saturation was observed 30 minutes after the onset of the extracorporeal circulation ; 91-96% in the medium rate of perfusion and 94-98% in the high rate of perfusion.The changes in the pulmonary arterial systolic pressure under various rates of perfusion were as follows (Fig. 6); During the established pulmonary edema the pulmonary arterial pressure was 40 mmHg or higher. Under the low perfusion rate 20-30 minutes elapsed before the pulmonary arterial pressure came down to the normal value (20 mmHg). It was 28 mmHg in one instance. It had also a tendency to begin to elevate after 30 minutes of perfusion. Under both the high and the medium perfusion rates the pulmonary arterial pressure fall to the normal range within 5 minutes perfusion. The de
- 社団法人日本循環器学会の論文
- 1960-12-20