人工心肺装置による体外循環に関する実験的研究

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Since the first months of 1955, the design of a pump-oxygenator system and it's method of application of extracorporeal circulation has been studied in our experimental laboratory for the purpose of creation a most simplified Pump-oxygenator Apparatus. Modified Sigma-motor Pumps named by Type III and IV, have been created in our laboratory. The Output of the Pump Type III and IV were 2050 ml/min and 8300 ml/min respectively. Fundamental studies of the Pressure-flow characteristics of these pumps revealed the necessity for obtaining the optimum occlusive setting of the pressure plate to maintain stable flow in face of considerable variation in systemic resistence during perfusion. Hemolysis due to pumping action is a direct function of stroke volume rather than presence or absence of total occlusion in these pumps studied. On the base of fundamental research concerned efficiency of oxygenation and debubbling, the most simplified bubble oxygenator model I-IV have been constructed of two vinyl plastic tube employing the same principle of a vertical blood-oxygen mixing tube and an antifoam coated debubbling tube in our laboratory. The experiments of extracorporeal circulation utilizing those pump-oxygenator model I-IV have been done in 10 dogs, obtaining the results as follow : All of three dogs perfused with model I died within 24 hours. One of two dogs perfused with model II lived for five days and one of two dogs perfused with model III survived for three days. Finally there was one long term survival in three doge undergoing perfusion with model IV. A step-by-step improvement of oxygenator's design has carried out on the earlier models led to the configuration of the model IV proving no cardinal defect of it's function for extra-corporeal circulation. Subsutitution of a helical reservoir for the vertical glass reservoir for the final elimination of all bubbles in oxygenator model IV (modified De Wall's type) has improved the over all poor results described above. Of the total number of 19 dogs which were by-passed with the helix reservoir oxygenator, seven died within 24 hours, one lived for six days, and eight surived more than one week. In the first 11 dogs undergoing perfusion, the survival rate obtained was only 30 per cent. There was, however, survival rate of 86 per cent in the latter consecutive series of eight dogs perfused by well-drilled team. A striking improvement in survival rate was epecially evident when total body perfusion has been done by the highly disciplined team keeping a well-balanced in-and-out flow and an adequate application of the bubble exygenator. During this study, techniques and team work have been develeped which appear to have reduced the hazards of total body perfusion. It seems to be more important what team is driving apparatus than what type of apparatus is used. This proves the all importance of team work and technical skill.
千葉大学の論文

人工心肺装置による体外循環に関する実験的研究

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