重症呼吸不全におけるvenopulmonary-ECMO(extracorporeal membrane oxygenation)の有用性 : 酸素加効率,酸素加血分配と循環動態に対する犬の実験的検討

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The purpose of this study was to find the most effective circulatory conditions and oxygenation for venopulmonary extracorporeal membrane oxygenation (VP-ECMO). In 10 dogs under controlled ventilation, Pao_2 at the carotid artery was kept over 100 mmHg as controls (Group C), and the hemodynamics were measured. Then, Pao_2 was decreased to less than 50 mmHg, i.e. respiratory failure (Group RF). Thereafter, we established the bypass of VP-, and venoarterial (VA-) ECMO (Group VP and Group VA, respectively) from the right atrium to the pulmonary or femoral artery. Pao_2 and the hemodynamics were measured at each bypass flow, i.e. 10～70 ml/kg/min. Pao_2 in Group VP was significantly higher than in Group RF at a bypass flow of 40 ml/kg/min or higher. In Group VA, however, Pao_2 was not significantly higher than in Group RF, at 40 ml/kg/min of bypass flow. Left and right ventricular stroke work in each state showed no significant difference. The pulse pressure in Group VP was maintained, but in Group VA. The pulse pressure decreased, and the aortic flow became non-pulsatile. The results suggest that effective oxygenation in VP-ECMO is attained at a bypass flow of 40 ml/kg/min or higher, and right and left ventricular function can be maintained.
東京女子医科大学の論文
1996-04-25