经皮穿刺静脉-静脉体外膜肺的动物实验研究

Animal experience of percutaneous venous-venous extracorporeal membrane oxygenation

目的在犬急性肺损伤的动物模型上探讨经皮穿刺静脉-静脉体外膜肺(V-VECMO)支持的效果。方法6只雄性犬利用油酸(0.1ml/kg)建立急性肺损伤模型。经皮穿刺右颈内静脉和右股静脉放置插管(分别是17Fr、10Fr),接ECMO管道灌注流量35～40ml/kg/min,氧气流量1～1.5L/min。ECMO前2h与呼吸机并用,呼吸机参数为SIMV模式,FiO20.5,TV5～6ml/kg,RR20次/分;后2h停止呼吸机的使用。记录注射油酸前、肺损伤出现后ECMO前、ECMO2h、ECMO4h的动脉血气值变化。结果注射油酸后4～6h,在纯氧高通气状态下犬动脉氧分压为106±15mmHg。ECMO2h动脉氧分压为98±7mmHg氧饱和度95.5±2.2%;ECMO4h动脉氧分压为67±3mmHg,氧饱和度为92.3±2.2%。ECMO过程中二氧化碳分压低于注射油酸前水平(p<0.05)。结论经皮穿刺V-VECMO可以帮助机体排出二氧化碳,吸收氧气,降低急性肺损伤的机械通气模式。

Objective To investigate the effect of percutaneoous venous-venous extracorporeal membrane oxygenation(V-V ECMO) in canine acute lung injury (ALI).Methods Six canines underwent ALI with the injection of oleic acid 0.1ml/kg. The device of V-V ECMO connected with 17Fr cannular inserted through right jugular vein and 10Fr cannular inserted through right femoral vein. The arterial blood gas parameters were recorded before injection of oleic acid, after ALI, ECMO 2h, ECMO 4h. Results ALI appeared after injection of oleic acid 4-6h lately. Aterial oxygen tension was 98±7 mmHg and oxygen saturation was 95.5±2.2% at ECMO 2h. At ECMO 4h arterial oxygen tension was 67±3 mmHg and oxygen saturation was 92.3±2.2%. The carbon dioxide tension of artery during ECMO was lower (P<0.05).Conclusion Oxygen is taken in efficiently and carbon dioxide is given out in ALI via percutaneous V-V ECMO, so the conventional ventilator mode can be modified.