无泵型体外人工肺辅助技术对犬急性呼吸窘迫综合征模型的通气支持

Ventilatory support of pumpless extracorporeal lung assist in a canine model of acute respiratory distress syndrome

背景：使用无泵型体外肺辅助技术进行气体交换可有效进行体外氧合呼吸支持，使患肺休息，再逐步恢复正常功能。目的：观察无泵型体外肺辅助技术对犬急性呼吸窘迫综合征模型的通气效果。设计、时间及地点：观察性实验，于2006-06/09在中国医学科学院阜外心血管病医院动物实验中心完成。材料：杂种犬6只，雄性，体质量（22.66±1.21）kg。呼吸机Servo 900c（Siemons Elema公司，德国）；流量仪（美敦力，探针FP-32E，传感器TX50）；血气分析仪（Nova biomedical200，美国）；低阻力膜肺（Nova Breath0.5，德国）；血流动力学监护仪（飞利浦MP50，美国）。方法：实验动物使用戊巴比妥30mg/kg麻醉后，静脉推注油酸0.08-0.10mL/kg，以动脉血氧分压/吸入氧浓度〈26.6kPa（200mmHg）为标准建立急性呼吸窘迫综合征模型，在成功建立急性呼吸窘迫综合征模型后，经一侧颈动脉与股静脉连接无泵型体外肺辅助系统，进行通气支持，对比支持前后动脉血气的变化。主要观察指标：记录无泵型体外肺辅助通气模型呼吸支持前后犬的动脉血氧饱和度、氧分压、二氧化碳分压的变化。结果：无泵型体外肺辅助模型通气前动脉血氧分压（6.17±0.45）kPa，动脉血氧饱和度为（80.47±3.70）%，通气后动脉血氧分压（8.47±0.47）kPa，动脉血氧饱和度为（94.65±1.48）%，无泵型体外肺辅助支持前后差异有显著性意义（P〈0.01）。二氧化碳分压由（4.71±0.23）kPa降为（2.57±0.19）kPa（P〈0.01）。结论：无泵型体外肺辅助技术可以对犬急性呼吸窘迫综合征模型的损伤肺进行有效支持。

BACKGROUND： Pumpless extracorporeal lung assist （pECLA） technique of gas exchange may effectively progress extracorporeal membrane oxygenation respiratory support, rest the affected lung, and gradually recover the normal function. OBJECTIVE： To study the effect of ventilation in the canine model of acute respiratory distress syndrome （ARDS） with pECLA support. DESIGN, TIME AND SETTING： An observation study was carried out at the Animal Experiment Center in Fuwai Hospital, Chinese Academy of Medical Sciences ＆ Peking Union Medical College, from June to September in 2006. MATERIALS： Six hybrid canines aged （22.66±1.21） kg were adopted. Respirator Servo 900c （Siemons ELema Corporation, German）; Flow monitoring （Medtronic lnc, Probe FP-32E, Transducer TX50）; Blood gas analyzer （Nova Biomedical 200, USA）; Low-resistance membrane oxygenator （Nova Breath 0.5, German）; Hemodynamic monitoring （Philips MP50, USA）. METHODS： After the canines were anesthetized with 30 mg/kg pentobarbital sodium, 0.08-0.10 ml/kg oleic acid was injected intravenously. When the partial pressure of oxygen in artery （PaO2）/arterial oxygen saturation （SaO2） was less than 26.6 kPa （200 mm Hg）, the ARDS model was established successfully, and pECLA was connected with the model between unilateral carotid and venae femoralis for the ventilatory support. Then the change of arterial blood gas before and after pECLA support was evaluated. MAIN OUTCOME MEASURES： Changes of SaO2, PaO2 and partial pressure of carbon dioxide in artery in canines were recorded before and after pECLA support. RESULTS： The PaO2 increased from （6.17±0.45） kPa before support to （8.47±0.47） kPa after support, the SaO2 increased from （80.47±3.70）% before support to （94,65±1,48）% after support, indicating statistically significant differences （P 〈 0.01）. The carbon dioxide in artery decreased from （4.71±0.23） kPa to （2.57±0.19） kPa （P 〈 0.01 ）. CONCLUSION： The pECLA technique can effectively support ARDS canine model.