Geelhoed G W, Adkins P C, Corso P J, Joseph W L
Ann Thorac Surg. 1975 Aug;20(2):177-87. doi: 10.1016/s0003-4975(10)63873-8.
Extrapulmonary support in respiratory failure has become possible for prolonged periods with clinical application of the membrane lung oxygenator. The membrane lung may be perfused in a venovenous circuit, in which case it functions by prepulmonary venous oxygenation, or it may be pumped in venoarterial perfusion as partial or total cardiopulmonary bypass. Four patients were placed on venovenous membrane lung (GE-Peirce) perfusion for periods ranging from 6 to 112 hours. In oxygenating blood flows of less than 50% of the cardiac output, a viable PaO2 (mean, 52 mm Hg) was obtained in 2 patients with 60% FIO2, including 1 survivor who was weaned from the membrane lung. The remaining 2 patients had heart failure and insufficient venovenous membrane lung flows to improve systemic oxygenation (mean PaO2, 45 mm Hg on 100% FIO2). Four other patients were placed on venoarterial membrane lung (GE-DuaLung) bypass for 18 to 110 hours. With 40 to 85% of the cardiac output bypassed through the membrane oxygenator, immediate improvement was seen in systemic oxygenation (mean PaO2, 75 mm Hg), effective compliance (mean increase of 75%), and reduction in pulmonary hypertension (mean decrease, 15 mm Hg). These changes during bypass allowed the lungs to be put at rest with a decrease in FIO2 and positive end-expiratory pressures. This clinical experience indicates that venoarterial membrane lung bypass may be both supportive and therapeutic, decompressing the pulmonary circuit and maintaining systemic oxygenation. Membrane lung supported by either mode of perfusion has been shown to be clinically effective in patients suffering acute respiratory failure.
随着膜式肺氧合器在临床上的应用，呼吸衰竭患者能够长时间获得肺外支持。膜式肺可以在静脉-静脉回路中进行灌注，在这种情况下，它通过肺前静脉氧合发挥作用；或者在静脉-动脉灌注中作为部分或全心肺旁路进行泵血。4例患者接受了静脉-静脉膜式肺（GE-皮尔斯）灌注，时间为6至112小时。在氧合血流量低于心输出量50%的情况下，2例患者在吸入氧浓度为60%时获得了可维持的动脉血氧分压（平均52 mmHg），其中1例存活患者成功撤下膜式肺。其余2例患者存在心力衰竭，静脉-静脉膜式肺血流量不足以改善全身氧合（在吸入氧浓度为100%时平均动脉血氧分压为45 mmHg）。另外4例患者接受了静脉-动脉膜式肺（GE-双肺）旁路治疗18至110小时。在心输出量的40%至85%通过膜式氧合器旁路时，全身氧合立即得到改善（平均动脉血氧分压为75 mmHg），有效顺应性（平均增加75%），肺动脉高压降低（平均降低15 mmHg）。旁路过程中的这些变化使肺得以休息，同时降低了吸入氧浓度和呼气末正压。这一临床经验表明，静脉-动脉膜式肺旁路可能具有支持和治疗作用，可减轻肺循环压力并维持全身氧合。已证明，两种灌注方式支持的膜式肺在急性呼吸衰竭患者中均具有临床疗效。
