Chapman J, Adams M, Geha A S
Division of Cardiothoracic Surgery, Case Western Reserve University, Cleveland, Ohio.
J Thorac Cardiovasc Surg. 1990 Apr;99(4):741-50.
Respiratory support by means of arteriovenous extracorporeal membrane oxygenation driven by systemic arterial pressure, in contrast to pump-driven venoarterial extracorporeal membrane oxygenation, is attractive because of its simplicity and lack of trauma to formed blood elements. Although arteriovenous extracorporeal membrane oxygenation has been shown to improve arterial blood gases, useful levels of arteriovenous extracorporeal membrane oxygenation shunt flow may exert detrimental effects on systemic and pulmonary hemodynamics. Therefore the hemodynamic consequences of arteriovenous extracorporeal membrane oxygenation were studied in 11 dogs that were anesthetized, heparinized, and their lungs mechanically ventilated (FIO2 = 0.21) before and after induction of oleic acid pulmonary edema. The data indicate that arteriovenous extracorporeal membrane oxygenation shunt flows adequate to improve arterial blood gases resulted in significant changes in peripheral vascular resistance (-46%; p less than 0.05), systemic arterial blood pressure (-20%; p less than 0.05), and cardiac output (+110%; p less than 0.05). Dopamine infusion (5 micrograms/kg/min) proved to be more effective than volume expansion (15 ml/kg) in maintaining cardiac output, arterial blood pressure, and arterial blood gases. We conclude that pumpless arteriovenous extracorporeal membrane oxygenation, at flow rates adequate for respiratory support, can adversely alter systemic hemodynamics. However, these effects can be beneficially modulated by a moderate dose of inotropic medication.
与泵驱动的静脉-动脉体外膜肺氧合不同，由体动脉压驱动的动静脉体外膜肺氧合进行呼吸支持具有吸引力，因为其操作简单且对血液成分无创伤。尽管动静脉体外膜肺氧合已被证明可改善动脉血气，但动静脉体外膜肺氧合达到有效分流水平时可能会对全身和肺血流动力学产生不利影响。因此，在11只麻醉、肝素化且在油酸诱导肺水肿前后进行机械通气（吸入氧分数 = 0.21）的犬中研究了动静脉体外膜肺氧合的血流动力学后果。数据表明，足以改善动脉血气的动静脉体外膜肺氧合分流导致外周血管阻力显著变化（-46%；p < 0.05）、体动脉血压显著变化（-20%；p < 0.05）和心输出量显著变化（+110%；p < 0.05）。在维持心输出量、动脉血压和动脉血气方面，多巴胺输注（5微克/千克/分钟）被证明比扩容（15毫升/千克）更有效。我们得出结论，在足以进行呼吸支持的流速下，无泵动静脉体外膜肺氧合可对全身血流动力学产生不利改变。然而，这些影响可通过中等剂量的正性肌力药物得到有益调节。
