Lee K H, Shimizu Y, Yano T, Kishi H, Mizoguchi S, Terasaki H, Morioka T, Hashiguchi A, Esaki K, Dogomori H
Department of Anesthesiology, Kumamoto University Medical School.
Masui. 1990 Feb;39(2):257-63.
A full term newborn female, 3262g, aspirated meconium at birth and began to suffer from severe hypoxia and acidosis due to progressing pneumonitis, pneumothorax and pneumomediastinum. She also had severe hypotension and anuria. Venoarterial ECLA with a Kolobow membrane lung via the right internal jugular vein and the right common carotid artery was initiated. Blood gas parameters and blood pressure improved, and urine output increased to normal. ECLA permitted a reduction in FIO2 and airway pressure of mechanical ventilation, as well as frequent lavage of the lung. As the physical condition improved, the bypass flow was gradually decreased from 200 ml.kg-1.min-1 at the start to 130 ml.kg-1.min-1 for maintenance, then to 25 ml.kg-1.min-1 at the end. Bleeding throughout the ECLA for 69 hours could be minimized by a meticulous control of the activated coagulation time with a minimum dose of heparin and the transfusion of fresh frozen and platelet rich plasma. After ECLA, the carotid artery was simply ligated, and mechanical ventilatory support was carried out for 5 days. Her condition improved and she left the hospital without any neurological sequelae. ECLA will become an effective means of life support for a baby with severe MAS irresponsive to conventional ventilatory support.
一名足月新生儿女性，体重3262克，出生时吸入胎粪，因进展性肺炎、气胸和纵隔气肿开始出现严重缺氧和酸中毒。她还伴有严重低血压和无尿。通过右颈内静脉和右颈总动脉，使用Kolobow膜肺进行静脉-动脉体外膜肺氧合（ECLA）支持。血气参数和血压得到改善，尿量增加至正常水平。ECLA使得机械通气的吸入氧浓度（FIO2）和气道压力得以降低，同时便于频繁进行肺灌洗。随着身体状况改善，体外循环血流量从开始时的200毫升·千克-1·分钟-1逐渐降至维持时的130毫升·千克-1·分钟-1，最后降至25毫升·千克-1·分钟-1。通过使用最小剂量肝素精确控制活化凝血时间，并输注新鲜冰冻血浆和富含血小板血浆，可将ECLA过程中长达69小时的出血情况降至最低。ECLA结束后，简单结扎颈动脉，进行5天的机械通气支持。她的病情好转，出院时无任何神经后遗症。对于对传统通气支持无反应的严重胎粪吸入综合征（MAS）患儿，ECLA将成为一种有效的生命支持手段。
