Zwischenberger J B, Bowers R M, Pickens G J
Department of Surgery, University of Texas Medical Branch, Galveston 77550.
Ann Thorac Surg. 1989 Jun;47(6):868-71. doi: 10.1016/0003-4975(89)90022-2.
Life-threatening tension pneumothorax in neonates on extracorporeal membrane oxygenation (ECMO) has been associated with an increase in arterial oxygen tension and a decrease in peripheral perfusion, followed by a decrease in ECMO flow with progressive hemodynamic deterioration. To investigate this triad, chest tubes were placed bilaterally in 9 dogs to allow injection of air to produce tension pneumothorax. Six dogs were subsequently placed on standard venoarterial ECMO before the reinduction of tension pneumothorax. Measured values included arterial pulse pressure, inferior vena cava pressure, systemic arterial blood gases, peripheral arterial oxygen saturation, mixed venous oxygen saturation, and left heart cardiac output. Oxygen delivery was calculated from directly measured values. Each of the 6 dogs on ECMO demonstrated the triad of increased arterial oxygen tension (92 +/- 7 to 325 +/- 20 mm Hg; p less than 0.05), decreased peripheral perfusion (as evidenced by a decrease in pulse pressure from 55 +/- 4 to 31 +/- 5 mm Hg; p less than 0.05), and decreased mixed venous oxygen saturation (71% +/- 3% to 22% +/- 2% saturation; p less than 0.05) followed by a lower ECMO flow with progressive hemodynamic deterioration (oxygen delivery decreased from 285 +/- 11 to 111 +/- 12 mL/min; p less than 0.05). Aspiration of the intrathoracic air allowed return to baseline ECMO flow and hemodynamic stability in all dogs. The triad of increased arterial oxygen tension and decreased peripheral perfusion (as evidenced by a lower arterial pulse pressure and lower mixed venous oxygen saturation) followed by decreased ECMO flow with progressive hemodynamic deterioration consistently appears when tension pneumothorax occurs on ECMO.
接受体外膜肺氧合（ECMO）治疗的新生儿发生危及生命的张力性气胸时，动脉血氧分压升高、外周灌注减少，随后ECMO流量降低，血流动力学逐渐恶化。为了研究这一三联征，在9只犬双侧置入胸管，以便注入空气制造张力性气胸。随后，6只犬在再次诱发张力性气胸前接受标准的静脉-动脉ECMO治疗。测量值包括动脉脉压、下腔静脉压力、体动脉血气、外周动脉血氧饱和度、混合静脉血氧饱和度和左心输出量。根据直接测量值计算氧输送量。接受ECMO治疗的6只犬均出现了以下三联征：动脉血氧分压升高（从92±7 mmHg升至325±20 mmHg；p<0.05）、外周灌注减少（脉压从55±4 mmHg降至31±5 mmHg可证明；p<0.05）、混合静脉血氧饱和度降低（饱和度从71%±3%降至22%±2%；p<0.05），随后ECMO流量降低，血流动力学逐渐恶化（氧输送量从285±11 mL/min降至111±12 mL/min；p<0.05）。抽出胸腔内空气后，所有犬的ECMO流量均恢复至基线水平，血流动力学稳定。当ECMO治疗期间发生张力性气胸时，始终会出现动脉血氧分压升高、外周灌注减少（表现为动脉脉压降低和混合静脉血氧饱和度降低），随后ECMO流量降低、血流动力学逐渐恶化这一三联征。
