Vogler C, Sotelo-Avila C, Lagunoff D, Braun P, Schreifels J A, Weber T
Department of Pathology, St. Louis University School of Medicine, MO.
N Engl J Med. 1988 Jul 14;319(2):75-9. doi: 10.1056/NEJM198807143190203.
We found fibrin thrombi or thromboemboli at autopsy in 22 of 23 infants with respiratory failure who had been treated with venoarterial extracorporeal membrane oxygenation (ECMO). In addition, distinctive basophilic aluminum-containing emboli were found in 12 of the infants; the distribution of these emboli was similar to that of the thromboemboli, except that an aluminum-containing embolus was found in a lung in only 1 infant. Sixteen infants had pulmonary thrombi or thromboemboli. We also found friable aluminum-containing concretions adhering loosely to the mixing rods of heat exchangers that had been used to warm the blood flowing through the ECMO circuit; such concretions were not present on unused mixing rods. We propose that these aluminum-containing concretions developed as the silicone coating of the heat exchanger wore away and aluminum metal was exposed to warm, oxygenated blood and that fragments of aluminum-containing concretions formed emboli. This hypothesis is supported by the fact that aluminum-containing emboli were generally not present in the lungs, which are bypassed by ECMO. Although infarcts were found in 16 of the 23 infants, we cannot be certain whether any of the infarcts were caused by the aluminum-containing emboli.
在接受静脉-动脉体外膜肺氧合（ECMO）治疗的23例呼吸衰竭婴儿中，我们在22例婴儿的尸检中发现了纤维蛋白血栓或血栓栓子。此外，在12例婴儿中发现了独特的含嗜碱性铝栓子；这些栓子的分布与血栓栓子相似，只是仅在1例婴儿的肺部发现了一个含铝栓子。16例婴儿有肺血栓或血栓栓子。我们还发现易碎的含铝凝结物松散地附着在用于加热流经ECMO回路血液的热交换器的混合棒上；未使用的混合棒上没有这种凝结物。我们认为，这些含铝凝结物是由于热交换器的硅胶涂层磨损，铝金属暴露于温暖的含氧血液中形成的，含铝凝结物的碎片形成了栓子。这一假设得到以下事实的支持：含铝栓子通常不存在于ECMO绕过的肺部。虽然在23例婴儿中有16例发现了梗死灶，但我们不能确定任何梗死灶是否由含铝栓子引起。
