Gattinoni L, Pesenti A, Bombino M, Pelosi P, Brazzi L
Istituto di Anestesiologia e Rianimazione, Università degli Studi di Milano, Italy.
New Horiz. 1993 Nov;1(4):603-12.
Long-term extracorporeal support for acute lung failure was introduced in 1972. In the 1970s, much effort was concentrated on technical improvements. However, a multicenter study comparing continuous positive-pressure ventilation and continuous positive-pressure ventilation plus extracorporeal circulation failed to show improvement in survival rates. In the 1980s, new physiopathologic concepts were developed, such as extracorporeal CO2 removal coupled with lung rest. The main complication of the technique was bleeding due to systemic heparinization. However, the technology used in that period was the same as in the 1970s. Recently, technological improvement--such as percutaneous cannulation and surface-heparinized artificial lungs--has allowed clinical performances to improve substantially. "Lung rest" philosophy, coupled with safe technology, may provide a rational basis to test this technique in a randomized fashion for widespread use.
急性肺衰竭的长期体外支持于1972年被引入。在20世纪70年代，大量精力集中在技术改进上。然而，一项比较持续正压通气和持续正压通气加体外循环的多中心研究未能显示生存率有所提高。在20世纪80年代，出现了新的病理生理概念，如体外二氧化碳清除与肺休息相结合。该技术的主要并发症是全身肝素化导致的出血。然而，那个时期使用的技术与20世纪70年代相同。最近，诸如经皮插管和表面肝素化人工肺等技术改进已使临床性能有了实质性提高。“肺休息”理念与安全技术相结合，可能为以随机方式测试该技术以供广泛应用提供合理依据。
