Frank B R, Tao W, Brunston R L, Alpard S K, Bidani A, Zwischenberger J B
Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston 77555-0528, USA.
ASAIO J. 1997 Sep-Oct;43(5):M817-20.
Percutaneous cannulas with low resistance are necessary for arteriovenous carbon dioxide removal (AVCO2R) to allow highest flow at lowest pressure to maximize CO2 removal. Commercially available arterial (A) and venous (V) percutaneous cannulas (8-18 Fr) were tested for pressure/flow characteristics under conditions that simulated percutaneous AVCO2R at clinically pertinent flow rates between 200-1000 ml/min to obtain the M number previously described by Delius, et al. The Bio-Medicus (Bio-Medicus, Grand Rapids, MI) 17F A, Research Medical, Inc (RMI) (Model FEM II, Research Medical, Inc., Midvale, UT) 16F A, and RMI 18F V cannulas exhibited the lowest M numbers that correlated with low resistance to flow. The four most clinically favorable arterial cannulas (8, 10, 12, and 14 Fr), coupled with a venous cannula four French sizes larger, were used in an AVCO2R circuit in adult sheep (n = 3) at varying mean arterial pressures (MAP) between 65-105 mmHg. The 8, 10, 12, and 14 Fr arterial cannulas allowed an arteriovenous flow of 208 +/- 72, 530 +/- 37, 848 +/- 66, and 944 +/- 96 ml/min, respectively, at a MAP of 65 mmHg. An increase in MAP to 105 mmHg was associated with approximately a 41, 30, 32, and 27% increment in blood flow, respectively. In summary, an arterial percutaneous cannula of 10 Fr or larger will allow AVCO2R blood flow greater than 500 ml/min, as previously shown by Brunston et al. to achieve total CO2 removal without incurring hypercapnia.
对于动静脉二氧化碳清除（AVCO2R）而言，低阻力的经皮插管是必要的，以便在最低压力下实现最高流量，从而最大限度地清除二氧化碳。对市面上可买到的动脉（A）和静脉（V）经皮插管（8 - 18F）进行了压力/流量特性测试，测试条件模拟了临床相关流速（200 - 1000 ml/分钟）下的经皮AVCO2R，以获得先前由德利乌斯等人描述的M数。百麦克斯（Bio - Medicus，密歇根州大急流城）17F A插管、研究医疗公司（RMI）（型号FEM II，犹他州米德瓦尔研究医疗公司）16F A插管以及RMI 18F V插管的M数最低，这与低血流阻力相关。将四种临床上最适用的动脉插管（8、10、12和14F）与大四号法国规格的静脉插管相结合，用于成年绵羊（n = 3）的AVCO2R回路中，平均动脉压（MAP）在65 - 105 mmHg之间变化。在MAP为65 mmHg时，8、10、12和14F动脉插管的动静脉血流量分别为208±72、530±37、848±66和944±96 ml/分钟。MAP增加到105 mmHg时，血流量分别增加约41%、30%、32%和27%。总之，如布伦斯顿等人之前所示，10F或更大尺寸的动脉经皮插管将使AVCO2R血流量大于500 ml/分钟，从而在不引起高碳酸血症的情况下实现二氧化碳的完全清除。
