体外式肺補助法(ECLA)下肺内液体充填による肺蘇生法の基礎的研究 Total fluid filling of the lungs under extracorporeal lung assist (ECLA) for the treatment of lung injury

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急性肺傷害の早期に肺を液体で充填して肺胞に集積した炎症細胞やサイトカインを希釈・洗浄すれば肺の治癒を促進するかもしれない。しかし, 肺を液体で充填するのは非生理的で, 生体肺への影響はわかっていない。今回, 体外循環と人工肺を用いた呼吸補助 (ECLA) 下の長時間肺内液体充填が及ぼす影響を正常肺および急性肺傷害モデルで調べた。正常イヌおよびオレイン酸肺傷害イヌを用い, V-AバイパスECLA下に乳酸リンゲル液を気管内に注入して15cmH<SUB>2</SUB>O圧で両肺を4時間完全に充填した。排液後, 通常の人工呼吸を開始し, 肺機能の回復をみながら徐々にECLAを離脱した。排液の24時間後に動物を剖検した。正常イヌはすべてECLAおよび陽圧人工換気を離脱でき, 肺酸素化能や肺コンプライアンスの悪化もなかった。しかし, 肺傷害イヌでは, 排液後, 一過性に改善するもののECLA離脱後に肺酸素化能が悪化した。今後, ECLA離脱までの時間や充填液の組成などについて検討が必要である。

We examined the effects of complete and prolonged filling of the bilateral lungs with Ringer's solution on normal and injured lungs in dogs supported by extracorporeal lung assist (ECLA) using an artificial membrane lung. After anesthesia, dogs were endotracheally intubated and mechanically ventilated, then venoarterial bypass ECLA was started. In normal group, the lungs were filled with Ringer's solution at 15 cmH<SUB>2</SUB>O for 4 hrs, then the fluid was drained and mechanical ventilation was reinstituted. In lung injury group, oleic acid 0.15 ml/kg iv. was administered to injure the lungs before initiation of ECLA. All dogs in normal group could be weaned from ECLA and mechanical ventilation after fluid drainage from the lungs. The lung oxygenation and lung compliance recovered almost normal even after fluid filling. The lung water content at the termination of the experiment was not increased compared with that of normal dogs without fluid filling. In lung injury group, lung oxygenation transiently ameliorated after fluid drainage. However, airway exudates increased and pulmonary oxygenation deteriorated after weaning from V-A bypass ECLA. No dog in lung injury group could be weaned from mechanical ventilation. These results suggest that total fluid-instillation of the lungs can be performed safely without sequelae under ECLA support. In oleic acidinduced lung injury, however, fluid filling of the lungs for 4 hr produced only transient amelioration in pulmonary oxygenation. More prolonged instillation and ECLA support might be mandatory to gain time for lung injury to improve.

収録刊行物

  • 蘇生

    蘇生 20(2), 167-172, 2001-07-20

    The Japanese Society of Reanimatology

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