体外膜肺联合血液滤过治疗肺肾衰竭的实验研究

目的 观察体外膜氧合器（ECMO）联合高容量血液滤过（HVHF）对急性呼吸窘迫综合征（ARDS）、急性肾功能衰竭（ARF）的治疗作用。 方法 采用实验犬32只，随机分为A、B、C、D 4组。静脉注射油酸复制ARDS模型及双侧输尿管结扎复制急性肾功能衰竭模型。A组用ARDS呼吸机治疗；B组ARDS用ECMO治疗；C组ARDS＋ARF用HVHF治疗；D组ARDS＋ARF用ECMO联合HVHF治疗。监测血气、血流动力学以及血生化等指标。 结果 治疗后B组氧分压（PaO2）逐步上升，在治疗4 h后高于A组[（95.58±8.14） 比（82.79±12.37） mm Hg，P < 0.05]； C组PaO2治疗中较成模时无明显改善；D组PaO2呈逐渐上升趋势，在各时间点均高于C组（P < 0.05）。各组血流动力学指标在治疗中保持稳定。C、D组HVHF治疗后Scr、BUN明显降低[C组：Scr (320.89±65.42) 比(655.04±181.22) μmol/L，BUN (20.42±6.65) 比（41.53±10.59）mmol/L；D组：Scr (334.15±45.97)比（697.48±101.66） μmol/L，BUN (19.12±6.39) 比（39.10±11.60） mmol/L，P均< 0.01]。 结论 ECMO可以有效地改善ARDS低氧血症，联合HVHF可以提供肺肾功能联合支持。

Experimental study of extracorporeal membrane oxygenation combined with high volume hemofiltration in the treatment of acute respiratory distress syndrome and acute renal failure

Objective To investigate the role of extracorporeal membrane oxygenation (ECMO) in the treatment of oleic acid-induced acute respiratory distress syndrome (ARDS) and the role of ECMO combined with high volume hemofiltration (HVHF) in the treatment of ARDS accompanied with acute renal failure in canines. Methods Thirty-two dogs were randomly divided into 4 groups. The model of acute renal failure was established by the ligation of bilateral ureter, meanwhile the model of ARDS by intravenous injection of oleic acid. The models of ARDS were randomly assigned into ARDS respiratory machine group(A) and ECMO treatment group(B). The animals of ARDS accompanied with acute renal failure were randomly assigned into HVHF treatment group(C) and ECMO+HVHF treatment group(D). Blood gas, hemodynamic and biochemical parameters were measured. Results During treatment, PaO2 increased gradually in group B, which was higher than that in group A after 4 hours treatment[（95.58±8.14） vs（82.79±12.37） mm Hg, P < 0.05]. PaO2 in group C was not improved during treatment, while it increased gradually in group D and was signiflcantly higher than that in group C (P < 0.05). Hemodynamic parameters remained stable during treatment. There was a sharp decline of Scr and BUN after hemofiltration treatment[group C:Scr (320.89±65.42) vs (655.04±181.22) μmol/L, BUN (20.42±6.65) vs （41.53±10.59） mmol/L; group D: Scr (334.15±45.97) vs（697.48±101.66） μmol/L, BUN (19.12±6.39) vs（39.10±11.60）mmol/L, all P < 0.01]. Conclusion ECMO can significantly improve the hypoxemia. ECMO combined with HVHF can effectively provide organ support in the treatment of ARDS accompanied with acute renal failure