中文摘要
題目：靜脈-靜脈型體外膜氧合插管形式中之再循環現象離體評估
研究生：陳偉右
指導教授：陸鵬舉 教授
體外膜氧合(Extracorporeal Membrane Oxygenation, ECMO)，簡稱葉克膜，是利用體外循環的方式，暫時性的代替人體心肺功能，維持人體血液循環與血氧濃度，以減輕病患的心肺負荷並延長急救治時間。葉克膜依插管方式的不同，可分為靜脈-動脈型(用於心、肺衰竭)與靜脈-靜脈型(僅用於肺衰竭)兩種。其中靜脈-靜脈型葉克膜在臨床上存在「再循環」(Recirculation)的缺點，此現象會減少葉克膜迴路中高含氧血輸送回人體的含量，進而降低其效率。本研究以風箱理論(Windkessel Model)及ㄧ維彈性血管混合模型建立仿生循環測試台來模擬人體心博、血壓與心輸出量等生理條件，再將靜脈-靜脈型葉克膜裝置於平台上，並於工作流體中添加感光水乳液，藉由其照射紫外光後會變色的機制來類比出人體血液的氧合(Oxygenation)和去氧合(Deoxygenation) 的血氧變化特徵。再循環量測上，為使用光學量測的方式發展出在仿生循環測試台上定量再循環程度的量測方法。實驗中，將靜脈-靜脈型葉克膜以兩種形式裝置於仿生循環測式台上，分別為1)雙側插管(Double-site Cannulation)：使用兩支單腔室導管(Single-Lumen Catheter)由上腔靜脈端與下腔靜脈端插入；2)單側插管(Single-site Cannulation)：使用一支雙腔式導管(Double-Lumen Catheter)由上腔靜脈端插入，以量測在不同程度下之葉克膜循環流量、循環方向、導管相對位置與插入距離之再循環率，以評估影響再循環之重要參數。

SUMMARY

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a life support treatment for saving severe acute respiratory failure by machine-assisted extracorporeal blood oxygenation and carbon dioxide removal. The VV-ECMO drains de-oxygenated blood from patient’s large vein to the oxygenator and pumps the oxygenated blood back to the vena cava near the right atrium. Often some of the reinfused oxygenated blood would be sucked back into the drainage cannula rather than entering the desired systemic circulation, resulting in the so-called “recirculation” phenomenon. This phenomenon is the major issue in VV-ECMO cannulation that limits the support efficacy. In this study, we set up various VV-ECMO cannulation scenarios on a specially designed Mock Circulation Loop (MCL) and measured the recirculation rate in-vitro. The fluid used on the present MCL was a mixture of water, glycerol and photochromic slurry with bulk density and viscosity similar to those of the human blood. This blended photochromic slurry, which can change color under the irradiation of ultraviolet light, has been used as the media to quantify the level of oxygenation. The color of the slurry mixture can be detected and characterized using spectrometric analysis. An empirical scaling rule relating color chromaticity and recirculation rate was established on the calibration loop prior to formal recirculation assessment. VV-ECMO support efficacy pertaining to double- and single-site cannulations was evaluated in relation to ECMO pump flow rate and the deployment positioning. For double-site cannulation, we studied the ECMO circuit flow direction effect, namely, atrio-femoral flow (AF flow) and femoro-atrial flow (FA flow), and confirm that femoral drainage may lead to better support efficacy for pump flow greater than 2 L/min. In general, for both double- and single-site cannulations, VV-ECMO recirculation deteriorates as pump flow increases. The recirculation rate can be as high as 20% and 40% respectively for single-site and double-side cannulations when pump flow reaches 2.5 L/min and the trend is nearly linearly increasing as the support flow goes further higher.

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