【摘要】 目的本文旨在探讨经典体外循环与温心不停跳体外循环,双心室旁路与选择性顺行脑灌注各式的利弊。方法本文从研究体外循环与缺血再灌注损伤之间关系开始,首次提出了体外循环悖论问题。基于"广义生命时空场论"与机体损伤反应综合征"SD1D2F"4阶段说之学术观点,我们探讨了体外循环悖论的产生原因与心肺旁路所致的缺血再灌注损伤病理生理及细胞分子生物学机制,并提出了解决体外循环悖论问题的临床总体方略和解决缺血再灌注损伤问题的临床对策。另对经典体外循环(简称ECC)、温心不停跳ECC,双心室旁路与选择性顺行脑灌注四式之利弊做了评价。此外,对ECC各式的升主动脉和/或上下腔静脉阻断时限,深低温停循环时限与总转流时限等安全时限问题做了深入探讨与评价,并提出了一套关于"心肺脑保护体外循环各式"统一命名的建议方案与几个新的ECC术式设计。结果上述心肺脑保护体外循环各式均有弊端,任何一式均不能同时完全保护心肺脑三者功能。结论体外循环悖论是解决现有心肺旁路各式弊端的关键所在,对该问题之学术论战将会引发ECC的一场新的革命。更多还原

【Abstract】 Objective The purpose of this paper was to study the advantages and disadvantages of various types of extracorporeal circulation(ECC) including classical ECC,beating heart ECC,biventricular bypass,and selective antegade cerebral perfusion with deep hypothermic circulatory arrest.Methods By studying the relationship between ECC and ischemic reperfusion injury(IRI) during cardiopulmonary bypass surgery,a paradox of extracorporeal circulation(PECC) was identified here for the first time.Based on the theory of general life time-space field(GLTSF) and the view of "SD1D2F" in the four periods of body injury response syndrome(BIRS),the causes of PECC and the pathophysiological and cellular mechanisms of IRI induced by cardiopulmonary bypass were discussed.The general strategy and approach for PECC and a set of clinical counter-measurements for IRI were proposed.The advantages and disadvantages for cardiopulmonary bypass(CPB),warm beating heart ECC,biventricular bypass(BVB) and selective antegade cerebral perfusion with deep hypothermic circulatory arrest(SACP+DHCA) were evaluated.The problems of safe time limit in the processes of ascending aorta clamping,and/or superior and inferior vena cava clamping,deep hypothermic circulatory arrest and total rotating flow(TRF) during various types of ECC were evaluated.A unified scheme for various types of heart lung brain protection in ECC and several designs of new types for ECC were proposed.Results Among various types of heart-lung-brain of ECC,no single type of approach can simultaneously protect the functions of all three organs from injury.Conclusion The paradox of extracorporeal circulation is a key issue in solving the problems of various types of CPB.Addressing this controversy might generate a revolutionary new approach in the future study of ECC.更多还原