Murkin J M
Department of Anaesthesia, University Hospital, University of Western Ontario, London, Canada.
Ann Thorac Surg. 1995 May;59(5):1308-11. doi: 10.1016/0003-4975(95)00107-v.
Recent developments in techniques for managing cardiopulmonary bypass are outlined with a view toward interventions aimed at decreasing the incidence of perioperative central nervous system dysfunction and overt stroke. Recent reports assessing central nervous system dysfunction after hypothermic and normothermic cardiopulmonary bypass are reviewed and critiqued along with data assessing techniques for cerebral protection during hypothermic circulatory arrest. Controversy surrounding optimal pH management is explored along with a proposal that pH-stat may be most satisfactory to ensure better brain cooling where circulatory arrest is anticipated, whereas alpha-stat may avoid cerebral hyperemia and thus decrease the cerebral embolic load during moderate hypothermic cardiopulmonary bypass. Newer developments in cerebral monitoring techniques are also reviewed.
本文概述了体外循环管理技术的最新进展，旨在采取干预措施降低围手术期中枢神经系统功能障碍和明显中风的发生率。同时回顾并批判了近期关于低温和常温体外循环后中枢神经系统功能障碍的报告，以及评估低温循环停搏期间脑保护技术的数据。探讨了围绕最佳pH管理的争议，并提出在预期循环停搏时，pH稳态可能最有利于确保更好的脑降温，而α稳态可能避免脑充血，从而在中度低温体外循环期间降低脑栓塞负荷。还回顾了脑监测技术的最新进展。
