alcor人体冷冻程序

A patient being prepared for cryoprotectant perfusion

at Alcor's facility in Scottsdale, Arizona.

在亚利桑那州斯科茨代尔的Alcor基地，医护人员正准备对病人进行冷冻保护剂

灌注。

Alcor Procedures

Alcor的冷冻程序

The purpose of cryonics is to preserve life. Alcor therefore intervenes in the dying process at the earliest moment that is legally possible. If proper procedures are followed immediately after the heart stops, then legal death need not impact the biology of cryonics or its prospects for success. For further information concerning this issue

see Cardiopulmonary Support in Cryonics.

人体冷冻的目的是保护生命。因此，Alcor会在法律允许的范围内，尽可能早地干预死亡过程。如果在心脏停止跳动后立刻采取适当措施，那么虽然在法律上病人已经死亡，但并不会影响人体冷冻的实施以及冷冻成功的概率。欲了解有关该问题的更多信息，请参见人体冷冻中的心肺支持。

Cases with Cardiopulmonary Support

有心肺支持的案例

It is customary practice in medicine to discontinue care of terminal patients, and declare legal death, when the heart stops beating. The several minutes of time between when the heart stops and the brain dies (by conventional criteria) provides a window of opportunity for Alcor to artificially restore blood circulation and preserve brain viability even though a patient is legally deceased. Cryonics cases in which life support techniques are promptly used to maintain brain viability after the heart stops are considered to be ideal cases.

当心脏停止跳动，从法律上讲病人已经死亡，此时医学上的常规做法是终止对临终病人的护理。尽管病人在法律上已经死亡，但Alcor利用从心脏停止跳动到脑死亡这之间的几分钟，可以人为地恢复血液循环，并维持大脑活力。在人体冷冻案例中，在心脏停止跳动后，若能够立即采用生命支持技术保持大脑活性将是十分理想的情况。

Standby

Alcor strongly encourages members who are terminally ill to relocate to cooperative hospice facilities in Scottsdale, Arizona. If relocation is not possible, Alcor may deploy equipment and a transport team to a remote location. As a dying patient's condition becomes critical, Alcor personnel wait nearby on a 24-hour basis. This is called "standby." When the heart stops beating, an independent nurse or physician pronounces legal death, and the Alcor team begins life support procedures as described below.

待命

Alcor强烈建议身患绝症的会员搬到位于亚利桑那州斯科茨代尔的与alcor合作的临终关怀医护机构。如果搬迁不易实现，Alcor可以部署设备和运输小组前往病患所在处。由于临危病人的病情十分危急，因此Alcor人员需要提前24小时就在病人身边等候，这个过程称之为“待命”。当心脏停止跳动，第三方护士或者医生宣告患者在法律上已经死亡之后，Alcor团队就会立即展开如下所述的生命救助程序。

Stabilization

稳定

The patient is placed in an ice water bath, and blood circulation and breathing are artificially restored by a heart-lung resuscitator (HLR). The HLR, or "thumper," is a mechanical device used in emergency medicine to perform CPR. In cryonics, the term CPS (cardiopulmonary support) is used instead of CPR because the intent is to provide life support, not cardiac resuscitation. Because cryonics patients are legally deceased, Alcor can use methods that are not yet approved for conventional medical use. This enables Alcor to use new technologies that can support the brain longer and more effectively than traditional CPR. In particular, the combination of simultaneous compression-decompression CPS and rapid cooling are known to be especially effective for protecting the brain during cardiac arrest.

将病人放置在冰水浴中，通过心肺复苏器（HLR）恢复病人的血液循环和呼吸。HLR（又称thumper）是急诊中用于心肺复苏（CPR）的机械装置。在人体冷冻中，我们用心肺支持（CPS）代替心肺复苏（CPR），其目的在于提供生命保护而非心脏复苏。由于人体冷冻患者在法律上已经去世，因此Alcor可以采用一些传统医学不能使用的方法。这使得Alcor可以运用比传统心肺复苏更有效的新科技保护大脑。值得一提的是，在心脏停搏期间，将压-减压的心肺支持技术和快速冷冻技术结合可以很好地保护大脑。

Intravenous lines are also established, and protective medications are administered. These include:

建立静脉通道并注入保护药物，包括：

?Free radical inhibitors

?自由基抑制剂

?NOS (nitric oxide synthase) inhibitors

?NOS（一氧化氮合成酶）抑制剂

?PARP (Poly ADP-ribose polymerase) inhibitors

?PARP（聚ADP核糖聚合酶）抑制剂

?Excitotoxicity inhibitors

?兴奋毒性抑制剂

?Anticoagulants

?抗凝剂

?Pressors

?升压药

?pH buffers

?PH缓冲液

?Anesthetic

?麻醉剂

These drugs help maintain blood pressure during CPS, and protect the brain from "reperfusion" injury. Anesthesia reduces brain oxygen consumption, which further protects the brain.

这些药物有助于在心肺支持过程中维持血压，保护大脑免受“灌注损伤”。而麻醉剂可以降低大脑的耗氧量，进一步保护大脑。

Transport

运输

If the patient is in a hospital where the administration is unwilling to allow cryonics procedures, the patient is moved to an alternate location while CPS and cooling are maintained without interruption. Femoral arteries and veins are surgically accessed and the patient is placed on cardiopulmonary bypass. This means that blood is circulated through a portable heart-lung machine (pictured below) that takes over the function of the patient's own heart and lungs. External CPS is no longer necessary, and is discontinued.

如果病人在医院，而其行政管理领导又不允许进行人体冷冻，就要将病人转移他处，保证心肺支持和降温过程不受干扰。通过外科手术找到病人的股动脉和静脉，

并完成体外循环。这意味着，便携式心-肺机（如下图）将替代病人的心脏和肺部完成血液循环。此时，不再需要心肺支持，终止心肺支持操作。

Within minutes, a heat exchanger in the heart-lung machine reduces the patient's temperature to a few degrees above the freezing point of water. Blood is also replaced with an organ preservation solution that is specially designed to support life at low temperature. If the patient is located outside of Arizona, they are packed in ice for air shipment to Alcor's facility in Scottsdale, Arizona.

在几分钟内，心肺机中的热交换器将病人体温迅速降低，仅比水的冰点高几度。血液也会被专门用于在低温下保护生命的器官保存液代替。如果患者不在亚利桑那州，则将其用冰块封装并空运至Alcor位于亚利桑那州斯科茨代尔的基地。

This treatment is similar to procedures used by transplant surgeons to support the life of organs moved around the country for transplant, except that Alcor's procedures are applied to whole patients. Remarkably, studies show that whole animals can survive up to three hours of cold storage on ice using existing medical technology. Even longer periods can be survived if the preservation solution is continuously circulated. The MHP2 preservation solution used by Alcor was developed in 1984 during pioneering experiments in which animals were successfully recovered after 4 hours of bloodless perfusion at +4°C.

这种处理方法和运输移植器官的程序类似，器官的运输过程要保持器官活性，将其运输到全国完成移植手术。Alcor的处理方法和运输移植器官的唯一区别在于，Alcor是对整个病人进行处理和运输。值得注意的是，采用现有的医疗技术，生物体可以在冰藏条件下存活三个小时。如果保存液连续循环则可以保持更长时间的活性。

Cryoprotective Perfusion

灌注冷冻保护液

At Alcor major blood vessels are connected to a perfusion circuit by a physician or veterinary surgeon. The preferred vascular access points are the aortic arch and right auricle of the heart, which are accessed by thoracic surgery (median sternotomy). Traditionally, neuropreservation patients have been treated by this same procedure, except that the descending aorta was clamped. In 2000, Alcor began treating neuropreservation patients by directly accessing the carotid and vertebral arteries. This requires careful surgical transection of the spinal column because vertebral arteries are located within the column.

Alcor通过外科医师将主要血管连接到灌注回路。首选的接入位置是主动脉弓和右心房，可以通过胸外科手术接入（在胸骨正中进行手术）。传统上，仅保存大脑的病人也采用相同的手术过程，唯一不同的是将主动脉夹住。在2000年，对仅保存大脑的病人，Alcor开始通过直接对颈动脉和椎动脉的灌注来进行冷冻。由于椎动脉位于脊柱内，这就要求脊柱外科手术中须格外小心脊柱横断。

A base perfusate similar to the preservation solution used during transport is circulated through the patient at a temperature near 0°C (the freezing point of water) for several minutes. This washes out any

remaining blood. The cryoprotectant concentration is then linearly increased over 2 hours to one half the final target concentration. This slow introduction minimizes osmotic stress, and allows time for the cryoprotectant concentration to equilibrate (become the same) inside and outside cells. A rapid increase to the final concentration is then made, and the final concentration is held until the venous outflow concentration equals the target concentration (approximately one hour). Temperature, pressure, and cryoprotectant concentration data are continuously monitored and acquired by computer.

在运输过程中，病人的温度接近0°（水的冰点），采用类似于保存液的一种基本灌洗液在病人体内循环几分钟，从而冲洗出所有的剩余血液。冷冻保护剂的浓度在两小时内线性增加，最终达到目标浓度的二分之一。这种缓慢的推入可以将渗透压降为最小，并使得细胞内外冷冻保护剂的浓度有足够的时间达到平衡（变成相同）。之后将保护液的浓度快速升为最终浓度，之后一直保持最终浓度，直到静脉流出浓度等于目标浓度（时间约需1小时）。计算机将连续监测温度、压力和冷冻保护剂浓度的数据。

The status of the brain is visually monitored through two small holes in the skull made using a standard neurosurgical tool (14 mm Codman perforator). This permits verification of brain perfusion by dye injection, and observation of the osmotic response of the brain. A healthy brain slightly retracts from the skull in response to cryoprotectant perfusion. An injured brain swells, indicating that the blood-brain barrier has been compromised. This injury is often seen in patients who suffered a long period of untreated cardiac arrest.

采用标准外科手术工具（14mm可德曼穿孔器）在颅骨上钻两个小孔，通过这两个小孔可由肉眼观测大脑状态。这样一来，结合染色注射就可以检测大脑的灌注情况，并且可以观察大脑的渗透压变化。当一个健康的大脑被灌注冷冻剂时，它会从头骨缩回。受伤的大脑则会膨胀，这说明血-脑屏障已经受到的损伤。这种损伤常见于在心脏骤停后长时间未能开始进行冷冻手术的病人。

The cryoprotectant solution Alcor uses to prevent freezing is a mixture of chemicals developed by mainstream cryobiologists for long-term banking of transplantable organs. The solution has been specifically

validated for structural preservation of the brain. At the end of perfusion, these chemicals are present at a concentration of approximately 60%. In tissues adequately penetrated by the solution, the small amount of remaining water is not able to freeze. Instead of freezing, tissues vitrify when they are cooled to cryogenic temperatures. Variable penetration of the solution appears to result in a combination of vitrification and partial freezing in various body tissues, but total vitrification (ice-free preservation) of the brain, at least under ideal conditions.

Alcor采用的冷冻保护剂是一种化学混合物，由权威低温生物学家研发用于移植器官的长期保存的液体。已经有专业机构验证这种溶液可以良好的保护大脑结构。在灌注结束时，这些化学试剂的浓度到将达约60%。在保护剂充分渗透到人体组织后，组织中剩余的少量水不足以结冰。当人体组织被降温到低温下时，它们不会结冰，而是被玻璃化。不同的溶液渗透率，决定了在不同人体组织中玻璃化和结冰的比例，但至少在理想条件下，可实现大脑的全部玻璃化（无冰保存）。

Cooling

降温

After cryoprotective perfusion, patients are cooled under computer control by fans circulating nitrogen gas at a temperature near -125°C. The goal is to cool all parts of the patient below -124°C (the glass transition temperature) as quickly as possible to avoid any ice formation. This requires approximately three hours, at the end of which the patient will have "vitrified" (reached a stable ice-free state). The patient is then further cooled to -196°C over approximately two weeks.

在灌注冷冻保护剂后，计算机控制的风扇将氮气循环，将患者冷冻至-125°C，这样做的目的是将患者所有组织器官尽快玻璃化而防止结冰（玻璃化温度为-124°C）。这大约需要三个小时，结束后，病人达到玻璃化（一种稳定的无冰状态）。接下来将病人进一步冷却至-196°C，约需要耗时两周至数周时间。

Patients are monitored by sensitive "crackphone" instruments during this long cooling period to detect fracturing events that tend to occur when large objects are cooled below the glass transition temperature. Contrary to media reports, fracturing is not a result of mishandling. It is a universal problem for large organs cooled to liquid nitrogen temperature. The federal government recently awarded $1.3 million dollars to specifically study the problem of fracturing during cryopreservation.

大型器官在被冷却到低于玻璃化温度时容易发生压裂。在长时间的冷冻期间，采用敏感的破裂麦克风设备对压裂进行实时监测。与媒体所报道相反的是，破裂不是处理不当的结果。这是大器官冷却到液氮温度的常见一个问题。联邦政府最近已经拨款130万美元，用于研究低温保存过程中的破裂问题。

Long-Term Care

长期护理

Currently Alcor patients are stored under liquid nitrogen at a temperature of -196°C. The liquid nitrogen is held in vacuum-insulated dewars that require replenishment every few weeks. Liquid nitrogen is used because it is inexpensive and reliable.

目前，Alcor患者都存储在液氮中，温度为-196°C。液氮在真空绝缘的杜瓦瓶

中保存，每隔几个星期就需要进行补给。之所以使用液氮是因为它便宜又可靠。

Alcor is currently experimenting with an alternative "vapor phase" storage system that would retain the safety and reliability advantages of liquid nitrogen, but allow patients to be maintained at controlled temperatures warmer than liquid nitrogen. This will reduce or eliminate fracturing injury.

Alcor正在尝试用一个“汽相”的存储系统作为替代品，它不仅保持了液态氮的安全性和可靠性等优点，还可以使得在患者在比液态氮温暖的受控温度下进行保存。这将减少或消除压裂伤害。

Cases without Cardiopulmonary Support

无心肺支持的案例

Unfortunately not all Alcor members can be reached at the moment their heart stops. In cases of sudden illness or serious injury, blood circulation may stop for hours before any cryonics procedures are possible. If a physician determines that an Alcor member in cardiac arrest cannot be resuscitated by current technology (i.e. declares legal death), the most important actions are administration of heparin (a drug that prevents blood clotting) followed by chest compressions to circulate the heparin, cooling with ice, and prompt shipment on ice to Alcor. Alcor will cooperate with local funeral directors in making these arrangements. Alcor will also negotiate with authorities to limit the extent of any autopsy that may be required. (Alcor recommends that all members execute a Religious Objection to Autopsy).

不幸的是，并非所有的Alcor成员都可以在他们的心脏停止的瞬间接受手术。如果是突发疾病或严重受伤的情况下，冷冻手术开始前血液循环可能会停止几个小时。如果某位心脏停搏的Alcor成员经医生确定，无法采用现有技术得到恢复（即在法律上已经死亡），最重要的操作是施用肝素（一种防止凝血的药物）；并紧接着通过胸部按压，使肝素在人体中循环；同时用冰冷却，并立即在冰中保存运送至Alcor。Alcor将和当地殡葬官员合作完成上述安排。Alcor

还会与当局协商，尽可能限制需要尸检的程度（Alcor建议所有成员都以宗教信仰为由避免尸检）。

The application of cryonics to patients who are clinically dead is perhaps the single most misunderstood aspect of cryonics. How can cryonics help someone who is clinically dead? The answer is that life and death are not binary "on-off" states. For cells, organs, and people, death is a process, not an event.

人体冷冻的对象是临床上已经死亡的病人，或许这一点是人体冷冻唯一的也是最容易被误解的方面。人体冷冻如何帮助临床上已经死亡的病人呢？答案是生死并不是二进制的“开-关”状态。对于细胞、器官和人，死亡是一个过程而不是一个事件。

For example, the brain is commonly believed to "die" after 5 minutes without oxygen at normal body temperature. This is a myth. Brains have been revived after one hour of warm cardiac arrest, and living human brain cells have been recovered after 4 hours and even 8 hours of clinical death at normal temperature. What really happens is that after 5 minutes without oxygen, chemical changes occur in the brain that cause blood vessels to swell when circulation is restored. Without special interventions, this swelling eventually stops the restored blood flow, resulting in the death of all brain cells hours later. The practical result is that a brain that is deprived of oxygen for more than 5 minutes is usually doomed to die within hours. But doomed is not the same as dead.

例如，人们一般认为，在正常体温下，大脑在缺氧五分钟后就会“死亡”。但是，这并非事实。在暖心跳停搏一小时后，大脑可以复苏，并且，常温下临床死亡4到8小时候后，活的人脑细胞仍可恢复。真实的情况是，在缺氧5分钟后，大脑中的化学物质发生变化，导致恢复循环时血管膨胀。在没有特殊干预的条件下，血管膨胀会最终会导致恢复得到的血液全部停止，进而导致大脑细胞在几个小时后全部死亡。实际情况是，大脑在缺氧5分钟以上，就被认定会死亡。但被认定和真正的死亡并不是一回事。

The biological changes known to occur in the first hours following cardiac arrest are fundamentally minor and reversible in principle. Technology already exists that could recover people after more than 5 minutes of cardiac arrest, although it is seldom used. The conventional medical research value of donated brain tissue and living brain cells recovered from post-mortem donors further highlights the minor nature of brain changes in the early hours of clinical death.

原则上讲，发生在心脏停搏后一小时内的生物变化基本上是轻微的、可逆的。尽管很少使用，但现有的技术已经可将心脏骤停5分钟以上的病人恢复。传统的医学采用捐赠的脑组织和细胞进行研究，它们都是完成验尸后，恢复得到的脑组织和脑活细胞，这些研究的价值进一步凸显了临床死亡后几个小时内，大脑的性质只发生了轻微变化。

Ultimately the difference between life and death for a cell, an organ, or an organism reduces to a difference in how atoms are arranged inside it. It therefore seems certain that future medicine capable of diagnosis and repair at a molecular level will be able to resuscitate people after longer periods of clinical death than medicine can today. How much memory and personality would survive repair and healing after hours of cardiac

arrest is not currently known.

归根结底，细胞、器官或者有机体的生和死之间的区别在仅仅在于其内部原子排列的差异。因此，几乎可以肯定，由于未来的医疗水平能够在分子水平进行诊断和修复，在复苏已经临床死亡很久的病人方面，未来的技术将比今天的技术更加有效。目前还不知道的是，在心脏停搏几小时后，经过了修复和治愈复苏后的病人会保留多少之前的记忆和人格。

Ethics of Non-Ideal Cases

非理想手术中伦理问题

Cryopreservation of clinically dead patients is double speculation. First, as with all cryonics cases, it is assumed that the cryopreservation process will someday be reversible. Second, it is assumed that future medicine will be able to successfully recover people after long periods of cardiac arrest. Alcor therefore encourages members to reduce their risk profile for heart attack and stroke, and relocate close to Alcor during serious illness if possible. If despite these precautions a member experiences unattended cardiac arrest, Alcor will still proceed with cryopreservation unless a member indicates otherwise in their paperwork.

对临床上已经死亡的非理想手术情况的患者进行冷冻保存是一种双重投机。首先，和所有人体冷冻的情况相同，它假设在未来冷冻保存的过程是可逆的。第二，假设将来有医学手段能在心脏停跳较长时间后，仍能成功的将患者复苏。因此，Alcor鼓励会员们减少他们心脏发作和中风的风险，若患有严重疾病，最好能搬迁到离Alcor比较近的地方。如果即使在这些防范措施下，仍有成员发生心脏停搏并且无人值守时，Alcor将继续进行冷冻保存手术，除非该会员在他的相关协议中表达了相反意愿。

Cryonics should never be confused with funeral arrangements. Alcor rarely accepts cases involving legal death of a non-member. The combination of strong emotion, false hope, unfamiliarity with cryonics, low probability of success, and high cost of cryonics without life insurance make accepting such cases ethically difficult. People who think they may someday be interested in cryonics should therefore investigate cryonics now. Waiting until cryonics is needed almost always means it won't be available.

人体冷冻决不能和葬礼相混淆。非Alcor会员在法定死亡后，Alcor很少接受他们的手术案例。综合了强烈的感情，虚无的希望，对人体冷冻的不熟悉，较低的成功率，高昂的费用又不可使用人寿保险支付，这一系列因素使得非会员从伦理上很难接受人体冷冻。那些未来可能会对人体冷冻感兴趣的人，现在就应该着手对人体冷冻进行调查研究。而等到需要进行人体冷冻时才开始关注，往往是来不及的。

For Alcor members who have chosen to be cryopreserved under poor conditions if necessary, there is a final ethical point. As long as resuscitation medicine remains an unfinished science, it is unethical to use the label "dead" as a basis to dismiss cryonics. Calling someone "dead" is merely medicine's way of excusing itself from resuscitation problems it cannot fix today. This makes people feel better about abandoning the patient and making the unwarranted assumption that nobody

could ever fix the problem. Cryonics, in contrast, is conservative care that acknowledges that the real line between life and death is unclear and not currently known. It is humility in the face of the unknown. It is the right thing to do.

如果Alcor会员不得不选择在非理想条件下进行人体冷冻，在这种情况下还有一个终极逻辑依据：只要复苏技术仍是一门发展中的科学，以冷冻患者已经死亡为由，宣判人体冷冻没有意义就是不合理的！宣布某人死去，只不过是现代医学的一种逃避责任的做法，为自己眼下无法修冷冻复苏问题而辩解。人们放弃病人时，假想这一问题永远无法修复，似乎这让人们好受很多，但这一假设却毫无根据。相反，人体冷冻承认生与死之间的界限模糊不清，并且现在仍无法确知，这种对未知事物的谦卑态度无疑才是正确的。

Further information on Alcor procedures can be found in the Alcor Library section on Alcor Procedure and Training Manuals. See also the Alcor at Work Photo Gallery.

欲了解更多的Alcor手术详情，请访问Alcor资料库中的手术流程说明和培训手册，其中也有Alcor的工作照片库。

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