Chapter 1829

The sternum was opened, the bleeding was quickly stopped, and the operative field was exposed. Zheng Ren found that, as expected, there were heavy adhesions in the mediastinum.

This is the case with the second operation. After the first operation, the human body will have fibrous connective tissue hyperplasia, which will change the normal physiological and anatomical structure.

Seeing the messy sticky tissue inside, Zhao Yunlong had a headache.

Elephant nose surgery itself is the largest operation in cardiothoracic surgery, and the second-stage elephant nose surgery...

Difficulty × 10!

Zheng Ren stretched out his hand, and slapped the hemostatic forceps and blunt scissors on his hands.

Lao He glanced at it, and felt that it would take at least a few minutes to open the aorta, and this was Boss Zheng's surgery. If it were someone else, it would take at least 30-60 minutes to successfully dissociate to the aortic arch.

He took out the USB flash drive, quickly found the audio file, and clicked on the song Good Luck.

Familiar and melodious music sounded, but this time Su Yun didn't complain. He didn't seem to hear that the background music had switched at all, and he was concentrating on cooperating with Zheng Ren's wandering.

The two hemostatic pliers flew up and down, which was really beautiful.

The blunt scissors dissociated, and the crackling sound of the ultrasonic knife sounded.

"Prepare for heparinization." Zheng Ren said in a deep voice while wandering away.

Lao He was a little surprised, surprised by Boss Zheng's self-confidence. Heparinization does not take long and is usually done after the surgical area is prepared.

Boss Zheng had confidence in his freedom, estimated the time, and ordered heparinization early in the morning.

Lao He began to prepare calmly while paying attention to the progress of the operation.

After 3'12", the aortic arch completely appeared in the surgical field.

The aortic arch and its branches were freed and banded separately.

"Heparinized."

The moment Zheng Ren happened to put on the belt, Lao He said.

The time was just right, and Lao He knew that it was not because he cooperated well, but because Boss Zheng had an extremely accurate assessment of his level.

If the medical group is a machine, it is just a component. Boss Zheng has already figured out the level of level, and calculated it into the operation process.

It looks like the cooperation is seamless, but it is actually a manifestation of Boss Zheng's calculation ability. Lao He just sighed with emotion, but didn't continue to think about it.

The operation was still going on at a high speed, so there was no room for him to be distracted.

After heparinization, Zheng Ren inserted the 24F arterial cannula into the right subclavian artery 2 to 3 cm. Don't dare to insert too deep on this side, because if the cannula is too deep, it may enter the innominate artery and seriously affect cerebral perfusion.

Subsequent insertion of the right atrium secondary catheter or superior and inferior vena cava cannulation.

"Full flow transfer to cool down."

Only one person spoke in the operating room, and the quiet atmosphere in the operating room proved the difficulty of the operation from the side.

Oxygenated blood was supplied to the whole body from the right subclavian artery through the innominate artery to the aorta, and the coronary sinus retrograde perfusion catheter was blindly inserted through the right atrium.

"Report the temperature of the nasopharynx."

"35°C."

"33°C."

"30°C."

"27°C."

When the temperature of the nasopharynx dropped to 26-28°C, the ascending aorta was blocked, and cold-blooded cardioplegia was perfused retrogradely through the coronary sinus.

While continuing to cool down, complete disease detection, artificial valve replacement, proximal artificial vascular anastomosis, and coronary artery anastomosis during coronary artery bypass grafting.

Zheng Ren moved quickly, but the more he probed, Su Yun felt a little flustered.

Marfan syndrome is a congenital disease. After ascending aortic valve replacement + coronary artery transplantation 2 years ago, the patient's local changes were greater than originally expected.

The adhesion is very heavy, let's not talk about it. The air bubble sign faintly appeared in the middle of the anastomotic segment, indicating the possibility of subsequent dissection.

Does the operation have to be done together with a bypass?

Even Su Yun was caught off guard by this situation and had some headaches.

When he saw the situation in the operation area, he raised his eyes and glanced at Zheng Ren.

Zheng Ren didn't seem to have any emotional changes at all, and he was performing the operation calmly.

Su Yun felt a little more at ease in his heart, there was a boss around, so there was nothing to be afraid of.

"22°C." Lao He continued to report the temperature.

"20°." Zheng Ren said.

The values ​​mentioned by the two are completely different concepts. What Lao He reported was the temperature of the nasopharynx, the key points that must be paid attention to in deep hypothermia and circulatory arrest surgery.

The 20° mentioned by Zheng Ren is the angle at which the patient's head is lowered. After Zheng Ren finished speaking, the three of them stopped the operation at the same time, and Lao He began to adjust the angle of the operating table.

The head side is down at an angle of 20°.

Zheng Ren then blocked the innominate artery, left common carotid artery, and left subclavian artery in sequence, reduced the arterial flow to 8ml/kg·min, performed continuous selective cerebral perfusion, and opened the ascending aorta clamp at the same time, and began to make the aortic arch Department of surgery and arch descending.

"20°C." Lao He was still concentrating on reporting the temperature.

This temperature is the clarion call to start the general attack.

After Lao He reported the temperature, Zheng Ren immediately blocked the ascending aorta, and the heart stopped beating by cold perfusion at the root of the aorta.

"Slush."

The prepared ice mud was delivered to Zheng Ren's hand.

Zheng Ren tried it first, with ice and water, 4 degrees Celsius. There are no big pieces of ice, all are small pieces of ice, which can cool the heart as fast as possible.

In general heart surgery, being able to make this kind of perfect ice slush can at least improve the completion of the surgery by a few percentage points.

This is a detail, but an indispensable detail.

Zheng Ren was very satisfied, and put ice mud on the surface of his heart to cool down.

When the temperature of the nasopharynx dropped to 18 ℃, Zheng Ren began to occlude the three brachiocephalic vessels in the aortic arch, and the arterial perfusion flow rate of cardiopulmonary bypass was changed to 6 ml/(kg·min) for selective antegrade cerebral perfusion.

The aortic arch was cut along the long axis of the aortic arch, proximal to the anastomosis of the original artificial vessel, and distal to the proximal opening of the left subclavian vein.

Because the heart stopped beating and deep hypothermic extracorporeal circulation had been established, when the aortic arch opened, no blood flowed out.

A clean aortic arch with a clear operative field.

The purpose of deep hypothermic circulatory arrest surgery is for this moment, and at this moment, it seems almost perfect.

"Pay attention to the amount of thrombus in the brain." Zheng Ren cut open the aortic arch, and said in a deep voice: "If Lao He is not familiar with it, turn the screen to the side at 22 degrees, and I will watch it."

Lao He was a little ashamed, this should have been the anesthesiologist's job.

However, he is undergoing surgery and is still a new machine that he has just come into contact with. How can he have time to familiarize himself with, understand, and get used to it.

He did not hesitate to follow what Boss Zheng said. The ultrasound probe was placed on both sides of the neck of the patient, without affecting the position of the operation and the head. And the screen was facing Boss Zheng, with countless data floating on it.

The huge amount of data made Lao He helpless.

This should be a laboratory product, or it is still in its infancy, and it needs a computer to perform precise calculations and output the results.

But now there is no final result, only countless data signals appearing like snowflakes on the screen.

Zheng Ren raised his head to glance at the color Doppler ultrasound screen from time to time, but his hands didn't stop.