Chapter 2758 Don't Make This Mistake Next Time

The blood pressure fluctuated abnormally when closing the sternum, and repeated tachyarrhythmias occurred with a heart rate of 170-180 beats/min.

This is the value that occurs when the sternum is not completely closed. If the sternum is forcibly closed, the patient may not be able to get off the operating table.

"Boss Zheng, did you make a judgment before the operation?" Zhao Yunlong knew that Zheng Ren's choice was right, so he asked softly.

"Echocardiography showed that the patient's heart was enlarged, but this is not the main reason. The basis for judging to delay chest closure is previous treatment." Zheng Ren began to prepare for delayed chest closure while explaining.

"Boss Zheng, are you going to have an ultrasound now?" Lao He pushed the machine in and asked.

"good."

Lao He didn't mind that he was carried from home to the operating room by Boss Zheng early in the morning just for a transesophageal ultrasound examination, and he could do whatever he asked, and Lao He didn't complain.

Under general anesthesia and intubation with a ventilator, it is also a skill to successfully complete transesophageal echocardiography, not everyone can do it.

"Wait a minute." Lao He flew to the computer, plugged in the USB flash drive, and the singing of good luck came out.

"If you don't listen to this song now, you won't have surgery." Lao He explained with a smile.

Although the operation has reached the final step, Lao He still insists on playing Good Luck.

Stepping on the rhythm of good luck, Lao He felt his body was a little lighter, as if he had become a fairy.

The difficult operation became very smooth in his hands. After a few minutes, Lao He said softly: "Boss Zheng, the SAM sign is obvious."

SAM sign is a sign in M-mode ultrasound diagnosis.

It mainly refers to the forward movement of the anterior leaflet of the mitral valve during systole. In obstructive hypertrophic cardiomyopathy, the CD segment during systole is not a slow rising platform, but an abnormal waveform that protrudes upward, that is, toward the interventricular septum. The phenomenon is called systolic forward motion, or SAM sign for short.

"Give a small amount of β-receptor blockers and quickly replenish plasma." Zheng Ren gave the doctor's order, and then began the procedure of delaying chest closure.

"Adjust the dose of levosimendan to 0.5μgkg/1min." Zheng Ren said, and the Xie Yi people had already handed over the child-sized sternum spreader.

Zheng Ren replaced the adult's sternum spreader with a smaller children's one, and then simultaneously observed blood pressure, central venous pressure, heart rate and rhythm, cardiac contractility, and pulse oxygen saturation.

His hands slowly changed the distance between the sternum, looking for the most favorable for stable blood pressure, no slowing down of the heart rate or a significant increase in heart rate, no ventricular arrhythmia, decreased CVP, strong myocardial contraction, no heart expansion, and increased oxygen saturation. s position.

"Boss, you are too delicate." Su Yundao, "It is not possible to perform surgical operations with millimeters as the calculation unit. Cardiothoracic surgery is about roughness!"

Zheng Ren smiled, the roughness Su Yun said is probably different from what other people understand.

"With a more accurate position, the postoperative recovery will be faster. If there are no accidents, the edema will gradually subside in 2-3 days, and Lao Zhao will be able to close his chest in about 5 days." Zheng Ren said.

Zhao Yunlong lowered his head and watched Boss Zheng's way of moving the child-shaped sternum spreader intently.

There are explanations for every angle, every distance, and every movement, but Zhao Yunlong knows that this is an instinct formed by his rich surgical experience, and Boss Zheng may not be able to explain it clearly.

Let's take a closer look, go back and think about it, if there is a chance next time, you can try to do it, Zhao Yunlong thought to himself.

Place pericardial and mediastinal drainage tubes, and use sterile transparent surgical film to seal the incision and spreader.

"Send it to the ICU." Zheng Ren turned and stepped off the stage, then turned around and asked, "Old Zhao, do you often perform delayed chest surgery?"

"Occasionally, very rarely. But the doctors and nurses in the ICU are experienced, Boss Zheng can rest assured." Zhao Yunlong knew what Zheng Ren meant by asking, so he immediately replied.

"Okay, that's it."

Even with delayed chest closure, the completion rate of the operation reached 101%. Zheng Ren expressed his satisfaction with this.

The patient should be fine.

"Boss Zheng, thank you." Director Lang bowed deeply and said softly.

"You're welcome." Zheng Ren said, "IABP shouldn't be used. I have experience this time, so I won't make such a mistake next time."

"Next time..." Director Lang murmured.

"Huh?" Zheng Ren heard something in Director Lang's words, and looked at him suspiciously.

But director Lang didn't continue talking, but asked, "Boss Zheng, isn't IABP the right one? Every time I encounter a similar situation, I use IABP to solve it."

"Don't be too dogmatic." Zheng Ren said, "After clinically judging that there are many early symptoms of cardiac tamponade, emergency measures such as pericardial puncture and drainage should be performed immediately to relieve it. Up to this point, your treatment is no problem, and you have done a great job."

Seeing Director Lang's mood was not right, Zheng Ren did not overly stimulate him, but praised him rarely.

"We did not see the common situation of cardiac tamponade caused by hemorrhage caused by coronary perforation during the operation. It is said that even if there is pericardial puncture and drainage, there will be more or less. This situation is too rare."

"Boss Zheng, it must be caused by the rupture of the small branch." Director Zhang Lin asked.

"It should be, or it can be considered that the small branch ruptured. As the pressure of the pericardial cavity increased, the damaged point has healed itself." Zheng Ren said, "It is indeed a bit of bad luck. In fact, if this patient does nothing, it may be better. Some."

"..."

Director Lang was speechless, Boss Zheng's words made him feel ridiculous.

The absurd black comedy style and nonsensical words are not suitable for the operating room, Director Lang said he could not accept it.

"But I think it's more likely because the patient is older, and the main cause of his cardiac tamponade is the high degree of congestive swelling of the myocardium, not the hemorrhage in the pericardium." Zheng Ren explained, "In my analysis, it should be caused by you. Cardiac edema caused by extensive myocardial infarction during PCI operation."

"Myocardial edema is severe in the early stage of myocardial infarction, and the left coronary artery is dominant, and the myocardial infarction involves a large area, which leads to this special change."

"That is to say, it is not the cardiac tamponade caused by coronary artery rupture and bleeding, but the acute necrosis and effusion caused by cardiac tamponade."

"Under this rare situation, everything you did, Director Lang, was wrong." Zheng Ren finally told the truth.

"Although the IABP measures adopted have reduced the afterload of the patient's ventricle, they have not been able to reduce the compression of the pericardium on itself in time, so the symptoms are getting worse."

"..."

Director Lang listened to Boss Zheng's talk about the patient's condition, and his judgment on the patient's condition was not the rupture and bleeding of the small coronary artery branch that Director Zhang Lin said before, but another complication.

In an instant, Director Lang was in a daze.