Chapter 2964

Because it was in the operating room of the system, Zheng Ren was not particularly impatient. This is an incomparable advantage that others have, and Zheng Ren is already used to it. He silently watched the condition of the experimental subject go from bad to worse, and began to measure various values.

Laboratory values ​​indicated that the subject had symptoms of metabolic acidosis and acute renal failure.

Zheng Ren is aware of the possibility of gas embolism during the use of ECMO. It is estimated that the renal artery was tethered by gas embolism, and there were cases where the operation failed before it was completed.

It's good to be able to find out, Zheng Ren's mood is stable. This is the significance of the system operating room, to discover the problem in advance, and to study how to avoid this situation as much as possible.

After confirming that there was a problem with the kidney, Zheng Ren ended the lung transplant operation, but he did not leave the operating room of the system, but performed a kidney angiography on the experimental subject.

The final conclusion proved Zheng Ren's judgment - gas embolism.

After placement of ECMO, liver and kidney function should be improved, because ECMO can improve the perfusion of peripheral organs.

Looking for similar information in journals, there is very little relevant information. Zheng Ren can only make judgments based on limited information and his own imagination.

Worsening kidney function could be a sign of ECMO malfunction or suggest pre-existing kidney disease. After Zheng Ren tried several methods, he discussed with Lao He, and finally decided to use continuous renal replacement therapy as a circuit independent of the ECMO system to avoid air embolism.

Persistent metabolic acidosis may be due to hypoperfusion of any organ, tissue necrosis, or distal extremity infarction. Oxygenator failure can manifest as massive hemolysis. Distinguishing between hematuria, disseminated intravascular coagulation, and hemolysis requires emergency diagnostic examination, continuous measurement of values ​​during surgery, and timely treatment are very important.

Solving one problem after another, Zheng Ren tirelessly led Lao He to study.

Every time he verified and solved the problem, Zheng Ren found that in addition to the failure caused by renal gas embolism, there is a 15% possibility of acute liver failure when ECMO is used.

Because Xiao Shishi has just completed two interventional embolization operations for liver cancer, his liver function is relatively poor. Liver failure is also a top priority for surgery. Zheng Ren didn't want to show off his skills and complete the liver transplant operation at the same time as the lung transplant.

The transplantation of one organ is afraid that a small stone will not be able to withstand it, let alone more organs.

Finally, I decided with Lao He to measure the liver function every 10 minutes during the operation. If the small stone still progresses to a persistent increase in bilirubin or an acute increase in liver enzymes under the condition of appropriate ECMO flow and blood pressure, it must be done. Liver dialysis using a molecular sorbent recirculation system.

"Old He, do we have intraoperative liver dialysis?" Zheng Ren asked.

"No, only Xiehe and Imperial Capital have liver and gallbladder in the imperial capital." Lao He said, "We don't perform as many liver surgeries as they do. In addition, this kind of situation is not common, so the equipment has not been brought in for the time being."

Zheng Ren didn't hesitate and called Zhou Chunyong.

Borrowing a piece of equipment for use is easy to borrow and return. Bao Longtao, the daring dean of the imperial capital, will never embarrass himself because of this matter.

Lao He is very helpless, in his opinion, even if there is a problem with liver function, there is still time to get it down. But Boss Zheng put on a posture that he must make the operation perfect, so he didn't say much.

After nearly 10 hours of discussions and rounds of brainstorming, Lao He was completely exhausted by Boss Zheng.

Seeing Boss Zheng going to the operating table in high spirits for surgical training, Lao He held 12 A4 paper records in his hand and slowly closed his eyes.

There are so many details that need to be paid attention to in anesthesia, ECMO, and extracorporeal circulation. What about surgery? It is estimated that there are more points to pay attention to.

"Old He, do you want to drink some Red Bull?" Ringer's voice came.

"Ah? Chu Lin, why are you here?" Lao He was stunned for a moment, what time is it, why does Linge... need to ask, Chu Lin is also planning to stay in the community hospital for a while to do logistics work .

The Department of Science and Education was almost transparent to the clinic in the era when Director Mao was in charge, and basically did not do other serious things except to ask for a card for the trainee doctor. There is a stale smell, and when it comes to science and education, clinicians frown.

This is part of Lin's job, but Lao He is still not used to it.

He wanted to say hello to Ringer, but his eyelids seemed to be standing together, and it took a lot of effort to open them.

"If you can't, go back to sleep." Ringer persuaded, "I think you've exhausted your energy too much, and I think you'll be useless tonight. It's useless to stay here, and the efficiency is low instead. It's not a one-day job, I see what Boss Zheng means, this is a marathon."

"Well, Boss Zheng is still young, in good health, and full of energy." Lao He glanced at Zheng Ren who was standing silently operating under the shadowless lamp, and sighed, "My old arms and legs are really failing."

"What were you discussing just now?"

"Boss Zheng took me through the anesthesia work of the operation from beginning to end." Lao He said, "The type of intubation, the depth of intubation, the frequency of the ventilator, the tidal volume, the end-expiratory pressure... and then Various matters needing attention during ECMO, as well as kidney and liver dialysis preparations.”

"usually……"

"Chu Lin, Boss Zheng is so demanding." Lao He said, "Gandan has applied several times to get the liver dialysis equipment during the operation, but he hasn't come in yet. Boss Zheng is in charge of borrowing the equipment from the imperial capital to ensure nothing goes wrong. "

"I heard it, and I was just about to ask you, is it meaningful to borrow this thing?" Linge asked in a low voice.

"Of course it is meaningful. Once the bilirubin rises during the operation, it is much better to go to liver dialysis immediately than to treat the symptoms after the operation." Lao He said, "But the meaning...is the same thing. If someone else , I guess it will be enough to deal with it like this. The operation will not be delayed for a long time, and it is better to go back to do dialysis during the operation. And knowing that there are not many people with kidney dialysis during the operation, this is a very cutting-edge treatment."

"Look at what you said." Ringer smiled.

"Chu Lin, I'm not joking." Lao He said seriously, "If you don't believe me, you can ask the clinician. When they say dialysis is the kidney, there are not many people who know about liver dialysis during surgery."

Ringer nodded, and he raised the incident level again.

Boss Zheng must care about the things he cares about, and there is nothing to say. For a problem that might arise, it doesn't matter how much effort Boss Zheng has put into going to the imperial capital to borrow equipment.

If it weren't for the age difference between Boss Zheng and the little patient, Linge would even think that the little patient was Boss Zheng's illegitimate son. If it weren't for his own son, who would be willing to go to such lengths to prepare for surgery and treatment.

Treating patients like family members, Dean Yan will talk about it every time the hospital has a weekly meeting. There are really not many doctors who can really treat patients like family.

Boss Zheng... Even Linge felt that he had gone too far.