medical road high rise

Chapter 221 The role of cardioplegia
Chapter 221 The role of cardioplegia solution
"First perform a double clamp on the distal end of the radial artery." Qin Feng said.

Zhao Qi hurriedly followed suit and clamped the distal end twice with a blood vessel clamp.

Qin Feng waited for a while, and directly cut off the radial artery two centimeters from the wrist joint. At the moment of cutting, the radial artery had segmental spasms due to tension.

"Prepare the heparin solution." Qin Feng said calmly.

Lu Shan came up, inserted the injection needle along the proximal end of the radial artery, and delivered the heparin solution to fill the radial artery.

Soon, under the influence of the drug, the segmental cramps disappeared.

"Indigo base."

This drug is an alkaloid extracted from traditional Chinese medicine. It has strong resistance to bacteria and can also play an antiviral role.

Qin Feng used it here mainly to mark the radial artery and avoid bacterial invasion. Although the operating room is a sterile environment, it should be avoided as much as possible.

After marking the back side of the radial artery, Qin Feng directly cut off the radial artery bridge with a scalpel and handed it over to Zhao Qi for storage.

Zhao Qi needs to measure the inner diameter and length of the radial artery graft, which is one of the preparations before transplantation.

While Zhao Qi was measuring and recording, Qin Feng still didn't stop moving, and started to suture the incision.

It was quite easy to cut it open, but it was a lot of work for Qin Feng to sew it up.

Because of the stitching of the incision, once there is an error, even if it is only 0.1mm, it will cause blood to leak. This part, Qin Feng can't get up quickly.

"Brother Qin, don't you suture the incision in the deep fascia?" Lin Xue saw that Qin Feng avoided the incision in the deep fascia.

"No, sutures can cause compartment syndrome."

Because the blood vessels in the deep fascia are ischemic due to surgery to block the blood vessels, the muscles, nerves and other tissues supported by them will swell reactively after repairing the blood vessels and restoring blood flow due to long-term ischemia. As a result, the contents of the interspace increase and the pressure increases, which will cause compartment syndrome.

This disease is a vicious circle of diseases. After the onset, there will be obvious swelling and pain of the limbs, and may even produce clinical manifestations such as signs of neurological dysfunction.

When surgically blocking blood vessels and involving the deep fascia, the best way is to retain the incision in the deep fascia, which can effectively decompress the fascia and avoid excessive internal pressure and intermuscular syndrome. levy.

After bypassing the deep fascia, Qin Feng divided and divided the superficial fascia layer by layer, and used a drainage tube to drain the accumulated blood in the wound cavity out of the body, and then wrapped the upper limbs with elastic bandages.

"Prepare for myocardial protection."

After Qin Feng finished suturing, he operated on the skin of the patient's chest again to expose the heart.

There are two conditions for heart bypass surgery, one is extracorporeal circulation, which is a preparation for stopping the heart, and the other is myocardial protection.

Qin Feng's surgery is not beating heart bypass surgery, extracorporeal circulation is not needed, only myocardial protection is needed.

This step is not complicated. After opening the skin, find out the aorta, and then use cold cardioplegic solution to intubate the root of the aorta for retrograde perfusion of the tubular venous sinus.

The reason why the conventional antegrade perfusion is not chosen is that the conventional perfusion method is not very effective in protecting the ischemic myocardium in the narrow distal end.

In the past, this defect was not obvious because of the medical environment, but now with the expansion of the medical environment, there are more and more surgical indications, so many cases have severe coronary artery stenosis, and the number of cases of complete occlusion is also increasing.

A genius doctor proposed the retrograde perfusion method. The doctor who proposed this theory discovered that there is no valve duct in the coronary venous system, that is to say, it can directly exchange with cardiomyocytes through capillaries and sinusoids, and does not affected by narrowing of blood vessels.

Another important point is that coronary artery lesions generally do not affect the coronary venous system, so even if there is extensive coronary artery disease, cold cardioplegia can still enter the myocardium evenly after retrograde perfusion through the coronary sinus.

Most of the cardioplegic solution flows out from the coronary ostia through capillaries, and part of it is directly drained to the right ventricular cavity through the sinusoid vascular system.

During retrograde coronary sinus perfusion, the distribution of cold cardioplegia in the left ventricle is better than that in the right ventricle, and subendocardium is better than epicardium, which is suitable for myocardial protection.

Therefore, for this patient, coronary sinus retrograde perfusion is the best option.

Qin Feng poured 800ml of fluorocarbon cardioplegia along the catheter at the root of the aorta, and at the same time told Zhao Qidao, "Infuse 10ml every 400 minutes."

Zhao Qi nodded and took the cardioplegia solution.

Qin Feng asked Lin Xue for medical ice chips, which are to cool down the heart muscle.Ensure that the cardioplegia solution can be circulated in the ventricle.

"Expose the coronary arteries and begin the selection of coronary anastomoses."

Zhao Qi quickly put down the cardioplegia, handed the measured radial artery data to Lu Shan, asked Lu Shan to show Qin Feng, and then began to search for the coronary artery himself.

After all, it came from a famous medical university, and it was quickly found accurately, and Zhao Qi revealed it.

Qin Feng recalled the lesion area shown by the angiography in his mind, and quickly found the lesion area at the end of the epicardium, and marked the incision with indigoline.

Zhao Qi showed his surgical field, Lu Shan was given the task of cardioplegia, and Lin Xue helped stop the blood circulation.

Basically, one person has two positions. Fortunately, Qin Feng was fast enough to enlarge the incision at both the proximal and distal ends of the coronary artery, completely controlling the incision in the center of the coronary artery.

Such precision, except for Qin Feng, no other doctor in the Second Hospital can do it.

Even if other doctors can do it, they don't dare to try it. If they make a mistake, there will be bleeding.

"Coronary artery probe." Qin Feng stretched out his hand.

Lin Xue patted the spy on Qin Feng's hand. Qin Feng went to the vascular department to get it. It was specially used to measure the diameter of the distal end and the proximal end. It was also a unique surgical instrument for the vascular department and cardiac surgery.

After the measurement, Lin Xue recorded it, and Qin Feng made another 8mm incision, and the coronary vessel incision step stopped temporarily.

Qin Feng replaced with a microvascular device, which was also borrowed from the Department of Vascular.

Because the diameter of the coronary artery is very small, it is very difficult without specific equipment.

"Temporarily stop the heartbeat, and clear the blood at the coronary anastomosis." Qin Feng said seriously.

"Isn't it a non-stopping bridge?" Zhao Qi asked puzzled.

The sudden change made him unable to react.

"The patient's heart was beating too fast, which seriously affected the fibrillation of the blood vessels. Only by stopping the beating of the heart can the smooth operation of the blood vessels be guaranteed."

(End of this chapter)