Siheyuan: Rebirth in a prosperous era, great doctors are sincere

Come here.

Li Pingan and Andre naturally wanted to meet Lev.

Lev lived alone in a ward, and he was very happy when Li Pingan came over. When they met, they first talked about Lev's condition.

to be frank.

Lev's illness was already very serious. At this time, he no longer concealed his illness. He said that he had known that he had coronary heart disease for many years.

The only medicine I often took before was nitroglycerin.

Nitroglycerin can directly relax vascular smooth muscle, especially small blood vessel smooth muscle, causing peripheral vasodilation, reducing peripheral resistance, reducing blood return to the heart, reducing cardiac output, reducing cardiac load, and reducing myocardial oxygen consumption, thus angina pectoris is relieved.

In addition, it can still promote the formation of collateral circulation, but the effect is not very significant.

Li Ping'an shook his head and recommended Suxiao Jiuxin Pill to him.

Suxiao Jiuxin Pill is a Chinese patent medicine whose ingredients are Chuanxiong and borneol. It has the effects of promoting qi and activating blood, removing blood stasis and relieving pain, increasing coronary blood flow and relieving angina pectoris.

Used for coronary heart disease and angina pectoris due to qi stagnation and blood stasis.

It can be used for emergency treatment when coronary heart disease and myocardial ischemia attacks. It has a relatively fast onset of effect and high safety.

Nitroglycerin is a nitrate drug that can dilate coronary arteries and increase blood supply to the coronary arteries, thereby improving myocardial blood supply. It is one of the nitrate drugs and can also be taken sublingually during an acute attack of myocardial ischemia. .

Compared with Suxiao Jiuxin Pills, nitroglycerin may cause hypotension and cause patients to have obvious symptoms of discomfort.

Lev was very interested. He and Li Ping'an talked about the differences in the ingredients, functions, and side effects of the two drugs. He also expressed that if his operation could be successful, he would be willing to try the drug Suxiao Jiuxin Pill.

Lev's face looked obviously unnatural when he mentioned the surgery.

He was not optimistic about the operation.

But as a biochemistry expert who is proficient in Western medicine, he also knows that the disease he has is difficult to treat. At this stage of development, he can only take the risk of trying surgical treatment, because without surgery, he will never know when. The condition may worsen, shock may occur again, or even death.

The two didn't talk much.

After Li Pingan confirmed that Lev had a strong desire for surgery, he left the ward to find Kalinin.

Kalinin is the health expert of the Soviet delegation, but because he has to perform surgery on Lev, he has to stay in the Soviet Red Cross Hospital for a period of time every day.

Li Pingan, Andrei, Nikita and Kalinin discussed the surgical plan together.

Li Ping'an proposed to use bypass surgery instead of directly replacing the narrowed blood vessels.

The original blood vessels are still useful.

Generally speaking, coronary artery bypass grafting is based on the serious disease of all three branches of the heart and blood vessels. If the heart blood vessels are already occluded, they will be occluded again. If the bridged vessels are occluded after bypass, the bridge can be re-bypassed, or the original occlusion or severe occlusion can be opened. Stenosis, if it is not a serious lesion, generally will not be bypassed.

There are usually three to four bridges. As long as one is not blocked, it can form collateral circulation of microvessels.

These are experiences confirmed by later generations.

If this surgical plan is used, there is at least hope of success.

Kalinin and others thought for a long time and finally agreed.

The surgical plan was basically finalized, because no one had ever done this kind of surgery before, and the surgical steps needed to be discussed in detail.

While preparing for Lev's surgery, several people can discuss the specific process of this operation in detail.

Eat a normal diet one week before surgery to help adjust the electrolyte balance. If Lev takes diuretics for a long time, he will take an appropriate amount of oral potassium chloride one week before surgery to overcome the potassium deficiency in the body.

Penicillin was used to prevent infection 3 days before surgery, and the patient was given a dose of antibiotics during preoperative medication on the day of surgery.

Intravenous infusion of glucose, insulin and potassium chloride solution was started 1 week before surgery to protect the myocardium.

Nikita also had to keep telling Lev the gradually improving surgical plan so that he could be mentally prepared and to enhance his confidence.

This operation will be performed by Kalinin, and Li Pingan, Andrei and even Nikita may serve as surgical assistants.

With so many doctors working together, this surgery will definitely be done well.

After returning to the Sixth Hospital, Li Ping'an reported the matter to Ran Qian.

Of course Ran Qian supports it.

This surgery is a pioneering work.

If it fails, the responsibility will naturally be borne by the Soviet expert and chief surgeon Kalinin, but if it succeeds, Li Ping'an will have to share some of the credit.

There is.

After undergoing such a major operation with Kalinin, the top surgical expert in the Soviet Union, Li Ping'an will definitely grow.

At least.

He should know how to use the artificial heart-lung machine.

Improvements should also be made in related techniques such as vascular suturing.

Ran Qian was very cooperative.

He took over all the surgical arrangements that Li Ping'an had not yet performed, and asked Li Ping'an to go to the Suguo Red Cross Hospital every day to discuss the surgical plan with Kalinin and others.

She knew it.

What Li Ping'an was most used to was Xiaolu and a few surgical nurses working as assistants, and he also asked Xiaolu and others to follow him to the Su Guo Red Cross Hospital.

Lev is a member of the visiting delegation from the Soviet Union and has a special status. In order to facilitate Li Pingan and others, the Red Cross Hospital of the Soviet Union sends a car to pick up Li Pingan, Andre, Xiaolu and others every day.

We first went to the steel rolling mill to pick up Andre, and when Li Ping'an and his wife arrived at the Sixth Hospital after breakfast, they went over to pick up him, Xiaolu and others.

We had a meal at Suguo Red Cross Hospital for lunch. After get off work, the hospital's car took Li Ping'an to the Sixth Hospital.

in this way.

About a week passed.

Lev's preoperative preparations were all done and he was ready for surgery.

In the operating room of the Soviet Union Red Cross Hospital, Kalinin, Li Ping'an and others began to operate on Lev.

Intravenous combined anesthesia.

Surgery can be performed in two ways.

One is a beating heart bypass surgery, in which case the vascular anastomosis is completed while the heart continues to beat.

Another method is to rely on extracorporeal circulation to perform vascular anastomosis. The surgical effects of the two methods are basically the same.

Beating heart bypass surgery does not require extracorporeal circulation, has less surgical trauma and less blood loss, but requires high technical skills from doctors, and improper operation can easily lead to surgical failure.

Cardiac arrest bypass surgery requires the support of an extracorporeal circulation machine to replace the beating of the heart and lung functions, making the surgery more precise and meticulous.

Several doctors have discussed it.

To reduce the risk, they decided to wait until the heart stopped before performing the surgery.

The first is to establish extracorporeal circulation.

The median sternal incision is a standard open-heart surgery incision for cardiopulmonary bypass. It has good exposure and is suitable for any part of the heart surgery.

The incision starts slightly below the sternal notch and reaches about 5cm below the xiphoid process.

Saw the sternum along the middle and use an electric knife to cut the sternum periosteum, separate the sternal notch and reach the retrosternal dissection of the xiphoid process and separate the retrosternal space.