Start From Emergency Doctor

Chapter 305

Zhou Yuan did not answer, but carefully checked.

Indeed, the patient’s condition is very bad, and the biggest difficulty is the judgment and repair of the endometrial rupture.

If this problem is not solved, the patient’s life is at risk at any time.

After two seconds of silence, Zhou Yuan raised his head: “Repair the arteries first.”

The most urgent task is to repair the arteries and restore the blood supply.

Due to the fire, some blood vessels were damaged, and if they were not repaired in time, the blood circulation could not support the tissues at the end, which would cause great irreversible loss at that time.

“It’s difficult to repair…” the chief physician whispered.

After speaking, he regretted it.

Who is it to say that it is difficult…

This is Zhou Yuan!

The suture itself is Zhou Yuan’s famous skill. The chief physician actually told him that it was difficult for him to take things easily!

“Let’s get started…” the chief physician of thoracic surgery said quickly.

“Vascular clamp.” Zhou Yuan entered the state directly.

Surgical forceps, tissue scissors, blocking forceps, curved forceps.

A handful of instruments were delivered to Zhou Yuan.

Zhou Yuan’s speed is very fast, and the instrument is moving in his hand.

Both the director and Yizhu have an illusion that it is not the human hand controlling the instrument, but the instrument and the hand being together… the instrument is an extension of Zhou Yuan’s hand!

This is a state that is difficult to achieve, and it is also a state that all surgeons aspire to.

“Even if you don’t become a doctor, you will still have food to be a tailor in the future…” Yizu muttered subconsciously.

The director looked up and stared at Yisuke: “What are you talking nonsense?”

Yisuke quickly closed his mouth obediently.

Ten minutes or so is a moment’s effort for surgery.

“It’s done. Start to establish extracorporeal circulation.” Zhou Yuan whispered.

Stanford-A aortic dissection must be performed under cardiopulmonary bypass.

The chief physician and Yizhu cooperated well. Zhou Yuan ordered them, and the two immediately chose the femoral artery with good pulsation on the left side for femoral artery intubation.

“Choose the venous drainage tube to be intubated in the superior and inferior vena cava.” Zhou Yuan said while handling the sternum incision.

The reason why the chief physicians were not allowed to choose the conventional venous drainage catheter intubation was that the patient’s condition was already very poor, and the intubation of the superior and inferior vena cava could be replaced with deep hypothermia circulatory arrest at any time according to the patient’s condition during the operation.

The main purpose of treating incisions is to open a familiar surgical field.(Read more @ wuxiax.com)

Surgeons have their own habits, accustomed incisions, accustomed surgical field positions, etc. Any change may affect their performance.

Although Zhou Yuan will not be affected too much, he must avoid all factors that increase the risk of surgery as much as possible.

“Extracorporeal circulation is established.” The chief physician said immediately.

Zhou Yuan nodded, dropped the scalpel, incised the ascending aorta, etc., then made an incision in the left and right coronary arteries and said: “Perfusion of cardioplegia.”

Cardioplegia can protect the myocardium. This step is very important in Stanford-A aortic dissection.

The first dose of cardioplegia is generally perfused through the opening of the left and right coronary arteries after the ascending aortic dissection is cut, which is the perfusion method used by Zhou Yuan.

The subsequent dose plan is continuous retrograde perfusion through the coronary sinus or intermittent perfusion through the left and right coronary artery openings.

This step is different from the previous cardiac pacemaker placement surgery to infuse cardioplegia. It is not possible to infuse cardioplegia directly through the aortic root because there is a false cavity in the aortic dissection. Once the cardioplegia enters the false cavity, it will cause Cardiac arrest is difficult.

“The perfusion of cardioplegia is complete.”

Zhou Yuan nodded and picked up the scalpel again.

There are three basic surgical methods for type A thoracic aortic dissection, ascending aorta replacement, ascending aorta and ascending aortic arch replacement, and the more commonly used elephant trunk surgery.

The three surgical methods are different, the difficulty is different, and the applicable scenarios are naturally different.

For example, simple ascending aortic replacement is suitable for acute type A aortic dissection, and the purpose is to correct and prevent serious complications of aortic insufficiency or acute rupture.

For Zhao Mingshi, the most suitable method is actually to perform the second and third methods at the same time, that is, performing elephant trunk surgery at the same time as the ascending aorta and ascending aortic arch surgery.

But because his current situation is very dangerous, he must end the operation as soon as possible. As for the elephant trunk surgery, he can only wait until the second stage of surgery.

Again, in the eyes of doctors, life-saving is always the most important thing.

“Circulation arrest at deep hypothermia, retrograde cerebral perfusion in the superior vena cava.” Zhou Yuan glanced at the instrument.

The patient’s vital signs are a bit bad, the heart rate is only about 40, and the blood pressure is far below the normal range.. ……

The deep hypothermia cessation cycle begins.

Zhou Yuan stared at the thermometer in the nasopharynx.

When the temperature dropped to 30 degrees Celsius, Zhou Yuan blocked the ascending aorta three centimeters away from the beginning of the innominate artery.

“Scalpel.”

He cut the arterial dissection, and then re-infused cardioplegia through the left and right coronary arteries.

“Switch to continuous reverse perfusion to protect the myocardium.” Zhou Yuan said.

The chief physician stepped forward to maintain the perfusion state.

Without squinting, Zhou Yuan began to trim the proximal dissection, extending to about 1.5 cm above the left and right coronary artery openings.

“The dissection has affected the aortic valve junction…”

Zhou Yuan was silent for two seconds.

This is not a good thing. The wider the aortic dissection, the more dangerous Zhao Mingshi and the more difficult the operation.

“Needle holder.”

As Zhou Yuan said, he began to stitch and reinforce the place.

After the junction is reinforced, the damage caused by the interlayer can be prevented as much as possible, unless the blood impact is great, it will generally not break.

“Felt strips.”

After completing the suture, Zhou Yuan added a felt strip to the intima and adventitia of the aorta.

The main function of this thing is to seal and prevent the blood from leaking.

After reinforcement and suture with 4-0 polypropylene thread, Zhou Yuan took the previously prepared artificial blood vessel and used 3-0 polypropylene thread to continuously suture the artificial blood vessel and the aortic root.

The temperature of the nasopharynx has been reduced to eighteen degrees under the effect of the deep hypothermia circulatory arrest.

“Doctor Zhou, the temperature is up.” The anesthesiologist reminded the doctor.

Zhou Yuan nodded, “Stop extracorporeal circulation.”

“Adjust the patient’s body position and take the head down 30 degrees.” Zhou Yuan said.

After completing the suture, Zhou Yuan opened the aortic blocking forceps, and repaired the blood vessels from the distal dissection to the proximal end of the innominate artery, and again took the felt strips and placed them on the intima and adventitia sides of the aorta. 0 polypropylene thread for reinforcement suture, 3-0 polypropylene thread for continuous suture of artificial blood vessel and aortic root……

Finally, Zhou Yuan began to infuse and exhaust the femoral artery to prevent various problems after the blood supply was restored due to the presence of air in the blood vessel.

Soon after the exhaust was completed, Zhou Yuan looked at the instrument next to him again. .