When the sternum was closed, the blood pressure fluctuated abnormally. There were repeated rapid ventricular arrhythmias, and the heart rate was 170-180 beats per minute.
This was still the value that appeared when the sternum was not completely closed. If the sternum was forcefully closed, the patient would probably not be able to get off the operating table.
"Boss Zheng, did you make a judgment before the surgery?" Zhao Yunlong knew that Zheng Ren's choice was right. He asked softly.
"The echocardiogram showed that the patient's heart was swollen, but this is not the main reason. The basis for determining whether to delay the chest closure is the previous treatment," Zheng Ren explained as he began to prepare for the delayed chest closure.
"Boss Zheng, are you going to do the ultrasound now?" Lao He pushed the machine in and asked.
"Okay."
Lao He did not mind that he was brought to the operating theater by Boss Zheng early in the morning just to do a transesophageal ultrasound. He did whatever he was told to do. Lao He did not complain.
Under general anesthesia and with a ventilator intubation, it was also a skill to successfully complete a transesophageal echocardiogram. Not everyone knew how to do it.
"Wait a moment." Lao He ran to the computer and plugged in the USB drive. Good Luck's singing voice flew out.
"If I don't listen to this song now, I won't be able to perform the surgery," Lao He explained with a smile.
Although the surgery had reached the final step, Lao He still insisted on playing good luck.
Stepping on the rhythm of good luck, Lao He felt his body become a little lighter, as if he had ascended to heaven.
The difficult operation became very smooth in his hands. A few minutes later, Lao He said softly, "Boss Zheng, the SAM sign is obvious."
The SAM sign was a sign in the diagnosis of M-mode ultrasound.
It mainly referred to the forward movement of the anterior mitral valve during systole. In obstructive hypertrophic cardiomyopathy, the CD segment of systole was not a slow rising platform. Instead, there was an abnormal waveform that protruded upward, which was the direction of the ventricular septum. This phenomenon was called the forward movement during systole, or SAM sign for short.
"Give a small amount of beta blocker and quickly replenish the blood plasma." Zheng Ren gave the doctor's order and then began the steps of delaying the chest closure.
"Adjust the dosage of levosimendan to 0.5μg? kg/1?? Min. "As Zheng Ren spoke, Xie Yiren had already handed over the child-sized sternum spreader.
Zheng Ren replaced the adult sternal dilator with a small child model and simultaneously observed blood pressure, central venous pressure, heart rate and rhythm, cardiac contractions and pulse oxygen saturation.
His hand slowly adjusted the distance between the sternum and the sternum, searching for the most stable blood pressure, heart rate, and CVP without ventricular arrhythmia.
Descending, strong contraction of the myocardium, no expansion of the heart, and rising oxygen saturation.
"Boss, you're too meticulous." Su Yun said, "There's no need to use millimeters as a unit of calculation to perform surgery. Cardiothoracic surgery is about roughness!"
Zheng Ren smiled. Su Yun's rough description was probably different from the others' understanding.
"The more accurate the position, the faster the postoperative recovery. If there are no accidents, the edema will gradually subside in two to three days, and Old Zhao can close his chest in about five days, "Zheng Ren said.
Zhao Yunlong lowered his head and stared intently at the way Boss Zheng moved the child-sized sternum spreader.
Every angle, every distance, and every movement had its own explanation, but Zhao Yunlong knew that this was an instinct formed from rich surgical experience. He was afraid that even Boss Zheng himself could not explain it clearly.
'It's better to watch carefully and think about it. If there's a next time, I can try to do it,' Zhao Yunlong thought.
Placing the pericardium and mediastinum drainage tubes, using a sterilized transparent surgical film to seal the incision and the dilator.
"Send him to the ICU." Zheng Ren turned around and immediately asked, "Old Zhao, do you often perform delayed chest closure surgery?"
"Occasionally, but rarely. But the doctors and nurses in the ICU are experienced, so don't worry, Boss Zheng. "Zhao Yunlong knew the meaning of Zheng Ren's question and immediately answered.
"Okay, that's it."
Even with delayed chest closure, the completion rate of the surgery was 101%. Zheng Ren was very satisfied.
The patient should be fine.
"Thank you, Boss Zheng," Chief Lang said softly and bowed deeply.
"You're welcome," Zheng Ren said. "IABP shouldn't have been used. Now that I have experience, I won't make this kind of mistake next time."
"Next time …" Chief Lang muttered.
"Huh?" Zheng Ren heard the hidden meaning in Chief Lang's words and looked at him in confusion.
However, Chief Lang did not continue speaking. Instead, he asked, "Boss Zheng, isn't IABP very suitable for the illness? Every time I encounter a similar situation, I use IABP to solve it. "
"You can't be too dogmatic," Zheng Ren said. "After the clinical judgment of early symptoms of cardiac tamponade, emergency measures such as pericardial puncture and drainage are often performed immediately to alleviate the symptoms. At this point, there's no problem with your handling. You did a great job. "
Seeing that Chief Lang's mood was not right, Zheng Ren did not over-stimulate him. Instead, he praised him, which was rare.
"Our intraoperative exploration did not find any cases of pericardial tamponade caused by blood accumulation caused by coronary artery perforation. Even if there is pericardial puncture drainage, it should be more or less rare. This situation is too rare."
"Boss Zheng, it was caused by a small branch rupture, right?" Chief Zhang Lin asked.
"It should be. We can also consider a small branch rupture. As the pressure in the pericardial cavity increases, the rupture has healed itself," Zheng Ren said. "Our luck is indeed a little bad. In fact, if this patient did not do anything, it might be better."
"…"
Chief Lang was speechless. Boss Zheng's words made him feel very ridiculous.
The absurd black comedy style and nonsensical words were not suitable for the operating theater. Chief Lang expressed that he could not accept it.
"But I think it's more likely because the patient is older. The main cause of his cardiac tamponade is a high degree of congestive swelling of the myocardium, not hemopericardium," Zheng Ren explained. "Based on my analysis, it should be during the process of your PCI operation, causing cardiac edema due to a widespread myocardial infarction.
"In the early stage of myocardial infarction, myocardial edema is intense. Moreover, the left coronary artery is dominant. The myocardial infarction involves a larger area, which leads to this special change.
"In other words, it's not a cardiac tamponade caused by coronary rupture and bleeding, but a cardiac tamponade caused by acute necrosis and exudation.
"In this rare situation, all the operations that you did after that, Chief Lang, were wrong." In the end, Zheng Ren still told the truth.
"Although the IABP measures reduced the afterload of the patient's ventricle, they did not reduce the pressure of the pericardium on himself in time, so the symptoms became more and more serious."
"…"
Chief Lang listened to Boss Zheng's explanation of the patient's condition. His judgment of the patient's condition was not the small coronary artery branch rupture and bleeding that Chief Zhang Lin had mentioned before, but another kind of complication.
In an instant, Chief Lang was a little absent-minded.
You've already exceeded your reading limit for today. If you want to read more, please log in.
Login
Select text and click 'Report' to let us know about any bad translation.
