Chapter 1830

Open the sternum, stop bleeding quickly and expose the operation field. Zheng Ren found that as expected, the adhesion in the mediastinum was very heavy.

The second operation is like this. After a surgical blow, the human body will have fibrous connective tissue hyperplasia and change the normal physiological and anatomical structure.

Looking at the sticky tissue inside, Zhao Yunlong had a headache.

Elephant nose surgery itself is the largest operation in cardiothoracic surgery, and the second stage elephant nose surgery

difficulty × 10！

Zheng Ren stretched out his hand and clapped the hemostatic forceps and blunt scissors on his hand.

Lao he glanced and felt that it would take at least a few minutes to open the aorta. Boss Zheng was the main knife. If you change someone else, it will take at least 30-60 minutes to free smoothly to the aortic arch.

He took out the USB flash disk, quickly found the audio files and clicked on the lucky songs.

The familiar and melodious music sounded, but Su Yun didn't complain this time. He didn't seem to hear the background music at all. He was dedicated to cooperating with Zheng Ren's dissociation.

Two hemostatic forceps fly up and down, which is very beautiful.

The blunt scissors are free, and the sound of the ultrasonic knife sounds.

"Prepare heparinization." Zheng Ren drifted away and sank his voice.

Lao he was surprised at boss Zheng's confidence. Heparinization does not take long. Generally, heparinization is carried out after the operation area is ready.

Boss Zheng has confidence in his freedom, estimates the time, and wants heparinization early in the morning.

Lao he began to prepare calmly and paid attention to the operation.

After 3 ′ 12 ″, the aortic arch appeared completely in the operation field.

Free the aortic arch and its branches and cuff them respectively.

"Heparinization is complete."

At the moment when Zheng Rengang was ready to strap, Lao he said.

The timing was just right. Lao he knew that it was not his good cooperation, but boss Zheng's extremely accurate evaluation of his level.

If the medical group is a machine, it is only a part. The level has long been understood by boss Zheng and calculated into the operation process.

Looking at the seamless cooperation, it is actually the embodiment of boss Zheng's computing ability. Lao he just sighed, but he didn't continue to think.

The operation is still going on at a high speed. He can't afford to be distracted.

After heparinization, Zheng Ren inserted 24F artery cannula into the right subclavian artery for 2 ~ 3cm. This side dare not be inserted too deep, because too deep intubation can enter the innominate artery and seriously affect brain perfusion.

Then insert the right atrial cavity secondary tube or superior and inferior vena cava intubation.

"Full flow turning cooling."

Only one person spoke in the operating room, and the quiet atmosphere in the operating room proved the difficulty of the operation from the side.

Oxygenated blood was supplied to the whole body from the right subclavian artery through the innominate artery to the aorta, and a retrograde coronary sinus perfusion tube was inserted through the right atrium.

"Report nasopharyngeal temperature."

“35℃。”

“33℃。”

“30℃。”

“27℃。”

When the nasopharyngeal temperature dropped to 26 ~ 28 ℃, the ascending aorta was blocked and cold blood cardioplegia was retrogradely perfused through the coronary sinus.

While continuing to cool down, complete lesion exploration, prosthetic valve replacement, proximal prosthetic vascular anastomosis, and coronary artery anastomosis during coronary artery bypass grafting.

Zheng Ren moves very fast, but the more he probes, Su Yun feels... A little flustered.

Marfan syndrome is a congenital disease. After ascending aortic valved pipe replacement + coronary artery transplantation two years ago, the local changes of the patient exceeded the original expectation.

The adhesion is very heavy. Let's not talk about it first. There is a faint bubble sign in the middle of the anastomotic section, which means the possibility of subsequent interlayer.

Should the operation be done together with phase I bypass?

Even Su Yun was caught off guard and had a headache.

When he saw the situation in the operation area, he raised his eyes and aimed at Zheng Ren.

Zheng Ren didn't seem to have any emotional changes at all. He was doing surgery calmly.

Su Yun felt a little more secure. He was afraid of his boss.

“22℃。” Lao he continued to report the temperature.

“20°。” Zheng Rendao.

The values they said are completely different concepts. Lao he reported the temperature of nasopharynx and the key points that must be paid attention to in deep hypothermia circulatory arrest surgery.

Zheng Ren's 20 ° is the patient's head down angle. After Zheng Ren finished, the three stopped the operation at the same time, and Lao he began to adjust the angle of the operating table.

The head side is downward at an angle of 20 °.

Zheng Ren then blocked the innominate artery, left common carotid artery and left subclavian artery in turn, reduced the arterial flow to 8ml / kg · min, performed continuous selective cerebral perfusion, opened the ascending aorta blocking forceps, and began the operation of aortic arch and descending arch.

“20℃。” Lao he is still concentrating on reporting the temperature.

This temperature is the horn to start the general attack.

After Lao he reported the temperature, Zheng Ren immediately blocked the ascending aorta, cold perfusion at the root of the aorta and cardiac arrest.

"Ice mud."

The prepared ice mud is sent to Zheng Ren's hand.

Zheng Ren tried first. There is ice and water, 4 degrees Celsius. There is no big ice, all are small pieces of ice, which can cool the heart as quickly as possible.

General heart surgery can make this perfect ice mud, which can at least improve the completion of the operation by several percentage points.

This is a detail, but it is an indispensable detail.

Zheng Ren was very satisfied. Ice mud was placed on the surface of the heart to cool down.

The nasopharynx temperature dropped to 18 ℃, Zheng Ren began to block three brachial vessels in the aortic arch, and the arterial perfusion flow of cardiopulmonary bypass was changed to 6 ml / (kg · min) for selective anterograde cerebral perfusion.

The aortic arch was cut along the long axis of the aortic arch, proximal to the original artificial vascular anastomosis and distal to the proximal end of the opening of the left subclavian vein.

Because the heart stopped beating and deep hypothermic cardiopulmonary bypass had been established, there was no blood outflow when the aortic arch was opened.

Clean aortic arch, clear operation field.

The purpose of deep hypothermic circulatory arrest surgery is for this moment, and at this time, it seems almost perfect.

"Pay attention to the amount of cerebral thrombosis." Zheng Ren cut open the aortic arch and said in a deep voice, "if Lao he is not familiar with it, turn the screen to 22 °, and I'll watch it."

Lao he was a little ashamed. It should have been the work of an anesthesiologist.

However, I'm still in surgery and just come into contact with the new machine. I don't have time to get familiar with, understand and run in.

He did not hesitate to do as boss Zheng said. The ultrasonic probe was placed on the patient's bilateral neck, which did not affect the position of the operation and the head. The screen is facing boss Zheng, and countless data are floating on it.

The large amount of data makes Lao he helpless.

This should be a laboratory product or an initial one. There should also be computer precision calculation and output the results.

But now there is no final result, only countless data signals on the screen appear like snowflakes.

Zheng Ren looked up at the color Doppler ultrasound screen from time to time, but the action in his hand didn't stop.