Chapter 2751

The night is getting dark, and the circulation department of Nanshan people's hospital is still busy.

Deputy director Lang, who is in charge of the emergency department, has been busy for 12 hours. Seeing an endless stream of patients, he has not seen any sign of rest for the time being.

The weather is getting colder, the temperature in the North has dropped sharply, and cardiovascular and cerebrovascular diseases have been reported. Today alone, Nanshan people's hospital accepted 12 patients with acute myocardial infarction.

According to the severity of the disease, deputy director Lang arranged the operation sequence and took time to take a look at the condition and medication of other patients during the interval of the operation.

Busy.

Director Lang is used to making such a moth when the temperature fluctuates greatly every year.

The difficulty is that fewer people are willing to do interventional surgery, not patients, but doctors.

Once upon a time, when there was a problem with the coronary artery, we had to do bypass surgery. We split the sternum, and the sternum saw hummed. It was scary to think about it. Now, just puncture the wrist or neck and put the tube in. Every patient knows how to choose.

But with more patients, the number of doctors must be relatively insufficient.

In the past, when the income was high, some people had cardiac intervention surgery. With the introduction of a series of measures such as the two vote system, the income became more and more transparent, and the disadvantages of the low overall wage level in the north were exposed.

If last year, there were three groups on stage together, now there is only themselves. Director Lang held his waist, took off his lead clothes and began to transfer to the ward.

He came into contact with interventional surgery relatively early. He first studied in Fuwai, and then went to 912. He was very familiar with the professors and directors of the two hospitals.

Although old, but learned technology can teach others.

Director Lang planned well and took the apprentice with him. He just had to sit down and have a good look. But it backfired. Director Lang was also very helpless to learn one by one.

It's just that he doesn't have a good stomach. In ancient times, soldiers with heavy armor gave more military pay, but this didn't exist in Nanshan people's hospital. Radiation subsidies are only a little money. It is said that the rules were formulated in 2004.

At the thought of this, director Lang is very angry. Are the prices in 2004 compared with those now? At that time, the house was flat, but now it is flat.

Are you going to the South yourself? Director Lang occasionally thinks of this problem recently.

But that's what I think when I'm free. Who has time to think about so many myocardial infarction patients in the ward in front of me.

Director Lang can catch his breath when he takes off his lead clothes to see the patient. More than 50 people have been wearing lead clothes for surgery. I really can't stand it.

And doing more and doing less is almost the same in terms of income. It is hanging only by the fairy spirit of "noble medical ethics".

As soon as I saw two more emergency patients, director Lang's face turned into bitter melon. When will it be a head!

But there's no way. Do it.

A critically ill patient was selected. Preoperative confession and surgical preparation were carried out at the same time. Director Lang is still very satisfied with his team, but I don't know when he can stick to it.

He took time to smoke a cigarette and looked at the patient's ECG again. It was a typical myocardial infarction. Director Lang put on his lead clothes and went into the operating room again.

The patient complained of chest pain for 6 hours. The ECG diagnosis was extensive anterior wall myocardial infarction, which was also supported by other examinations.

ECG shows that the patient's condition is very serious and there is no obvious remission after medication. At least an angiography should be done.

The operation was smooth. The angiography showed that the left anterior descending branch was completely occluded from the proximal first diagonal branch, the opening of the first diagonal branch was narrowed by more than 85%, the proximal left circumflex branch was narrowed by more than 90%, the forward blood flow was TIMI 2, and the right coronary artery was widely diffuse.

Fortunately, director Lang thought. If this is delayed for one night, there may be no one.

The coronary artery is blocked seriously. There's no way. Then remove the stent.

After the left anterior descending branch was opened, 2.5mm was inserted successively × 18.0mm、2.5mm × 2 29.0mm firbird supports.

When the two supports went in, director Lang was relieved. There should be no problem this time.

"Are you better?" Director Lang didn't take an X-ray, but habitually asked first.

"Director, no good." The patient's voice was a little low, like trying to hold it out.

The old man was very kind and tried not to cause trouble to director Lang and the nurse during the operation.

"Hmm? No good? How do you feel now?" Director Lang asked in some surprise.

"Chest and back... Stuffy, stuffy." The patient said, "it's more stuffy than before the operation."

Director Lang frowned and stared at the blood pressure value on ECG monitoring. The blood pressure was falling from the normal and slightly higher level before operation. Although not fast, but very smooth, very firm decline.

It was 90 / 60mmhg just now, and it has been reduced to 80 / 57mmhg for a while.

Strange, what's going on?

Is it pericardial tamponade caused by coronary artery rupture? Director Lang woke up, adrenaline and glucocorticoid were secreted in large quantities, and the fatigue and sleepiness just disappeared.

MB！ Coronary artery rupture is one of the most serious complications of cardiac interventional surgery, and even one or two words can be removed.

His hands shook a little, but he immediately calmed down and began to have an X-ray.

But the results of angiography made director Lang very confused. There was no obvious leakage of contrast medium in the coronary artery! However, it is not ruled out that slight damage may lead to problems.

Director Lang looked at the patient's declining blood pressure and immediately said, "norepinephrine 0.45 μ G per kilogram per minute. "

After norepinephrine was used, the patient's blood pressure was initially stable, but after a short rise under the action of the drug, director Lang was not allowed to breathe for 5 minutes, and the blood pressure began to decline again.

Although the contrast did not show any leakage of contrast medium, director Lang still suspected that it was pericardial tamponade, otherwise there was no way to explain these problems.

An echocardiography was called and there was a small to medium amount of effusion in the pericardium.

There should be a problem with the myocardium. The bleeding entered the muscle space due to increased pressure, resulting in a hematoma compressing the arterioles. There was not much blood. Director Lang analyzed it himself.

But the coronary artery ruptured... Director Lang was very depressed.

Coronary artery rupture is a serious complication with a low incidence during PCI, with an incidence of about 1%. The basic inducing reason is mainly related to myocardial diastolic dysfunction caused by closed pericardial hematocele after coronary artery perforation.

Director Lang is lucky. He has met two similar patients over the years. Not many cases have been encountered, but after all, I have seen them and have a little experience.

Prepare for pericardiocentesis immediately.

Director Lang tried lidocaine local anesthesia in the fifth intercostal space under the left * * of the patient's chest wall. One single spear drainage hose was punctured and implanted by sliding method. After about 10 minutes of open drainage, only 150ml blood was drawn out.

Observing the patient, director Lang was a little confused.

The amount of bleeding is so small that the patient's blood pressure is still falling... This is special!