Chapter 2757

When closing the sternum, the blood pressure fluctuates abnormally, and there are repeated rapid ventricular arrhythmias, with a heart rate of 170-180 beats / min.

This is the value when the sternum is not completely closed. If the sternum is forcibly closed, I'm afraid the patients can't get off the operating table.

"Boss Zheng, do you have judgment before operation?" Zhao Yunlong knew that Zheng Ren's choice was right. He asked softly.

"Echocardiography shows that the patient's heart is enlarged, but this is not the main reason. The basis for delaying chest closure is previous treatment." Zheng Ren began to make preparations for delaying chest closure, while explaining.

"Boss Zheng, are you going to do ultrasound now?" Lao he pushed the machine in and asked.

"OK."

Lao he didn't mind that he was brought from home to the operating room by boss Zheng early in the morning, just to do an transesophageal ultrasound and do whatever he was asked to do. Lao he didn't complain.

In the state of general anesthesia and with ventilator intubation, it is also a technology to successfully complete transesophageal echocardiography, which not everyone can.

"Wait a minute." Lao he rushed to the computer, inserted the USB flash disk, and the good luck song flew out.

"If you don't listen to this song now, you won't have surgery." Lao he explained with a smile.

Although the operation has reached the last step, Lao he still insists on playing good luck.

Stepping on the beat of good luck, Lao he felt that his body was a little lighter, floating like an immortal.

The difficult operation became very smooth in his hand. A few minutes later, Lao he whispered, "boss Zheng, the SAM sign is obvious."

Sam sign is a sign in M-mode ultrasound diagnosis.

It mainly refers to the systolic forward movement of the anterior lobe of the mitral valve. The CD segment of obstructive hypertrophic cardiomyopathy is not a slow rising platform in the systolic phase, but an abnormal waveform protruding upward, that is, to the ventricular septum. This phenomenon is called systolic forward movement, referred to as Sam sign for short.

"Give me a small amount β Receptor blockers, rapid plasma supplement. " Zheng Ren gave the doctor's order and then began the step of delaying chest closure.

"Levosimendan dose adjusted to 0.5" μ g? kg/1? min。” Zheng Ren said that Xie Yi had handed over the child's sternum spreader.

Zheng Ren replaced the adult sternum spreader with a small child type, and then observed the blood pressure, central venous pressure, heart rate and rhythm, cardiac systolic strength and pulse oxygen saturation at the same time.

His hand slowly changed the distance of the sternum to find the position most conducive to the stability of blood pressure, the non slowing or obvious increase of heart rate, no ventricular arrhythmia, the decrease of CVP, strong myocardial contraction, no cardiac expansion and the increase of oxygen saturation.

"Boss, you are too delicate." Su Yun said, "it's not as if surgery is done in millimeters. What's important about cardiothoracic surgery is ruggedness!"

Zheng Ren smiled. Su Yun's rough estimate is different from what others understand.

"A more accurate position, the postoperative recovery can be faster. If there is no accident, the edema can gradually subside in 2-3 days, and Lao Zhao can close his chest in about 5 days." Zheng Rendao.

Zhao Yunlong lowered his head and stared at the way boss Zheng moved the child sternum spreader.

Every angle, every distance and every action has a saying, but Zhao Yunlong knows that this is an instinct formed by rich surgical experience. I'm afraid boss Zheng can't explain it clearly.

It's better to look carefully and think about it. If you have a chance next time, you can try it. Zhao Yunlong thought of it in his heart.

Place pericardial and mediastinal drainage tubes, and seal the incision and spreader with sterile transparent surgical film.

"Take it to the ICU." Zheng Ren turned to step down, then turned back and asked, "Lao Zhao, do you often delay chest closure surgery?"

"I do it occasionally, but few. But the doctors and nurses in ICU have experience, so boss Zheng can rest assured." Zhao Yunlong knew the meaning of Zheng Ren's question, and he immediately replied.

"OK, that's it."

Even if the closure of the chest was delayed, the completion of the operation reached the level of 101%. Zheng Ren said he was very satisfied with this.

The patient should be fine.

"Boss Zheng, thank you." Director Lang made a deep bow and said softly.

"You're welcome." Zheng Rendao, "IABP should not be used. If you have experience this time, you won't make such a mistake next time."

"Next time..." director Lang murmured.

"Huh?" Zheng Ren heard what director Lang said and looked at him suspiciously.

But director Lang didn't go on, but asked, "boss Zheng, isn't IABP very symptomatic? Every time I encounter a similar situation, I use IABP to solve it."

"Don't be too dogmatic." Zheng Rendao said, "after clinical judgment of many early symptoms of pericardial tamponade, immediately take emergency measures such as pericardiocentesis and drainage to alleviate them. At this step, your disposal is no problem and you have done a great job."

Seeing that director Lang's mood was wrong, Zheng Ren did not over stimulate him, but praised him rarely.

"During our intraoperative exploration, we did not see the common situation of pericardial tamponade caused by blood accumulation caused by coronary perforation. It is said that even if there is pericardial puncture and drainage, it will be more or less. This situation is too rare."

"Boss Zheng, it was caused by the rupture of a small branch." Director Zhang Lin asked.

"It should be, or consider a small branch rupture. With the increase of pericardial pressure, the damaged point has healed itself." Zheng Ren said, "luck is really bad. In fact, this patient might be better if he didn't do anything."

“……”

Director Lang was speechless. What boss Zheng said made him feel ridiculous.

The absurd black comedy style and nonsense words are not suitable for the operating room. Director Lang said he could not accept them.

"But I think it is more likely because the patient is older. His pericardial tamponade is mainly due to the high congestive swelling of the myocardium, not the accumulation of blood in the pericardium." Zheng Ren explained, "according to my analysis, it should be the cardiac edema caused by extensive myocardial infarction during your PCI operation."

"In the early stage of myocardial infarction, myocardial edema is severe, and its left crown advantage, and the scope of myocardial infarction is large, which leads to this special change."

"In other words, it is not pericardial tamponade caused by coronary rupture and bleeding, but pericardial tamponade caused by acute necrosis and exudation."

"In this rare case, director Lang, all your operations are wrong." Zheng Ren finally told the truth.

"Although the IABP measures adopted reduced the ventricular afterload of patients, they failed to reduce the pericardial pressure on themselves in time, so the symptoms became more and more serious."

“……”

Director Lang listened to boss Zheng talk about the patient's condition, and his judgment on the patient's condition was not the rupture and bleeding of the small coronary artery branch mentioned by director Zhang Lin, but another complication.

In an instant, director Lang was in a trance.