Chapter 2974

Zheng Ren can't believe this figure is true.

More than 100% of the operation was completed, and now it has jumped by 17.2 percentage points on the basis of 110%!

He hesitated and immediately realized that it might be the effect of organ transplantation expertise.

Each organ transplantation specialization may improve the operation completion by 10%, so the original operation completion is 96%, plus 10%, it is 106%, plus 20% specialization bonus, which is this appalling figure.

Zheng Ren felt that he was invincible. The medical team worked together to pile up the completion of the original operation. Finally, he was really satisfied with the result.

"Boss, how do I feel that ECMO can withdraw? Is it an illusion?" Su Yun turned to step down and looked at the latest blood gas analysis value and asked in doubt.

"Sue, if I were a patient, I wouldn't go down with ECMO." Dr. Charles looked at the test sheet and expressed his point of view.

Zheng Ren hesitated and finally said, "take it down. I'll see the situation and stop it a little bit."

Su Yun looked at all kinds of machines with some worry.

Ventilator, monitor, 5 micro pumps connected by carotid artery and radial artery and infusion connected by TEE, and two chest bottles, ECMO and liver dialysis device.

This point was ignored before, which Zheng Ren never practiced in the system operating room. After all, the system operating room is just a simple training. Success is success. It's not like reality. There are so many troubles.

After the successful operation, with so many equipment, how do you send the small stone back?

An elevator can't hold so many things. Zheng Ren has nothing to do about it. I was thinking about how to successfully complete the operation, but I didn't expect that there were problems after the operation.

"Wait a minute. The plasma exchange device can be removed first." Zheng Ren hesitated for a moment and began to give medical advice.

Xiaoshi has passed the period of acute liver failure, and bilirubin has fallen to an acceptable value. It is also reasonable to remove the machine after one-time adsorption of bilirubin and plasma exchange. If you can't go down, get on the plane again. This is the best choice.

Zheng Ren glanced and wanted to find a small round stool to sit down and watch.

Through the lead glass, he was surprised to see that the operating room was already full of people. There were 20 people standing in a dense place, like sardine canned food.

The airtight lead door opened, Zheng Ren went out, and a heat wave came face to face.

"Boss Zheng, Congratulations!" Vice President Yuan said with a smile.

"Dean, why are you here?"

"Such a big operation, ringer must report it to me. Let me have a look and coordinate it. You're really well prepared. There's no accident." Vice President yuan smiled.

"Fortunately, fortunately, good luck, the operation went smoothly." Zheng Ren took off his mask and took a breath.

"When will the patient be sent back?"

"I have to wait. It may take about 2 hours between operations." Zheng Ren said, "there are too many pipes and machines on your body. You have to withdraw to send people to ICU."

"It's all right. I only arranged this operation. If you don't feel tired, boss Zheng, you can wait here for a few more hours and observe more. No one will rob you of the operation room." Director Xu said with a smile.

Zheng Ren moved in his heart and smiled, "director Xu, I'm not polite."

"You're welcome, boss Zheng, for such a big operation." Director Xu said with a smile, "the most important thing is that patients can step down safely and recover smoothly."

With director Xu's words, Zheng Ren was more supportive, polite, and turned back to the operating room.

"Boss, are you going to stop ECMO?"

"Well, observe for 6 hours, in the operation room. If you can, withdraw ECMO and go on." Zheng Ren said with certainty, "there should be no need for secondary surgery. The aseptic conditions here are enough, abundant resources and suitable for observation."

Everyone knows that the operating table in the operating room is most suitable for observation, but there must be that condition. 912, these are resources. In order to ensure the smooth progress of this operation, many people did their work silently.

Not to mention the needs of other departments, generally speaking, after the operation, there are at least 10 doctors around and occupy an operating room. This kind of thing, that is, the president and the director of the Department of Anesthesiology dare to think only when they turn on the green light. Before that, Zheng rengen didn't have this concept.

After he finished, he found a small round stool to sit in the corner and watched the Xie people wipe the surgical instruments.

"Yi Ren, I'm going to observe for six hours."

"Yes, I won't go down. First clean up and disinfect the operating box." Xie Yi said plainly.

"Boss, when will the ventilator be pulled out when you go back?"

"Don't worry, take it for 24 hours first." Zheng Rendao, "ECMO can go offline, which has exceeded expectations."

"Today's operation was very good." Su Yun said happily that he can also feel that the completion of the operation today is quite high, but there is no specific value given by the system panel.

"Well, it's done well, and the situation is better than expected. The organs printed in 3D have no rejection, and there is no need to take oral anti rejection drugs after operation, which is also a very important point."

"Zheng, do you really refuse to go to Mayo?" Dr. Charles looked at the values of various devices and had his own judgment. The operation was bound to succeed. But the more so, the more regrets he felt. The doctor came to Zheng Ren for the last time.

Zheng Ren quickly stood up and said apologetically, "doctor, if you want to see me have an operation, I can fly directly to Mayo when I have time."

He refused simply, and Dr. Charles sighed slightly.

Zheng Ren smiled and sent the doctor out of the operation room, but he didn't send the doctor out of the door. Instead, he asked Su Yun to send it and tell Wen xiaonuan the news of the success of the operation.

The operation is smooth and the degree of completion is very high, but the small stone is still lying on the operating table. We must not be careless.

If something really happens, but he is not at the scene, resulting in the delay of rescue, there is no place to cry.

Sitting on a small bench, Zheng Ren looked at various values. With the replacement of plasma bags by bags, Lao he was still monitoring blood gas, liver and kidney function.

Soon, Su Yun came back.

"Boss, sister Wen sat directly on the ground after hearing the news of the successful operation." Su yundao.

"Oh, she's too nervous." Zheng Ren's concern is not here. He is calculating the value in his heart and suddenly asks, "what do you mean with the doctor?"

"What sentence? Is the population aging?"

"Yes."

"There is a game called plague company. Have you ever played it?"

"Such an anti human name?" Zheng Ren frowned.

"A strategy game with infectious diseases as the theme developed by ndemic creations, an independent game studio in London, UK." Su Yun said, "I don't think it's that simple. This game is a little interesting. You can find it when you have time."

Zheng Ren stared at the values and chatted with Su Yun casually. He said that games are better than driving in the operating room.

"Why is it not simple?"

"Like you said, anti-human. I think it's those capitalists who moved early to change the mind of an aging society with the plague. They just let everyone get used to it and adapt first. The game setting is a little interesting. For example, Ebola virus is not strong and can't infect all mankind at all. Boss, if you design a virus, what are you going to do?"

"It must be a very long incubation period. Whether the outbreak is violent or not is secondary. It's best to start slowly so that everyone will be slack. But if it breaks out directly to a certain extent, it will spread the most widely." Zheng Ren said casually.

"Yes, only this way can conquer Greenland. I have contact with a friend of P4 laboratory in the United States, who studies all kinds of viruses, but I always feel that influenza is related to research every year."

"Don't be ridiculous, it's impossible." Zheng Ren denounced.

"Hey." It's rare for Su Yun not to raise a bar. If he does, it's too anti human. It's a criminal, not a bar elite.

Let's change the subject. Su Yun is just guessing, not sure. And this idea is really anti human. Even Su Yun can't draw such a picture with the most unrestrained and darkest ideas.

"Little stone, is this another life?" Su Yun looked at the values and spoke briskly and happily.

"Almost. According to the current indicators, ECMO can be withdrawn in more than five hours."

"That's good." Su Yun wandered around and felt bored in the room. He ran out to chat with someone.

Blood gas, liver and kidney function were measured once every half an hour, and the values continued to progress in a good direction.

After 4 hours, the liver dialysis equipment was removed.

After 6 hours, ECMO was removed.

With a ventilator, a monitor and a bed of micro pump, the medical team escorted all the staff back to the ICU.

Sitting in the intensive care unit, Zheng Ren stared at the values of the ventilator and monitor. Monitoring tests have been reduced from once every 30 minutes to once every hour.

The values of small stones are stable, the frightening total bilirubin during operation also returns to the preoperative level, and the values of renal function are also OK. There is no need to use dialysis and other equipment.

After ECMO was removed, the lungs replaced began to work with ventilator assisted breathing. The blood oxygen exchange was good, and the blood oxygen saturation was maintained between 98-100%.

"Boss, are you no longer worried about smoking?" Su Yun asked with a smile.

"Can you have a lung transplant at any time? Isn't that bullshit?" Zheng Ren said, "don't think about surgery. Take good care of yourself. Smoke less or less."

"Maybe the whole body will be changed in a few decades. Maybe now, looking at the research progress of Neurology, if it can be replaced together with memory, human beings will really be immortal." Su yundao.

"No, before we conquer tuberculosis, we also think that there will not be such a serious disease in the future. But you see cancer. Conquering cancer, there will be other diseases later. This is a battle, never ending."

"Don't think so much. Shouldn't it be celebrated?" Su Yun smiled.

"Little stone doesn't need a ventilator to help him breathe. If we leave the ICU, we should go back to Haicheng." Zheng Ren said, "I miss director Pan."

"It's Chinese New Year. So you're going to have surgery day and night?" Su Yun asked.

"Normal holidays, who has nothing to do, come to the hospital for the new year."

"Are you going to spend the new year with Uncle Ning?"

Su Yun is really annoying. If you're good, you won't say it well! The successful operation is a very happy thing. Why should he mention uncle Ning.

But now when I think of Uncle Ning, "there's nothing logical. It's been popular for several years to persuade people to learn medicine?"

"Forget, it seems to have been popular for a long time."

"There are fewer and fewer clinical children, and the pressure is increasing. There will always be a day of collapse. Although everyone's ability is limited, I can reduce the total pressure of the week by running to the emergency department."

"Don't say yourself so noble."

"It doesn't involve nobility. When you go to school, you have to recite Hippocrates' oath. Medical capitalization itself is a tear. But in the face of the torrent of the times, it's not personal strength that can be reversed. The tear of the times and the tear of cognition. What's that saying?"

"Which sentence are you talking about? This is the best and worst era; or is despicability the pass of the despicable and nobility the epitaph of the noble?" Su Yun asked.

Zheng Ren smiled. Su Yun was so clever that he said all his thoughts directly.

"Brother Yun."

While they were talking, a little nurse came up and whispered.

"Yes." Su Yun narrowed his eyes and showed a smiling face, "what's the matter."

"There's a problem on our side. See if there's any way."

Zheng Ren saw several medical staff around the patient in another ICU bed, discussing something. The perspective is limited and the patient's system panel is not seen. The strength of 912 is very strong, and Zheng Ren doesn't want to worry.

But taking the initiative to see what's going on and asking others for help are two concepts.

"The patient, male, 56 years old, was admitted to the Department due to loss of consciousness caused by a car accident. He was diagnosed as extremely severe craniocerebral injury. Cerebral hernia and right frontotemporal subdural hematoma were given perfect preoperative preparation. In emergency, right frontotemporal subdural hematoma and intracranial hematoma were removed under general anesthesia + skull flap decompression." The little nurse began to report the medical history quietly, professional and skilled.

"The gastric tube didn't go in before the operation. We wanted to go down after the operation, but the shutdown time of 1 minute is too short and too difficult!"

Er... Zheng Ren is a little helpless to see the girl who can't help talking to Su Yun.

The stomach tube is normal when the patient can't go in, the patient is in a coma, the swallowing and cough reflex is weakened or disappeared, and can't cooperate; Indwelling endotracheal intubation and air bag compress the esophagus to reduce the diameter of the esophagus and affect the insertion of gastric tube; The retained endotracheal intubation lasted too long, resulting in laryngeal edema, esophageal spasm or esophageal mucosal edema after extraction.

These are the reasons why I can't get into the gastric tube.

"How much paraffin oil did you touch?" Su Yun asked.

"A lot..." the little nurse said two words, and her face turned red.

"Go and have a look." Zheng Ren glanced at the vital signs of small stone and reduced the micro pump speed of dopamine by 1ml.

When he came to the patient after intracerebral hemorrhage surgery and suspended the ventilator, Su Yun took a look with a laryngoscope. Sure enough, esophageal spasm and edema were very serious, much heavier than expected.

Because the stomach tube is soft, even if it is well lubricated, it will fold in the convulsed esophagus and can't go in at all.

Su Yun pondered for a moment and Zheng Ren said, "deep vein puncture..."

"Eh? You think so, too?" Su Yun asked.

ICU was stunned when he was hospitalized. What is the relationship between lower gastric tube and deep vein puncture.

"Try it." Zheng Ren had no intention of reaching out, but said plainly.

"Do you have the guide wire for deep vein puncture?" Su Yun asked.

"It has been thrown away." ICU's main inpatient road.

"One more." Su Yun said, "if we use our guide wire, it will be more expensive."

ICU's hospitalization is always incomprehensible, but Su Yun has made it clear that for the guide wire of deep vein puncture, he is going to use a harder guide wire to go in first, and then go in the gastric tube.

This is the idea of a typical interventional doctor, but I didn't expect it to be used in nursing work.

Seeing that ICU's inpatient always went to prepare the guide wire, Su Yun smiled, "boss, if you were in Mayo, you would have professional equipment to solve this problem."

"It's all right. In our 912, we can deal with it." Zheng Ren smiled. "The principle is similar, but it's a little troublesome."

Su Yun raised his eyebrows and said nothing.

Soon, the inpatient always prepared a gastric tube and a nasal feeding bag with paraffin oil, cotton swab, gauze, 20ml syringe and a guide wire in the deep vein catheter; A stethoscope.

Su Yun did not explain, but after smearing the gastric tube with paraffin oil, measure the length of the gastric tube, insert the guide wire into the gastric tube, fold the top into a small circle, insert it from one nostril, and insert the gastric tube from the nostril to 14 ~ 18cm.

When he reached the throat, before Su Yun could speak, Zheng Ren raised the patient's head, put his jaw close to the sternal handle and put his body in a good position.

The assistant was very skilled. Su Yun said something in his heart. Then operate to make the gastric tube smoothly pass through the edema of the larynx, insert it into the predetermined depth, and then pull out the guide wire.

Fixing the gastric tube, pumping back the contents of the stomach or injecting air and listening to the sound of air and water indicate that the tube is successfully inserted.

"Well, it's done." Su Yun said easily.

ICU's hospitalization is always silly.

The patient's gastric tube she and the nursing group had six times, and she walked around the patient and the gastric tube almost all day.

I didn't expect Su Yun to start and solve the problem immediately.

It's really an eye opener this time. People can not only do lung transplantation, but also be good at such unexpected small operations. A guide wire for deep vein puncture solves a difficult problem that puzzles me all day. I can't believe it when I'm hospitalized.

"If it's all right, I'll go first." Su Yun said smartly.

"Brother Yun, boss Zheng, you two are busy." The general manager of ICU hurriedly said.

"Boss, if you don't need me, I'll lie down for a while." Su Yun said, "when do you expect to unplug?"

"24 hours." Zheng Ren said seriously, "it may take less than 24 hours, depending on the situation."

"So fast." Su Yun's tone is a little erratic. It seems that he can hardly believe his boss's judgment.

Su Yun left. Zheng ren'an sat quietly in front of the small stone bed, looking at various values, drainage and urine volume, and kept calculating in his heart.

He is like a hard and silent hill, standing beside the small stone to shelter from the wind and rain.

This is a war. Fortunately, he doesn't have to beware of the cold shots from behind. Zheng Ren sometimes thinks of it in his heart. It would be great if we could devote ourselves to treating patients and saving people, and all patients could cooperate very well without considering the cost and the psychology of patients' families.

Although this is impossible, Zheng Ren still thinks so occasionally.

In the end, all the great principles can't compare with the four words of curing the disease and saving people. Zheng Ren is also too lazy to think much. He silently looks at the small stone and all kinds of machines and numbers around him. The whole person is like a computer, tirelessly importing data and analyzing the cold and boring data into the condition in the central processing unit.

As time went by, five micropumps were withdrawn one after another. There was about 50ml clear urine in the urine bag every hour, and the airway pressure value of the ventilator

Late at night, Zheng Ren still observed all the values wisely without any fatigue.

With the stop of one instrument after another, Zheng Ren accurately calculated the inflow and outflow, maintained the body fluid balance, and tried to make the state of the small stone better and better as much as possible.

Adjust the parameters of the ventilator and watch the fluctuation of positive end expiratory pressure. As the little stone's vital signs became more and more stable, the sky lit up.

Zheng Ren refused Su Yun's request for a shift change. He looked after the small stone gently and attentively.

It was getting brighter and more people were in the ICU during working hours.

ICU Director Cai changed his clothes and came in. At a glance, he saw that boss Zheng still maintained the posture he left yesterday and looked at the postoperative patient motionless.

He walked over in surprise, took a look at the values, and then whispered, "boss Zheng, you haven't slept all night?"

"Director Cai, I'm at work." Zheng Ren turned his head and said with a smile when he saw him coming.

"Well, how's it going?"

"Very good. All values are normal." Zheng Rendao, "it is estimated that you can go offline and breathe independently at noon."

Noon

Director Cai was stunned. Do you want to be so fast?

Using a ventilator for 3 days after lung transplantation is a very whole thing. Will boss Zheng be too urgent to do so.

"Boss Zheng, do you want to stop observing for a day? If you are tired, I'll watch here." Director Cai tentatively said.

"I'm not tired. My condition has been allowed to go offline. Try it. If I can't, I'll take medicine to assist breathing for two days." Zheng Ren said gently.

Director Cai still couldn't understand. He winked, greeted the general manager of the hospital, and asked in a low voice, "urgently check the return this morning."

"Director Cai, I've been watching the patient myself. 15 minutes after the operation yesterday..."

Seeing that director Cai was not at ease, Zheng Ren asked about the treatment process, and began to talk about the process after the operation.

Monitor the incoming and outgoing volume for 24 hours and record it every 30 minutes; The liver and kidney function, blood gas analysis, blood routine, D2 polymer, etc. were examined once every 2 hours on average; Time, reason and vital signs of withdrawal of various drugs

As the director of ICU, I feel very different. It would be great if the hospitalization of his subordinates always had this level, reported the changes of the disease in a clear and orderly manner according to the timeline, and refined to the minute level.

But director Cai then smiled, and he knew he was dreaming. Use boss Zheng as the chief inpatient? Who is qualified in 912 now.

Zheng Ren said for 20 minutes, and finally said with a gentle smile, "director Cai, I don't think there's any problem."

"All right." Director Cai said politely, "with you, we don't care about this patient. We can say anything at any time."

"Please." Zheng Ren bowed slightly to express his gratitude.

Zheng Ren saw the ICU doctor start a new day's work. He smiled a little, sat on the chair and continued to observe the changes of his condition.

The chest of the little stone fluctuates under the action of the ventilator. The new lungs work well and the blood oxygen exchange is perfect. Zheng Ren also believes that there is no problem. After all, 127% of the operation completion is there. After the operation, he has no sleep all night. If there are any more problems, it won't make sense.

If the little stone can wake up and cross another hurdle, I hope the postoperative recovery can be faster.

The child is very sensible, and he doesn't know whether he is flustered or calm when he "floats" in the boundless darkness.

To stop calming himself is equivalent to lifting the seal. I don't know if he will wake up with intense agitation due to excitement and fear.

Zheng Ren began to think in his head. The closer he was to 24 hours after the operation, the more nervous he was.

There was no reason for this tension, and Zheng Ren knew it. Various objective indicators have been clearly placed in front of us. We have stroked them countless times and found no problems. But emotion is emotion. Even Zheng Ren, who is as motionless as a mountain, can hardly contain the objective emotional changes.

With the passage of time, Zheng Ren reduced the pumping speed of sedative drugs and began to wake up.

Very simple operation, but Zheng Ren is very nervous.

There are many things to worry about. No one is 100% sure. Zheng Rensheng was afraid of any accident. He observed the situation of the small stone without blinking.

Slight agitation and instantaneous increase of airway pressure.

"Little stone, don't panic when you wake up and breathe smoothly." Zheng Ren whispered in the little stone's ear.

Zheng Ren was not sure what he said. Xiaoshi heard it. He vaguely saw that Xiaoshi's eyelids moved slightly. Then Xiaoshi quieted down without resistance and went unexpectedly smoothly.

Zheng Ren is really a child with good medical obedience. Zheng Ren sighed slightly.

Generally speaking, when you wake up, you will toss for a period of time. After all, when you use a machine to assist breathing, most people are not used to subconsciously fighting against the machine.

But he only said a word, the slight agitation of the small stone disappeared without a trace, and the blood oxygen saturation also recovered from 92% to 99%.

If all patients have such good medical compliance, it will be a doctor's paradise. Zheng Ren smiled at the corners of his mouth.

A few minutes later, Xiaoshi gradually adapted to ventilator assisted breathing, and gradually gained strength as the metabolism and concentration of sedative drugs accumulated in the body decreased. His whole body was relaxed, only his eyelids kept beating.

"Slow down, don't worry, breathe more smoothly." Zheng Ren patted the small stone on the shoulder and said in his ear.

I don't know whether Xiaoshi heard it or not. Zheng Ren just vaguely felt that his breathing rate stabilized after he finished.

Zheng Ren didn't continue to talk to Xiaoshi. He was looking into Xiaoshi's eyes. Promised little stone that he could see his own when he opened his eyes. He must do it.

After more than ten minutes, the little stone slowly opened his eyes. His eyes were clear and flexible, and there was no turbidity and confusion under the action of sedative drugs.

Looking at each other, Zheng Renchang took a breath and smiled.

"Well recovered. Now close your eyes and continue to breathe smoothly." Zheng Ren said softly, "in another hour, I'll take off the ventilator and you can feel the fresh air."

Little stone blinked his eyes obediently and told Zheng Ren he understood. But instead of closing his eyes, he blinked twice.

"Can you move?" Zheng Ren asked.

The little stone's fingers moved slightly and moved, but writing and communication must not be possible.

"Do you want to go offline now?" Zheng Ren asked tentatively. With that, the little stone blinked again.

Zheng renslightly hesitated for a few seconds and said gently, "OK, but if your breathing function can't keep up, you need to use a ventilator for 12 hours."

Zheng Ren was the only one who spoke. Little stone just blinked to express his thoughts. But Zheng Ren felt that he could understand what Xiaoshi was thinking. There was no obstacle for the two to communicate in this strange way.

The heart beat a little faster, just like the reaction of the cell phone ringing when he was sleeping in the middle of the night and asking him to have an operation. Zheng Renxian took a deep breath, calmed his mood and took off the ventilator connector from the endotracheal tube.

The alarm of the ventilator sounded, and Zheng Ren ignored it directly. His attention is all on the small stone. Don't drop the blood oxygen saturation.

To Zheng Ren's surprise, without any twists and turns, little stone closed his eyes and "breathed" with his heart.

A breath of fresh air, normal people can not feel its existence, but it is the most precious thing for small stones.

The chest fluctuates, the oxygen saturation is 98%, the respiratory rate is 22 beats / min, and the heart rate does not fluctuate violently, which has been maintained at about 110 beats / min.

It's done! Zheng Ren shouted in his heart.

At this time, after the little stone breathed two or three times, a very complex emotion appeared on his face. The breathed air is incredibly sweet. After entering the lungs, it immediately participates in blood oxygen exchange, and then follows hemoglobin to provide a steady stream of oxygen to the body.

Incredible and relieved, many complex emotions were written on the little stone's face. However, he was not emotional, leading to the recurrence of the disease. Instead, he quickly closed his eyes and began to breathe hard and greedily.

The sound of air hitting the wall with breathing in the endotracheal tube is so pleasant, which is the sound of life. Zheng Ren listened carefully and used his ears to judge whether there were many secretions in the small stone's lungs.

Fortunately, there is not much phlegm, but the expression of small stone is very interesting.

Zheng Ren knows that the new lung is definitely different from the lung with severe fibrosis before. But this is theoretical. Zheng Ren doesn't know how smooth his breathing is after changing his lungs.

After observing for a few minutes, everything was stable, and Zheng Ren was finally relieved.

It seems that 24-hour offline is no problem. If everything goes well, you can unplug early tomorrow morning.

The sound of ventilator alarm was noisy. Seeing that the small stone was in a stable state, Zheng Ren turned back, hung the pipe and turned off the ventilator.

The sunshine outside was dazzling. Zheng Ren narrowed his eyes and looked at the blue sky in winter, feeling safe and happy.

The fastest speed to clean up the machine, Zheng Ren turned back.

Little stone opened his eyes and tried to raise his left fist. The infusion tube hanging on his arm was like a broken clothes and armor after a big war. For the rest of his life, the child's life was very good. Zheng Ren remembered the meeting on the hillside. This was his agreement with Xiaoshi.

His left hand clenched his fist and gently touched the thin fist of the small stone.

In the afternoon, the sun is bright.