Chapter 2757 Delayed Chest Closing

The operation of the built-in floating catheter is very simple. Zheng Ren put on sterile gloves and completed the operation within 1 minute.

A floating catheter was implanted in the right internal jugular vein. At this time, the measured cardiac output reached 6.1 L/min, and the SVO2 was 51%.

The anesthetist picked up a pen and paper and started to calculate, Zheng Ren said in a deep voice, "Don't forget, the systemic circulation resistance is 760/cm5."

"..." The anesthetist and Zhao Yunlong were startled. Not only them, even Su Yun was taken aback.

The measurement of cardiac output by the floating catheter needs to be calculated through a relatively complicated formula to obtain the systemic circulation resistance. Boss Zheng calculated it in his mind?

Let's hang up, Su Yun calculated the number 5 or 6 seconds later, and he silently cursed in his heart.

"Boss Zheng, is the cardiac output so low?" Zhao Yunlong asked.

"Preparing to open the chest." Zheng Ren said, "It is estimated that there is a problem with the heart muscle."

Myocardium... This judgment is too far from cardiac tamponade. Zhao Yunlong can also figure out the reason, but it is a rare situation after all.

"Boss Zheng, did the blood from the cardiac tamponade seep into the heart muscle?" Director Zhang Lin asked.

"Think about it, open it and see." Zheng Ren glanced at it and asked, "Is Yiren here?"

"Boss Zheng, Xiao Xie is going to pick up your surgical equipment and will be there soon." The patrol nurse said, "She just contacted me."

Zheng Ren nodded, and began to look at the patient's last echocardiogram with his arms folded.

Su Yun and Zhao Yunlong adjusted the patient's position and began to sterilize their hands. Xie Yi also came with the equipment box in the sterile package.

"Old Zhao." Zheng Ren suddenly said in a deep voice.

"Huh? Boss Zheng." Zhao Yunlong signaled that he heard it.

"Call the ICU and prepare the isolation room," Zheng Ren said.

Quarantine? Zhao Yunlong was stunned for a moment, but he didn't ask why. He had already finished brushing his hands, so he asked the anesthetist's assistant to make a call, and he stretched his head over to contact the ICU about the isolation room.

"Is it necessary to delay closing the chest?" Su Yun frowned and asked, "So serious?"

"I think it might be caused by more damage to the myocardium after taking the IABP." Zheng Ren turned to brush his hands, expressing his views on the patient.

Director Lang was stunned when he heard Boss Zheng's words. After taking IABP, the damage to the heart muscle was even worse... Is this saying that he made a mistake?

He was a little annoyed and dazed.

If someone in Nanshan City said that, it would definitely be blamed, but here is 912, so it shouldn't be. Director Zhang Lin was very enthusiastic. She came from home in the middle of the night and waited for her in the office.

Even this was not enough, Director Zhang Lin also contacted Boss Zheng, the Nobel laureate, to do thoracotomy.

He is a Nobel laureate, is it necessary to throw the blame on himself? There is no need for this at all, okay? In his opinion, it was a big deal, but in his opinion, it should be just an ordinary case.

However, IABP is of great benefit to patients with myocardial ischemia in clinical practice. Director Lang has already developed this technology ten years ago, and it can be said that there are countless people alive.

Balloon inflation during diastole, aortic diastolic pressure increases, coronary artery pressure increases, myocardial blood supply and oxygen supply increase; before systole, the balloon is deflated, aortic pressure decreases, cardiac afterload decreases, and cardiac ejection resistance decreases , Myocardial oxygen consumption decreased.

IABP can effectively increase myocardial blood supply and reduce oxygen consumption, and benefit patients with coronary heart disease the most.

Why did Boss Zheng still say it was IABP's fault? And what is he going to do? Delayed chest closure? Could it be that the patient returned to the ward with his chest open and blood dripping?

Isn't Boss Xiaozheng afraid of postoperative infection? To be honest, he didn't understand the operation of the delayed chest closure that Professor Su just said, it just sounded unreliable.

Various thoughts intertwined and collided in Director Lang's mind, he pondered in a daze. At this time, the operation has already begun.

The surgical instrument box full of metal texture is so eye-catching, and the cooperation between the instrument nurse and the operator is so exquisite that they don't even need to communicate with each other.

Under the shadowless lamp, no one spoke, only tacit cooperation.

There is even no eye contact between the operator, assistants, and equipment nurses, as if ten or eight of these operations are performed every day, and everyone has no interest in communicating at all.

Director Lang moved behind Boss Zheng and saw the sternum saw open the sternum, exposing the pericardium.

"It's not from cardiac tamponade." Su Yun said, "Echocardiography is fine."

"En." Zheng Ren said the first sentence at this time, only one word.

The pericardial wall was lifted, and the moment the pericardium was cut, the suction device was inserted. Director Lang carefully observed the pipe of the aspirator, and only a small amount of blood came out.

It's not cardiac tamponade, but why the patient's heartbeat is so weak, and the blood pressure still can't rise under the action of norepinephrine and dopamine? Director Lang was puzzled.

As the pericardium was cut open with a small delicate scissors, a swollen heart appeared in the operative field. The heart showed overall expansion and swelling-like changes, and the left ventricular activity was poor.

"Hey!" Su Yun said in surprise, "Is it all swollen like this?"

Zheng Ren did not speak, but continued to search. It was soon discovered that the single-spear drainage tube used for pericardiocentesis pierced the surface of the left ventricle of the heart and partially ruptured, and new bleeding was still seen on the surface of the heart wound.

Sure enough, it was his own fault, and secondary injury occurred in the pericardial puncture... When Director Lang saw this scene, his hands and feet were numb and cold.

Could it be that the similar symptoms appeared because of the pericardiocentesis performed by oneself, which caused damage to the left ventricular myocardium?

No way, he defended himself in his heart. This is an instinctive reaction of human self-defense, seeking advantages and avoiding disadvantages, and it is the same for everyone.

Why do you want to do pericardiocentesis? Isn't it because the patient's symptoms of chest tightness and chest pain have not been relieved after the stent is removed?

Director Lang defended weakly in his heart, and under the shadowless lamp, Zheng Ren had already cut off the pericardium with scissors, and used a 3×3cm autologous pericardial patch to suture continuously along the periphery of the wound to partially repair the damaged part of the puncture point on the surface of the heart to stop bleeding.

"Boss Zheng, I'm late." Lao He walked in while wearing a mask strap.

"Oh, it's not too late." Zheng Ren said, "The operation is almost over."

"..." Lao He was stunned for a moment, isn't it too late? Boss Zheng doesn't usually talk like that. While saying it was not too late, he told himself that the surgery was almost over...

"Get ready for transesophageal ultrasound," Zheng Ren said.

"Okay." Lao He didn't have time to think about it, and immediately started to get busy.

"Zheng...Boss Zheng, what are you going to do?" Director Lang stammered and asked in a low voice.

"There's no way to close the chest, let's have a B-ultrasound." Zheng Ren said, gently closing his chest with his hands.

The chest cavity was not completely closed, but as Zheng Ren's hands exerted force, the sternum wanted to gather together, and the monitor alarm sounded crazily.