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Chapter 165 Practitioner

Early in the morning of the third day, Ou Zhou, Jiang Yang, and Ke Feier, four brothers and sisters, drove the commercial vehicle in the villa to report to Wandao University for their master's and doctoral studies.

Prior to this, Jin Cheng and Liao Yunhui had already taken care of the matter at Bay Island University through their relationship.

Therefore, as soon as they arrive at the campus registration office, there will be a special person to greet them, and they will take care of the registration and accommodation formalities on their behalf.

Shui Jingxin's elective direction is also the development and research of artificial intelligence heart.

From then on, every Friday, Ou Zhou would drive over to pick her up and pick her up at Shuishe Mountain. The young couple spent a happy weekend with Jiangyang Ke Feier, and sent her back to campus early in the morning on Monday.

In the rest of the time, Ou Zhou and Jiang Yang devoted themselves to the construction of the Artificial Intelligence Heart Transplant Research Institute, hospital planning, recruitment of physicians and artificial intelligence heart researchers, equipment purchase and installation, nurse training, etc.

Among the various projects, the one that has not yet achieved results is the agent manufacturer of the artificial intelligence heart.

The real first artificial intelligence heart transplant was performed one morning two months later.

The main surgeon is Dr. Ou Zhoushuang, who is only 20 years old, and the deputy is Dr. Jiang Yangshuang, who is 23 years old.

A cardiac surgeon performs extracorporeal blood circulation, a cardiac surgeon monitors the electrocardiogram, and a cardiac surgeon acts as a secondary assistant.

Three nurses serve the surgical instruments.

The patient was a middle-aged man less than 40 years old, suffering from congenital heart disease. At this moment, his heart function was severely failing and he was on the verge of death.

It took Jin Cheng and Liao Yunhui a lot of effort, running no less than ten times before and after, before convincing the family members, paying 500,000 Hong Kong dollars, and then signed an artificial intelligence heart transplant agreement.

And this artificial intelligence heart is the product that Ou Zhou and Jiang Yang personally supervised during their joint master's and doctoral studies at Qingbei University.

At that time, after repeated comparisons and verifications, at the high price of 1 million yuan per payment for an artificial intelligence heart, a well-known medical device company was entrusted to order ten purchases, three of which were used on three simulated human bodies.

Now the artificial intelligence hearts carried in the three simulated human bodies have become teaching props in the Institute of Artificial Intelligence and the Institute of Life Sciences of Tsingbei University.

The medical device manufacturers that entrusted Jin Cheng and Liao Yunhui to bid for this time did not have relevant technical reserves and research. Even if those medical device companies got the full set of technical information from Ou Zhou and Jiang Yang, they would not dare to accept the order rashly.

It's not that they look down on the tens of millions of dollars in orders, but because this product is really unbelievable, breaking through the cognition of most experts in the industry.

As the mass producers of the world's first artificial intelligence heart organ, they have no idea what the future of this project is, so they dare not take this risk.

And if the patient does not receive a heart transplant at this moment, he may die at any time. Therefore, after researching, Ou Zhou and Jiang Yang decided to use their own products.

At the very least, this is a product verified by the two of them during their studies, and it is relatively safe to use.

The medical equipment and surgical equipment in the operating room are all configured according to the first-class level in the industry.

Several cardiac surgeons were also well-known in the industry, but they were recruited by Jin Cheng and Liao Yunhui with high salaries.The recruitment and training of a dozen nurses is relatively easy.

Thus, a medical institution integrating artificial intelligence heart research and transplantation in the world was born in the Sun Moon Lake Shuishe Mountain Scenic Area.

Jin Cheng and Liao Yunhui did not know what method they used, but unexpectedly got a prominent signboard, which was hung at the gate of the villa: Human Artificial Intelligence Organ Transplant Medical Practice Research Institute.

With this license, it is possible to carry out relevant research and medical transplantation of artificial intelligence human organs in an aboveboard manner.

For this reason, Ou Zhou and Jiang Yang spoke highly of the two rudder owners and fully affirmed their achievements.

The establishment of cardiopulmonary bypass surgery is a major part of human heart transplant surgery. The application of medical skills is relatively high. It requires the full integration of internal surgery and extracorporeal surgery in order to successfully pass the operation.

The first thing to do is to eliminate all infection lesions.The second thing to do is to correct malnutrition, anemia, and dysfunction of the liver, kidneys, and other organs.

The third point is that heart failure needs to be corrected so that the patient is in the best condition during the operation.

The fourth point is to stop using digitalis and diuretics 48 hours before the operation.

The fifth point is to eat a normal diet one week before the operation to adjust the electrolyte balance. If the patient takes diuretics for a long time, an appropriate amount of potassium chloride should be added orally one week before the operation to overcome the lack of potassium in the body.

The sixth point is to start using antibiotics to prevent infection 3 days before the operation, and give another dose of antibiotics when the preoperative medication is taken on the day of the operation.

Seventh point, intravenous infusion of glucose, insulin and potassium chloride solution (GIK) for critically ill patients from 1 week before operation to protect the myocardium.

Eighth point, psychological treatment should be given to patients before surgery to eliminate concerns and enhance doctor-patient cooperation.Let the patient understand the various situations that may arise during the operation, so that the patient can actively cooperate.

Anesthesia methods: compound intravenous anesthesia, fentanyl anesthesia and hypothermic anesthesia are the most commonly used anesthesia methods for cardiopulmonary bypass open-heart surgery.

Channel establishment: Radial artery pressure measurement, central venous pressure measurement, and establishment of intravenous infusion channels can be performed before or after anesthesia according to specific conditions.

Surgical Steps: Incision

The median sternotomy incision is a standard open-heart surgery incision for cardiopulmonary bypass, it reveals well, and is suitable for any part of the heart surgery.The incision starts slightly below the sternal notch and reaches about 5cm below the xiphoid process.

Then saw the sternum:

Cut the sternal periosteum with an electric knife along the middle, and separate the sternal notch to the retrosternal; then dissect the xiphoid process and separate the retrosternal space.After resection of the xiphoid process, the sternum was sawed longitudinally along the midline with an electric saw.The periosteum was hemostasis with electrocoagulation, and the sternum was hemostasis with bone wax.

Then cut the pericardium with a scalpel:

A longitudinal midline incision was made into the pericardium, up to the reflexed part of the ascending aorta, down to the diaphragm, and the lower part of the incision was cut on both sides to facilitate exposure.Afterwards, the pericardial incision margin was sutured to the soft tissue outside the sternum on both sides, and the sternum was opened with a spreader to expose the heart.

Then there is the extra-heart exploration:

The size, tension and tremor of the aorta, pulmonary artery, left and right atrium, left and right ventricle, superior and inferior vena cava and pulmonary vein are detected, and then the left superior vena cava and other malformations that can be found outside the heart are checked.

At this time, extracorporeal circulation is established:

A. Caval cuff: First separate the space between the aorta and pulmonary artery, then line the ascending aorta cuff, pull the band on the ascending aorta to the left, expose the inner side of the superior vena cava, and use right-angle forceps along the inner side of the superior vena cava Go around its rear strap.Use the same method to wrap the inferior vena cava sleeve with the lower vena cava clamp.

B. Arterial cannulation: At the distal end of the ascending aorta, two concentric purse-string sutures are made with No. 7 thread, neither of which penetrates the blood vessel.Put the purse string into the hemostat for hemostasis and fixation during intubation.The adventitia in the central part of the purse bag was excised.Inject heparin (3 mg/kg) into the right atrial appendage, and then use a small sharp-edged knife to cut an incision slightly smaller than the caliber of the arterial cannula in the center of the purse. While withdrawing the blade, put the arterial cannula into the incision of the ascending aorta and tighten it immediately. Two purse-string hemostats, and the arterial cannula and hemostats are fixed together with a thick silk thread.Finally, fix the arterial cannula on the edge of the incision or on the petiole of the spreader, and connect the cannula to the artificial heart-lung machine.

C. Vena vena cava catheterization: A purse-string suture is sewed on each of the right atrial appendage and right atrium, covered with a hemostat, and then an incision is made to insert a cannula into the superior and inferior vena cava (usually through the superior atrial appendage first), and the hemostat is tightened.Use a thick silk thread to surround the atrial appendage and atrial wall 2 to 3 mm below the cannula incision, and use this ligature to fix the upper and lower cavity cannula to prevent slippage.Connect the upper and lower cavity catheters to the artificial heart-lung machine.

D: Cold cardioplegia perfusion cannula: A mattress suture is made on the adventitia at the anterior side of the root of the ascending aorta, and it is inserted into the hemostat.After the cold cardioplegia infusion needle is exhausted, it is inserted into the central part of the mattress suture into the ascending aorta, the hemostat is tightened, and the cannula and the hemostat are fixed together with a thick thread.Connect the cannula to the perfusion set.

E. Left heart drainage intubation: the usual practice is to choose one of the following methods:

Left atrial drainage: A large mattress suture is made at the junction of the root of the right superior pulmonary vein and the left atrium, covered with a hemostat, and after a small incision is made in the mattress suture coil, the left atrial drainage tube is inserted into the left atrium and tightened The hemostat is ligated with a thick silk thread to fix the drainage tube and the hemostat together.Connect the drainage tube to the artificial heart-lung machine.

Left ventricular drainage: In individual patients, the effect of left ventricular drainage is better. A mattress suture is made in the avascular area near the apex of the left ventricle, a hemostat is put on, a small incision is made in the center of the mattress suture circle, and the left ventricle is inserted through the small incision. Ventricular drain tube, tighten the hemostat, and secure the drain tube and hemostat together.Connect the drainage tube to the artificial heart-lung machine system.

Check that there are no errors in all the pipelines and their connections, and make sure that there are no obstacles in each channel, and you can start extracorporeal circulation. After a few minutes of parallel circulation, block the superior and inferior vena cava and enter complete extracorporeal circulation. At this time, the blood in the superior and inferior vena cava Fully intubated into the artificial heart-lung machine, not into the right atrium.Simultaneously cooling the blood.

F. Block the ascending aorta: When the body temperature drops to about 30°C, lift the ascending aorta cuff, and block the ascending aorta with aortic blocking forceps.Immediately infuse 4°C cold cardioplegia solution (10-15ml/kg) through the infusion tube at the root of the aorta, and at the same time cool the heart surface with 4°C ice saline or ice chips to make the heart stop rapidly.

The operating indicators of extracorporeal circulation are as follows:
Mean arterial pressure: 5.33~9.33kPa (60~90mmHg).

中心静脉压：0.59～1.18kPa(6～12cmH2O)
Body temperature: around 28°C for general operations; deep hypothermia 20°C to 25°C for complex heart surgeries.
Myocardial temperature: keep at 15°C to 20°C.

Flow rate: 50-60ml/kg is medium flow rate; 70-80ml/kg is high flow rate, which is commonly used in clinical practice.It should be noted that the flow rate of children and infants should be higher than that of adults.

Dilution: The cell volume is generally around 25% to 30%.

It usually takes two to three hours to complete a single extracorporeal circulation process.

Not to mention removing the heart, implanting an artificial intelligence heart, connecting the aorta, pulmonary artery, superior vena cava, inferior vena cava, pulmonary vein, etc.Then start the artificial intelligence cardiac circulatory system, check various technical indicators, check whether there are surgical omissions and equipment omissions, and after the requirements are fully met, the extracorporeal circulation is cut off and all wounds are sutured.

It usually takes five to six hours to do a heart transplant operation, so the total time required for heart transplant surgery is greatly increased due to extracorporeal circulation.

The chief surgeon does not have good physical and psychological qualities, so it is difficult to complete this operation.

Brothers Ou Zhou and Jiang Yang cooperated with each other to perform many such operations during their master's and doctoral studies. The degree of tacit cooperation between the two is comparable to that of two programmed robots.

Compared with matched heart transplantation, the transplantation of artificial intelligence heart is relatively simple.

The convenience lies in that the connection of the aorta, pulmonary artery, superior and inferior vena cava, and pulmonary vein does not need to be sutured, but the intubation bagging technique is adopted, but reasonable fixation is sufficient.

There is also no procedure for suturing the heart dressing.

Because it is the world's first artificial intelligence heart physical verification test operation, it needs a good demonstration effect and psychological comfort.

Therefore, Ou Zhou and Jiang Yang's painstaking efforts in this operation have greatly increased compared with ordinary matching heart transplants.It took an extra two hours of surgery time.

The operation process went very smoothly. After carefully checking the details of each operation, he checked whether there were any missing instruments.After completing these procedures, start the operation of the artificial intelligence heart to check whether the indicators are normal.

Afterwards, cut off the extracorporeal circulation heart-lung machine, and then check the operating state of the artificial intelligence heart, whether it meets 80.00% of the working state of a normal human heart.

This is a basic guarantee.

If it is higher than this standard, it means that the probability of success of the operation is extremely high, and if it is lower than this standard, it means that the operation has a risk of failure.

(End of this chapter)