Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

Of course, it is even more impossible to take antihypertensive drugs.

Especially during this period, women always feel chest tightness and discomfort, and it is even difficult to fall asleep at night.

When I fell into the water some time ago, it was also because of a sudden blackout.

After the patient narrated these things, Lin Yi and Wu Jiang further confirmed that the patient was most likely suffering from acute coronary syndrome.

Later, the inspection results showed that it was indeed abnormal!
The patient's serum potassium was only 2.4mmo/l, while troponin, myoglobin, etc. were all elevated!
After seeing the test results, this female patient can be clearly diagnosed as acute non-ST-segment elevation myocardial infarction!

Although it is not clear whether the patient suffered from acute coronary syndrome at the beginning, or myocardial infarction induced by infection after falling into the water, electrolyte imbalance, etc., in short, the patient suffered from myocardial infarction at the end.

Of course, the current symptoms of her legs are also caused by myocardial infarction.

After hearing this diagnosis, the female patient and her man were immediately stunned.

She kept crying, and her man kept praying for Lin Yi and Wu Jiang.

"Doctor, please save my daughter-in-law! We can't let her live the rest of her life with disabilities like this!"

In fact, after the diagnosis came out, the medical staff present became nervous.

In addition to Wu Jiang's family members notifying his condition and issuing doctor's orders to strengthen ECG monitoring, adding aspirin, ticagrelor for antithrombotic, antiplatelet, lipid-lowering, tube expansion, myocardial nutrition and circulation improvement, the nurses also asked the nurses to pay close attention to the patients. Changes in condition.

"Aspirin and ticagrelor are prescribed for patients now, which is also a temporary solution. Only antithrombotic, antiplatelet, lipid-lowering, tube expansion, myocardial nutrition and circulation improvement treatments have been done."

"However, the symptoms of myocardial infarction in patients may not be completely resolved."

"If you want to really solve the patient's condition, then you have to perform surgery."

In the office, Lin Yi said to the others.

The others nodded slightly, and then Lin Yi continued:

"She is now in urgent need of balloon angioplasty to dilate her blood vessel."

The balloon dilatation mentioned by Lin Yi is a kind of interventional therapy.

A small balloon is placed in the narrow part of the stenotic blood vessel, and the balloon is inflated or contrast medium is injected to expand the balloon.

The plaque in the narrow part is squeezed, the narrow lumen is expanded, and the blood supply is restored.

In general, balloon dilation is a kind of pretreatment before stent implantation, and the stent can be more stably placed in the stenosis after balloon pre-dilation.For some special types of lesions, balloon dilatation alone can be used.

At present, there is also a drug balloon expansion method, that is, some drugs are placed on the outer membrane of the balloon, and after expansion, the drug is attached to the narrow part of the blood vessel to reduce plaque.

Based on the current situation, at present, they only need to expand the patient's balloon to achieve a very ideal therapeutic effect.

Corresponding to diseases such as myocardial infarction, you can choose thrombolytic therapy, or you can choose treatment options such as balloon angioplasty and stent implantation after intervention.

Although the overall treatment cost of balloon angioplasty and stent implantation is relatively high, compared with thrombolytic therapy, interventional therapy has a higher vascular opening rate, wider indications, and fewer bleeding complications, especially for acute myocardial infarction. For patients with infarction, it is generally recommended to give priority to the implementation of interventional therapy.

When he could choose interventional surgery options such as balloon angioplasty and stent implantation, Lin Yi still chose interventional treatment options.

After confirming it, Lin Yi asked Wang Qiaoya to prepare a one-time-use coronary artery balloon dilatation catheter, surgical instruments and anesthetic.

Ask Wu Jiang to communicate with the patient and family members, and get the informed consent for the operation signed by the family members.

Then, everything was ready and the operation began!
"The patient is under local anesthesia."

As soon as the anesthesiologist Ma's voice fell, Song Borui, under the guidance of color ultrasound, began to puncture the right femoral vein according to the method of percutaneous puncture technique.

The purpose of this procedure is to place the guide wire and catheter, and then perform venous manometry.

Percutaneous puncture technology is mainly used for various cardiovascular angiography and transvascular interventional therapy that requires percutaneous puncture to insert a catheter.

As for the patient's situation, the surgical plan they formulated was also to send a port-hole catheter through the femoral vein to the right ventricle, and then cross the pulmonary valve into the left lower pulmonary artery.

Immediately after that, the English letter J-shaped exchange guide wire was sent along the right atrium catheter to the end of the left lower pulmonary artery.

Then withdraw the end-hole catheter, retain the guide wire, and inject contrast medium or other preparations after the balloon is in place to inflate the balloon.

In general, 3 to 5 times of expansion can achieve the expected expansion effect.

After the final withdrawal of the balloon catheter, repeat measurements of hemodynamic parameters.

This is the entire operation plan process, and Wu Jiang can implement it step by step according to this plan.

But it backfired.

Less than half an hour after the operation, Song Borui stopped his hands with a sad face.

Wu Jiang on the side also frowned when he saw the situation on the color ultrasound screen.

Lin Yi, who had been paying attention to the patient's signs, asked worriedly when he saw that the two of them had stopped.

"What's the matter? What's the situation?"

The patient lying there also seemed to feel something was wrong, she also muttered a little emotionally.

"Doctor, doctor, I feel tight in my chest and I can't breathe! What's going on? Am I going to die!"

Lin Yi hurriedly comforted the patient, and immediately increased the oxygen supply for the patient.

After the patient calmed down a little, Lin Yi and the others hurriedly negotiated the operation plan again.

"I think you have also seen that in the actual operation, the patient's condition was found to be very special."

"Not only did the patient need to undergo endoluminal coronary angioplasty, but the patient's inferior vena cava was completely blocked."

"Especially with a complete occlusion of the inferior vena cava, I can't guarantee [-] percent success."

As soon as Lin Yi's words came out, Wu Jiang and Song Borui immediately understood the meaning of the words.

In other words, this kind of surgery can only be done once under the current situation!
Once the operation fails, the patient will never be able to stand up.

Moreover, after the patient's inferior vena cava is completely occluded, the effect of conventional thrombolytic therapy is minimal.

"I'll still come."

Then, Lin Yi said.

One of the great risks of interventional therapy is that the operator accidentally punctures a blood vessel. Hand stability is an important skill necessary for interventional therapy.

Surgeons can thread needles and guide threads on blood vessels that are several times thinner than a hair. Isn't an operation like interventional therapy pediatrics for Lin Yi?
"However, the patient's inferior vena cava has been completely blocked. How to deal with this problem?"