Start From Emergency Doctor

Chapter 196

“The patient’s current physical condition is more suitable for beating heart bypass.”

Cardiopulmonary bypass is a bypass when the heart stops beating and requires extracorporeal circulation. The beating heart bypass is an operation under a beating heart, and a fixator fixes the local target blood vessel.

Zhou Yuan explained: “The use of beating coronary artery bypass graft has many advantages. First, the beating coronary artery bypass graft does not require extracorporeal circulation, which can avoid reperfusion injury caused by myocardial ischemia, which makes the operation risky. drop to lowest.”

“Although beating heart bypass surgery is not comparable to minimally invasive stent technology, it has a smaller wound and faster postoperative recovery compared with beating heart bypass. It can also effectively reduce various postoperative complications, such as myocardial infarction , It can reduce the rate of arrhythmia and so on. Faster recovery will shorten the length of hospital stay, and it can also reduce the financial burden of patients.”

This is the best decision Zhou Yuan made after comprehensive consideration.

The director of the Department of Cardiology nodded, “What you said makes sense, but the heart bypass is not from the Department of Cardiology. You will wait until the director of the Department of Cardiology comes to tell him.” 26

“…”

The director of the Department of Cardiovascular Internal Medicine smiled: “Interventional stent technology is the job of our Department of Cardiovascular Internal Medicine. The heart bypass is very large and belongs to the surgical department.”

Zhou Yuan’s face is black: Then what are you asking?

“I heard that you are very good. When I saw you today, it was!” The director of cardiovascular medicine laughed.

After a while, the director of the heart surgery came.

Bring assistive devices for heart bypass surgery, including heart stabilizers, vein retractors, etc.

The same question, “Which method of surgery do you plan to use?”

Zhou Yuan repeated the answer just now.

“Well, my diagnosis is also a beating heart bypass… What blood vessel are you planning to use as a bypass?”

There are three types of blood vessels. Conventional saphenous vein bypass, arterial bypass and artificial blood vessel bypass.

Great saphenous vein bypass surgery has less damage and is simpler, but the long-term effect is worse than arterial bypass. Therefore, people over 80 years old can use great saphenous vein bypass alone. Under 55 years old can consider all arterial bypass, and other ages can use one. The internal mammary artery plus the great saphenous vein.

Arterial bypass has serious damage, high technical requirements, and more difficult surgery, but the long-term effect is larger and the saphenous vein is good, and it is suitable for young patients.

For artificial blood vessels, it would cost thousands to hundreds of thousands of materials, and Qian Wei would definitely not choose.

“Arterial bypass.” Zhou Yuan said.(Read more @ wuxiax.com)

The most suitable thing for Zhou Yuan to do is actually arterial bypass. Master vascular transplantation and master heart bypass surgery eliminate the difficult problems of arterial bypass, and the damage can be made up as much as possible through technology.

For Qian Wei, who is only in his twenties and thirties, arterial bypass must be used.

“How is the patient’s cardiopulmonary function?” the director of cardiology surgery asked.

If the left ventricular ejection fraction is less than 30%, the left ventricular end diastolic pressure is greater than 20mmHg or the left ventricular end diastolic volume is greater than 103ml/㎡, it indicates that the left ventricular function is significantly impaired, and medical treatment should be given to such patients , Try to improve myocardial blood supply and increase heart function reserve, and then perform heart bypass surgery.

Zhou Yuan said: “The cardiopulmonary function is okay. Both coronary angiography and left ventricular angiography have been done. The degree of coronary artery stenosis is 80%, and the obstruction is also clear. The best way is to perform heart bypass surgery.”

The director of cardiac surgery was silent for a while, marveling at Zhou Yuan’s youth.

Before witnessing it with my own eyes, it would be useless to hear of Zhou Yuan’s miracles and his superb medical skills.

As a doctor, who doesn’t rely on years of experience and surgery to improve his skills one by one, one by one?

Suddenly, a master surgeon in his twenties appeared. No matter who it was, he couldn’t believe it.

But in the end, the director of cardiac surgery nodded and said: “I’ll be there to assist you. I have done a lot of heart bypass surgery.”

Zhou Yuan laughed.

It seemed to see an intermediate treasure chest beckoning to himself.

“Carotid artery imaging is also needed. Check for stenosis of the carotid artery.” Zhou Yuan looked at Qian Wei on the bed.

Cardiac bypass surgery is the operation of the heart after all. The preoperative examination is very cumbersome, such as carotid artery stenosis. Once carotid artery stenosis is found, it may be before the heart bypass surgery or at the same time as the heart bypass surgery. Stenosis, so as to avoid the occurrence of cerebrovascular complications.

“Today I took analgesics and sedatives, and at the same time oral coronary dilatation drugs, combined with beta blockers, until the preoperative discontinuation of the drug.” Zhou Yuan ordered another order.

The role of analgesia and sedatives is to stabilize the patient and prevent emotional stress from causing angina pectoris.

Coronary expansion drugs are used to prevent coronary artery spasm. In the case of arterial stenosis that has already occurred, another spasm will cause the patient’s blood vessels to be directly blocked, and the condition will become more critical, and may even be directly life-threatening.

The role of beta blockers is to reduce myocardial oxygen consumption and relieve angina pectoris. Because Qian Wei belongs to unstable angina pectoris and has irregularities, he needs to take it until one hour before surgery.

To be honest, he hesitated when writing the list.

Zhou Yuan is very worried that the patient suspects that he prescribes drugs randomly and performs tests indiscriminately.

Ever since the hospital, Qian Wei has done seven or eight tests, including blood draws, coronary angiography, cerebrovascular angiography, carotid angiography, etc…

Then there are morphine, various infusions, and the names of various drugs that the average person does not understand.

However, every medicine Zhou Yuan prescribes and every check done is necessary, and the lack of any link may cause him to miss an important information, which may lead to an accident in the operation.

However, although Qian Wei cares about the cost, he believes in Zhou Yuan very much and has done the inspection obediently.

At one o’clock in the afternoon of the next day, Qian Wei’s various physical indicators, mentality, emotions, etc. have reached the best state, and Zhou Yuan is preparing for surgery.

Qian Wei’s wife could not visit, so she waited on the chair outside the ward. When she saw Zhou Yuan and others preparing to enter the operating room, Qian Wei’s wife immediately stood up.

“Doctor Zhou…My husband…”

Zhou Yuan stopped at the door, paused, a little unbearable: “If possible, try not to show up in front of Qian Wei, and don’t let him see it when you push to the operating room, otherwise it will arouse his emotions. Changes are not good for surgery.”

Qian Wei’s wife was taken aback, lowered her head silently, and walked towards the end of the corridor.

Just as Zhou Yuan was about to push the door in, Qian Wei’s wife suddenly turned her head and said, “Doctor Zhou, can you put his head to the end of the corridor when you push him out, so that he can’t see this side of the corridor, I can See him…”

Zhou Yuan nodded, and entered the ward with He Jianyi, the cardiologist, etc.

After a while, an operating bed was pushed out. .