Start From Emergency Doctor

Chapter 414

If you surpass others a little bit, you will be jealous, and if you surpass others a lot, you will only have envy.

The doctors in the operating room are in this situation now. The younger doctors like Wang Sheng, Chen Li and others are better, but Jiang Li’s heart is trembling!

It is precisely because of his age that he has seen so many places in the world that he knows more how valuable Zhou Yuan’s operations are. It is almost impossible to replicate them!

Even finding a second doctor who can achieve Zhou Yuan’s level is a big problem, let alone surpass Zhou Yuan!

Zhou Yuan’s double lung transplantation and suture can be regarded as textbooks. Even the consistency of movements and the choice of schemes have surpassed the textbooks, which is completely unattainable.

This can’t be achieved by hard work, but more by talent. Jiang Li and others dare not even have the mind to chase…

“Thoracic drainage tube.” Jiang Li repeated, placing the drainage tube in Chen Jianguo’s chest cavity.

This is indwelling in the patient’s body for drainage. When the chest is closed, this tube is deliberately set aside to facilitate postoperative treatment.

Zhou Yuan fixed the three rib wires to the broken end of the sternum, and then began to seal and suture the thoracic incision.

After half an hour, the final work was completed, Zhou Yuan put down the needle holder, and there were some fine beads of sweat on his forehead exposed under the tight mask.

“The operation is complete.” Zhou Yuan breathed a sigh of relief and said.

He took off his mask, his face was a little pale, and he smiled reluctantly.

Double lung transplantation itself is a very expensive operation. Zhou Yuan did two single lung transplantation, which is basically equivalent to twice the workload of other people, but in order to reduce the risk of patients and increase the success rate of the operation, he had to do so.

The success rate of double lung transplantation seems to be unremarkable in the world. Not only is the operation difficult, but the postoperative care is even more torture. Zhou Yuan has completed his operation. As for Chen Jianguo’s later recovery, we can only watch The nurses.

Zhou Yuan is just a doctor. After finishing this stick, he has to hand it over to others.

“After the operation, the double-lumen catheter was removed, a standard tracheal catheter was inserted, and the fiberoptic bronchoscopy was repeated, and the secretions and blood in the airway were sucked out.” Zhou Yuan thought for a while and said.(Read more @ wuxiax.com)

Jiang Li nodded, “I will explain to the nurse. Is there anything else I need to pay attention to?”

“After the operation, the patient continues to be mechanically ventilated, maintain a positive end-expiratory pressure of ~0.98 kPa for 24 to 72 hours, and continue to infuse fentanyl into the vein.”

The 72 hours after the operation is a period of high incidence of various postoperative complications, and it is also called the golden 72 hours. Generally, after these three days, the patient is much safer.

Mechanical ventilation can reduce lung reperfusion injury, and intravenous fentanyl can make patients better tolerate mechanical ventilation.

With that said, Zhou Yuan walked towards the operating room, Jiang Li, Wang Sheng and others followed, and the equipment nurse anesthetist and others set out to pack the equipment.

Jiang Li thought for a while, and fell into a dilemma: “How should I choose the immunosuppressive method?”

Immunosuppression is a necessary step after organ transplantation. Just like Zhou Yuan’s concern with two single lung transplants, even if the organ matching is successful, rejection reactions may occur, and even life-threatening, in order to reduce rejection reactions. The probability of occurrence of this disease indirectly reduces the risk of surgery, and patients must continue to take immunosuppressive agents after surgery.

Of course, taking immunosuppressive agents has advantages and disadvantages. On the one hand, it can slow down the rejection reaction, but at the same time, the patient’s own resistance to external pathogens will decrease. This is also the most important reason why lung transplantation is the most difficult in organ transplantation.

If it is a normal patient, Jiang Li would naturally not ask this question. After so many lung transplants, it is not a problem to choose an immunosuppressive one.

However, Chen Jianguo was a late-stage pulmonary purulent infection. The pathogenic bacteria in the purulent lesion invaded the blood circulatory system, existed in the blood for a long time and multiplied in large numbers.

Lung transplantation is equivalent to removing the lung lesions, but Chen Jianguo’s own situation is still not optimistic.

The sepsis has been controlled before the operation, and now it is barely worsening. Chen Jianguo’s skin and mucous membranes are still bleeding, accompanied by petechiae, and hepatosplenomegaly.

In addition, there is another symptom that cannot be ignored is sepsis.

Chen Jianguo’s body became very weak due to sepsis, and metastatic abscesses appeared around his lungs. This was discovered during the operation. It took a lot of money to clean the abscess, debride and disinfect the chest cavity. Many hours.

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Two days before the operation, Chen Jianguo was still taking antibiotics and combined Chinese medicine for treatment. At this moment, he needed to take immunosuppressive agents.

In general, Chen Jianguo now needs strong immunity, but after lung transplantation, he needs to weaken the patient’s own immunity to prevent serious rejection. A balance needs to be found.

Otherwise, it will either be killed by rejection reactions, or it will be eroded by foreign pathogens and cause critical illness.

Jiang Li and others have no choice at all. Chen Jianguo’s situation is extremely endangered. If he doesn’t have a lung transplant, he will die immediately. There is still a chance for a lung transplant. To put it bluntly, they were driven by ducks and had to be operated on.

0 ……… …….

Zhou Yuan paused, thinking about it.

Indeed, the choice of postoperative immunosuppressive agents is also a big problem.

There are many options for immunosuppressive agents, roughly divided into five categories, glucocorticoids, such as cortisone and prednisone, microbial metabolites, such as cyclosporin and tacrolimus, as well as anti-metabolites, poly Cloning and monoclonal anti-lymphocyte antibodies, alkylating agents, etc.

However, any kind of immunosuppressant must have certain side effects when it exerts its effect.

Take cyclosporine for example. This is an immunosuppressant discovered by a Swiss scientist in the late 1970s. After the discovery, it was widely used in organ transplant operations as a drug against organ transplant rejection.

The effect of cyclosporin has demonstrated the magical effect of clinical use in the past two decades, making the one-year survival rate of organ transplant patients other than small intestine transplantation as high as 70% to 85%.

Before cyclosporin was applied, the one-year survival rate was only about 30%!

However, it was soon discovered that cyclosporin can cause related neurotoxicity symptoms. Mild symptoms are headaches, limb tremors, sensory disturbances, and once severe, severe sequelae such as blindness will occur, and death may occur! Spoon.