Start as an Emergency Physician

"The patient's current physical condition is more suitable for a non-stop heart bypass. "

A cardiac arrest bypass is a bypass in a state where the heart stops beating and requires cardiopulmonary bypass. The non-stop heart bypass is a surgery under the beating of the heart, and the fixator fixes the local target blood vessels.

Zhou Yuan explained: "There are many benefits to using non-stop skipping coronary artery bypass grafting. First, non-stop coronary artery bypass grafting does not require cardiopulmonary bypass, which can avoid reperfusion injury due to myocardial ischemia, so that the risk of surgery is minimized. "

"Moreover, although non-stop heart bypass grafting is not as minimally invasive as the stent technique, compared with the stop-and-beat bypass, the wound is smaller, the postoperative recovery is faster, and it can also effectively reduce various postoperative complications, such as myocardial infarction, can reduce the arrhythmia rate and so on. Faster recovery will shorten the length of hospital stay, and it can also reduce the financial burden on patients. "

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

The director of the Department of Cardiovascular Medicine nodded, "What you said makes sense, but the heart bypass is not from the Department of Cardiovascular Medicine, you wait for the director of the Department of Cardiac Surgery to come and tell him." "

“......"

The director of the Department of Cardiovascular Medicine smiled: "Interventional stent technology is the work of our Department of Cardiovascular Medicine, and the heart bypass is very large, which is under the management of the Department of Surgery." "

Zhou Yuan's face darkened: Then what are you asking?

"I heard that you are very powerful, and when I saw you today, it really was!" said the director of the Department of Cardiovascular Medicine.

After a while, the director of the Department of Cardiac Surgery came.

Bring heart bypass surgery aids, including cardiac stabilizers, venous retractors, and more.

Same question, "What kind of surgery are you going to have?"

Zhou Yuan repeated the answer just now.

"Well, my diagnosis is also a non-stop heart bypass... What are you going to use for a vascular bypass?"

There are three types of blood vessels to choose from. Conventional saphenous vein bypass, arterial bypass and artificial vascular bypass.

Saphenous vein bypass surgery is relatively small and simpler, but the long-term effect is worse than that of arterial bypass, so the elderly over 80 years old can use saphenous vein bypass alone, under 55 years old can consider full arterial bypass, and other ages can use an internal mammary artery plus saphenous vein.

Arterial bypass grafting is large, the technical requirements are high, and the operation is more difficult, but the long-term effect is greater and the saphenous vein is better, and it is suitable for young patients.

If you artificial blood vessels, it will cost thousands to hundreds of thousands of dollars more in material costs, and Qian Wei will definitely not choose it.

"Arterial bypass. Zhou Yuandao.

The most suitable for Zhou Yuan is actually arterial bypass, master vascular grafting, master heart bypass, so that the difficult problems of arterial bypass do not exist, 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?" asked, the director of cardiac surgery

If the left ventricular ejection fraction is less than 100 percent, the left ventricular terminal diastolic pressure is greater than 20 mmHg or the left ventricular end-diastolic volume is greater than 103 ml/, indicating that the left ventricular function is obviously impaired.

Zhou Yuandao: "There is no problem with cardiopulmonary function. Both angiogram and left ventriculography have been done, the coronary artery stenosis is 80%, the site of obstruction is clear, and 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 his own eyes, even if he heard about Zhou Yuan's many miracles and heard that Zhou Yuan's medical skills were superb, it was useless.

As a doctor, which one doesn't rely on seniority and surgery, one by one, one knife at a time, to improve his skills?

Suddenly a master surgeon in his twenties popped up, and no matter who it was, it was unbelievable.

But in the end, the director of cardiac surgery nodded and said, "I'll assist you on the side." I've done a lot of heart bypass surgery. "

Zhou Yuan smiled.

It was as if I saw another mid-level treasure chest beckoning to me.

"Carotid angiography is also needed. The carotid arteries are examined for stenosis. Zhou Yuan looked at Qian Wei on the bed.

Cardiac bypass surgery is ultimately for the heart to go under the knife, and the preoperative examination is very cumbersome, such as carotid artery stenosis examination, once carotid artery stenosis is found, it may be before heart bypass surgery, or at the same time as heart bypass grafting, carotid artery stenosis should be reduced, so as to avoid cerebrovascular complications.

"Today, I took analgesics and sedatives, and at the same time took oral crown expansion drugs, combined with blockers, and continued until the preoperative discontinuation. Zhou Yuan opened another list.

The role of analgesics and sedatives is to stabilize the patient and prevent angina pectoris caused by emotional stress.

Coronary dilation drugs are given to prevent coronary artery spasm. In the case of arterial stenosis, another spasm will cause the patient's blood vessels to be blocked, and the condition will be more critical, and may even be directly life-threatening.

Blockers work to reduce myocardial oxygen consumption and reduce angina. Because Qian Wei belongs to unstable angina pectoris, it is irregular, so it needs to be taken until one hour before the operation.

To be honest, he was a little hesitant when he wrote the list.

Zhou Yuan was very worried that the patient would suspect that he was prescribing medicine and doing tests indiscriminately.

Since he came to the hospital, Qian Wei has done seven or eight examinations before and after, such as blood drawing, coronary angiography, cerebral angiography, carotid angiography, etc.

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

However, every medicine Zhou Yuan prescribed, every examination he did was necessary, and the lack of any link could cause him to miss an important piece of information, which would lead to an accident in surgery.

However, although Qian Wei cared about the cost very much, he believed in Zhou Yuan very much and obediently completed the inspection.

At one o'clock in the afternoon of the next day, Qian Wei's physical indicators, mentality, emotions, etc. reached the best state, and Zhou Yuan was ready for surgery.

Qian Wei's wife couldn't visit, so she waited on the chair outside the ward, and when she saw Zhou Yuan and others preparing to enter the operating room, Qian Wei's wife immediately stood up.

"Dr. Zhou... My husband he..."

Zhou Yuan stopped at the door, paused, and said a little unbearably: "If it's possible, try not to appear in front of Qian Wei, and don't let him see it in the process of pushing to the operating room, otherwise it will cause a change in his mood, which is not conducive to the operation." "

Qian Wei's wife was stunned, silently lowered her head, 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 at 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 heart surgeon, and others.

After a while, an operating table was pushed out. _

Feilu reminds you: there are three things to read - collection, recommendation, and points