Start as an Emergency Physician

Even if there is a difference of 0.1mm, the incision will not fit perfectly, resulting in blood leakage.

When performing fascial sutures, Zhou Yuan did not suture the incision of the deep fascia.

The blood vessels in the deep fascia area are ischemic due to the surgical blockade of the blood vessels, and the muscles, nerves and other tissues that are supported by the fascia will reactive swelling after repairing the blood vessels and restoring blood flow, resulting in an increase in the contents of the interstitial area and an increase in pressure, resulting in intermuscular compartment syndrome.

This is a vicious circle, progressive necrosis disease, which can be formed within 24 hours after surgery, and after the onset of the disease, there will be obvious swelling and pain of the limbs, deep fascial space tension, tenderness, passive stretching pain of deep fascial muscles, and even signs of neurological dysfunction.

The treatment method is to surgically insect the fascia to decompress, which is why Zhou Yuan retains the deep fascial incision.

After bypassing the deep fascia, Zhou Yuan sutured the superficial fascia layer by layer, then used a drainage tube to drain the blood in the wound cavity out of the body, and finally bandaged the upper limb with an elastic bandage with the help of He Jianyi.

Then came the highlight of the operation.

Zhou Yuan cut the skin of his chest with a scalpel, exposing his heart.

There are two more steps before heart bypass surgery can be performed: establishing cardiopulmonary bypass and myocardial protection.

Because Zhou Yuan chose the heart beating bypass surgery, only myocardial protection is required.

This step is not complicated, after dissecting the skin of the aortic opening, the aorta is revealed, and then the coronary venous sinus retrograde perfusion is performed with a cannula at the root of the aorta with cold cardiac arrest fluid at four degrees Celsius.

Conventional anterograde perfusion is not chosen because the conventional anterograde coronary perfusion method through the aortic root is not effective in protecting the myocardium from distal ischemia of stenosis.

Especially in recent years, with the gradual expansion of surgical indications, a considerable number of cases have severe coronary artery stenosis, and the number of complete occlusion cases is also increasing.

In this case, the long-standing defect of anterograde perfusion of the aortic root to inadequate myocardial protection of ischemia becomes more apparent.

Retrograde perfusion of coronary venous sinuses, on the other hand, is not affected by vascular stenosis because the coronary venous system is a tube without valves and can exchange substances with cardiomyocytes through capillaries and sinus spaces.

It is also important to note that coronary artery lesions generally do not involve the coronary venous system, so even if there is extensive severe coronary artery disease, retrograde perfusion of cold cardioaponomic fluid through the coronary sinuses can still evenly enter the myocardium.

Most of the asystole flows out of the coronary ostium through the capillaries, some of it drains directly into the right ventricular cavity through the The-besius sinus vascular system, and a small part of the cold cardioplagia flows into the left ventricular cavity through the sinus space, or from the precordial vein into the right atrium.

Laboratory observations have also demonstrated that the distribution of cold cardioaponsis in the left ventricle is superior to that of the right ventricle and subendocardial to the subepicardial in retrograde coronary sinus perfusion, which is appropriate for the important principle of myocardial protection, i.e., enhanced protection of the left ventricle and subendocardium.

Therefore, in the face of Qian Wei, who has coronary artery stenosis of 80%, it is obvious that retrograde perfusion of coronary venous sinuses is the best choice.

"Fluorocarbon asystole. "Zhou Yuan.

Zhou Yuan perfused 800 milliliters of fluorocarbon asystole along the catheter at the root of the aorta, and then handed it to the director of cardiac surgery, saying, "Perfusion of 100 milliliters again every 20 minutes." "

"Ice chips. Zhou Yuandao.

The instrument nurse retrieved the medical ice chips.

Zhou Yuan put some ice chips on the surface of the heart machine to cool down.

"Fluorocarbon asystole perfusion complete. The voice of the chief of cardiac surgery rang out again.

Zhou Yuan nodded, "Scalpel." "

"The coronary arteries are exposed and the coronary anastomosis selection is initiated. "

Zhou Yuan glanced at the data of the radial artery vascular bridge measured by the director of cardiac surgery, then picked up the scalpel and began to look for the coronary arteries.

The coronary artery is below the epicardium, and He Jianyi has already exposed it.

Zhou Yuan began to search for the lesion site of the coronary artery based on the lesion site shown by the previous coronary angiography.

The selection and incision of coronary artery anastomosis is an important part of heart bypass surgery, and it is also the key to the success of the operation.

It is necessary to choose anastomosis close to the normal wall of the stenosis or occlusion distal as much as possible, because the closer to the proximal lumen, the larger the diameter of the vessel, and the more convenient it is to perform anastomosis.

Soon, Zhou Yuan found the lesion near the end of the epicardium and made an incision mark with indigo.

"Vascular clamps. "

He Jianyi was helping to reveal the surgical field, so the director of cardiac surgery ran up to help Zhou Yuan stop the blood circulation.

When making a coronary incision, the lumen must be kept full, otherwise the blood vessels will become deflated, and the anterior and posterior walls will stick together, and the anterior wall will easily injure the posterior wall by mistake.

After Zhou Yuan cut open the epicardium covering the outside of the blood vessels, exposing the coronary arteries inside, Zhou Yuan put down the scalpel.

"Small blades. "

The scalpel is too large for the coronary vessels, which require the use of a delicate small blade.

Zhou Yuan pinched the small blade, used the tip of the blade to make a longitudinal cut against the center of the blood vessel's forearm, and after cutting the lumen, Zhou Yuan still looked at the blood vessels under the microscope, freed one hand, and said, "Small angled scissors." "

After receiving the small angled scissors, Zhou Yuan made several cuts along the incision towards the distal and proximal ends of the coronary artery to enlarge the incision.

This step needs to completely control the incision in the center of the coronary artery, once the incision is biased to one side, the vascular anastomosis cannot be done accurately, and there will be adverse consequences such as bleeding.

"Coronary probe. Zhou Yuandao.

This is a device used to measure the distal and proximal caliber of coronary arteries, and it is also a unique surgical instrument in cardiac surgery and cardiovascular medicine, and is not used in general surgery.

After the measurement, Zhou Yuan made an 8mm incision, and the incision step of the coronary vessel was completed.

In other words, the roadbed on both sides of the bridge has been erected during vascular bypass surgery, and now it is one step away from connecting the bridges.

That is, the anastomosis of the vascular bridge is performed.

The small diameter of the coronary arteries makes anastomosis difficult to perform, so special microvascular instruments are required.

The choice of sutures is also very particular, 6-0 sutures are generally used to anastomosis blood vessels with a diameter of 2mm, 7-0 sutures are used to anastomosis blood vessels under 2mm, and 7-0 sutures are used here.

Due to the small diameter of the coronary artery, the slightest pulse of the blood vessel may cause the suture needle to deviate and penetrate the entire blood vessel, which is extremely demanding for the main surgeon. _

To see the ununderlined version of the novel, please download the Feilu Novel AP