Start as an Emergency Physician

If you surpass others a little, you will be jealous, and if you surpass others a lot, you will only be envious.

That's the case with the doctors in the operating room today. Wang Sheng, Chen Li and others, these younger doctors are better, but Jiang Li's heart is shocked!

It is precisely because he is old and has seen a lot of the world that he knows better how valuable Zhou Yuan's operation is, and it is almost impossible to copy it!

Even finding a second doctor who can do Zhou Yuan's level is a big problem, let alone surpassing Zhou Yuan!

Zhou Yuan's double lung transplantation and suture surgery can be called textbooks, and even in terms of the consistency of the movements and the choice of schemes, they have surpassed the textbooks, which is completely unattainable.

This is not something that can be achieved by hard work, it is more dependent on talent, Jiang Li and others don't even dare to have the mind to chase...

"Chest drains. Jiang Li repeated and placed the drainage tube in Chen Jianguo's chest.

This is left in the patient's body for drainage, and the tube is deliberately left out when the chest is closed to facilitate postoperative treatment.

Zhou Yuan fixed three rib wires to the broken end of the sternum, and then began to seal the chest incision in layers.

Half an hour later, the final work was completed, Zhou Yuan put down the needle forceps, 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 a little forcefully.

Double lung transplantation itself is a very expensive operation, and Zhou Yuan still has two single lung transplants, which is basically twice the workload of others, but in order to reduce the risk of patients and improve the success rate of surgery, it has to be so.

The success rate of double lung transplantation is not impressive in the world, not only the difficulty of the operation, but also the postoperative care is torturous, Zhou Yuan has completed his operation, as for Chen Jianguo's later recovery, it can only depend on the nurses.

Zhou Yuan is just a doctor, and after completing this stick, he has to hand it over to others.

"The double-lumen catheter was removed postoperatively, a standard endotracheal tube was inserted, and the fiberoptic bronchoscopy was repeated to aspirate airway secretions and blood. Zhou Yuan thought for a while and said.

Jiang Li nodded, "I'll explain it to the nurse." Is there anything else I need to pay attention to?"

"After the operation, the patient continued to be mechanically ventilated, maintained at 0.49~0.98 kPa positive end-expiratory pressure for 24 to 72 hours, and continued intravenous fentanyl infusion. "

The 72 hours after surgery is a period of high incidence of various postoperative complications, and it is also known as the golden 72 hours, and the patient is much safer after spending these three days.

Mechanical ventilation can reduce reperfusion damage in the lungs, while intravenous fentanyl can make mechanical ventilation better tolerated.

As he spoke, Zhou Yuan walked towards the operating room, Jiang Li, Wang Sheng and others followed, and the instrument nurse anesthesiologist and others began to clean up the instruments.

Jiang Li thought for a while and fell into a dilemma: "How should the immunosuppression method be chosen?"

Immunosuppression is a necessary step after organ transplantation, just like Zhou Yuan's fear of two single-lung transplants, even if the organ matching is successful, rejection may still occur, and even life-threatening, in order to reduce the probability of rejection and indirectly reduce the risk of surgery, patients must continue to take immunosuppressants after surgery.

Of course, there are pros and cons to taking immunosuppressants, on the one hand, it can slow down the rejection reaction, but at the same time, the patient's own resistance to germs in the outside world will decrease, which is also the most important reason why lung transplantation is the most difficult in organ transplantation.

If it were an ordinary patient, Jiang Li would naturally not ask such a question, after so many lung transplants, it is no problem to choose an immunosuppressive one.

However, Chen Jianguo had an advanced purulent infection in the lungs, and the pathogenic bacteria in the purulent lesions invaded the blood circulatory system, persisted in the blood for a long time, and multiplied in large quantities.

The lung transplant is equivalent to removing the lung lesion, but Chen Jianguo's own situation is still not optimistic.

The sepsis had been controlled before the operation, and now it is barely worsening, and Chen Jianguo's skin and mucosa still have bleeding, accompanied by ecchymosis, liver and splenomegaly.

In addition to this, there is another symptom that should not be ignored is sepsis.

Chen Jianguo's body became very weak due to sepsis, and there was a metastatic abscess around the lungs, which was discovered during the operation, and it took more than an hour to clean the abscess site and debride and disinfect the chest cavity.

Two days before the operation, Chen Jianguo was still taking antibiotics and combined with traditional Chinese medicine for treatment, and now he needs to take immunosuppressants.

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, and a balance needs to be found in the middle.

Otherwise, they will either be killed by rejection, or they will be eroded by foreign germs and become critically ill.

Jiang Li and others can't choose at all, Chen Jianguo's situation is extremely dangerous, if he doesn't do a lung transplant, he will die immediately, and there is still a chance of life after a lung transplant, to put it bluntly, they were driven to the shelves and had to be operated.

Zhou Yuan paused and pondered.

Indeed, the choice of postoperative immunosuppressant is also a major challenge.

There are many options for immunosuppressants, roughly speaking, they are divided into five categories, glucocorticoids, such as cortisone and prednisone, microbial metabolites, such as cyclosporine and tenamycin, as well as antimetabolites, polyclonal and monoclonal anti-lymphocyte antibodies, alkylating agents, etc.

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

Take cyclosporine, for example, this is an immunosuppressant discovered by a Swiss scientist in the late seventies of the last century, and has been widely used in organ transplant surgery since its discovery, as a drug to resist organ transplant rejection.

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

Before the use of cyclosporine, the one-year survival rate was only about 30 percent!

However, it was soon discovered that cyclosporine can cause symptoms of related neurotoxicity, mild only headache, limb tremors, sensory disturbances, and once severe, then there will be serious sequelae such as blindness, and even death!