When the sternum is closed, blood pressure fluctuations are abnormal, and rapid ventricular arrhythmias occur repeatedly, with a heart rate of 170-180 beats per minute.

This is the value that appears when the sternum is not completely closed. If the sternum is forced to close, the patient will probably not be able to go down to the operating table.

"Boss Zheng, did you make a judgment before the operation?" Zhao Yunlong asked softly when he knew that Zheng Ren's choice was right.

"Echocardiac signs that the patient's heart is enlarged, but this is not the main reason. The basis for judging that the chest closure should be delayed is previous treatment." Zheng Ren began to prepare for delaying chest closure and explained.

"Boss Zheng, are you going to do ultrasound now?" Lao He asked, pushing the machine in and pushing it in.

"good."

Lao He didn't mind that he was taken from home to the operating room by Boss Zheng from his home early in the morning just to do a transesophageal ultrasound examination and do whatever he asked him to do. Lao He had no complaints.

In general anesthesia and ventilator cannulation, it is also a technique to successfully complete the transesophageal echocardiac examination, and not everyone can do it.

"Wait a moment." Old He rushed to the computer, plugged in the USB flash drive, and the song of good luck came out.

"Now if you don't listen to this song, you won't have surgery." Lao He explained with a smile.

Although the operation has reached the last step, Lao He still insists on playing good luck.

As he stepped on the rhythm of good luck, Lao He felt that his body had become a little lighter, and he seemed to have become an immortal.

The difficult operation became very smooth in his hands. A few minutes later, Lao He whispered: "Boss Zheng, sam sign is obvious." Am sign is a sign in m-type ultrasound diagnosis.

It mainly refers to the forward movement of the anterior systolic period of the mitral valve. Obstructive hypertrophic cardiomyopathy is not a slow ascending platform in the systolic period, but an abnormal waveform that protrudes upward, that is, in the direction of the ventricular septum. This phenomenon is called forward movement of the systolic period, and is simply called sam sign.

"Give a small amount of β-blockers to quickly replenish plasma." Zheng Ren gave a medical advice and then began the step of delaying the chest closure.

"The dose of levosimendan is adjusted to 0.5g??kg/1??min." Zheng Ren said, Xie Yiren had handed over the child-type sternum expansion device.

Zheng Ren changed the adult sternum opener to a small children's type, and then observed blood pressure, central venous pressure, heart rate and rhythm, heart contraction strength, and pulse oxygen saturation at the same time.

His hand slowly changed the distance between the sternum and looked for the position that was most conducive to the stability of blood pressure, the heart rate did not slow down or significantly increased, there was no ventricular rhythm disorder, the CVP decline, the myocardial contraction was strong, the heart was not swelling, and the oxygen saturation increased.

"Boss, you're too fine." Su Yun said, "It's not about performing surgery based on millimeters. The heart and chest surgery is rough!"

Zheng Ren smiled, and Su Yun’s rough words were probably different from what others understood.

"The recovery after surgery can be faster in a more accurate position. If nothing unexpected happens, the edema can gradually subside in 2-3 days, and Lao Zhao can close his chest in about 5 days." Zheng Ren said.

Zhao Yunlong lowered his head and stared at Boss Zheng's way of moving the child's sternum expansion device.

Every angle, every distance, and every action has its own explanation, but Zhao Yunlong knew that this was an instinct formed by rich surgical experience, and I am afraid that Boss Zheng himself could not explain it clearly.

It’s better to take a closer look and think about it when you go back. If you have the next chance, you can try it. Zhao Yunlong thought to himself.

Place the pericardial and mediastinal drainage tube, and seal the incision and opener with a disinfected transparent surgical membrane.

"Send it to the icu." Zheng Ren turned around and stepped down, then turned around and asked, "Old Zhao, do you often do delayed chest closure surgery?"

"I do it occasionally, very little. But IU's doctors and nurses have experience, so don't worry, Boss Zheng." Zhao Yunlong knew what Zheng Ren said meant, and he answered immediately.

"Okay, that's it."

Even if the chest closure was delayed, the completion rate of the surgery reached 101%, and Zheng Ren said he was very satisfied with this.

The patient should be fine.

"Boss Zheng, thank you." Director Lang bowed deeply and said softly.

"You're welcome." Zheng Ren said, "Iabp should not be used. If you have experience this time, you won't make such a mistake next time."

"Next time..." Director Lang murmured.

"Huh?" Zheng Ren heard something in Director Lang's words and looked at him in confusion.

But Director Lang did not continue to talk, but asked, "Boss Zheng, isn't iabp very correct? Every time I encounter similar situations, I use iabp to solve them."

"You can't be too dogmatic," said Zheng Ren. "After clinically judging that there are many early symptoms of pericardial tamponade, you should immediately perform emergency measures such as pericardial puncture and drainage to relieve it. At this point, your treatment is fine and you did a great job."

Seeing that Director Lang was in a wrong mood, Zheng Ren did not over-stimulate him, but praised him rarely.

"We did not see common pericardial tamponade caused by coronary perforation during surgery. In theory, even if there is pericardial puncture and drainage, it will be more or less. This situation is too rare."

"Boss Zheng, it was caused by the rupture of the small branch." Director Zhang Lin asked.

"It should be, or you can consider that the small branch is ruptured. As the pressure of the pericardial cavity increases, the damage point has healed itself." Zheng Ren said, "I am really lucky. In fact, if this patient does nothing, it might be better."

“…”

Director Lang was speechless, and Boss Zheng's words made him feel ridiculous.

The absurd black comedy style and nonsensical words are not suitable for the operating room, and Director Lang said he could not accept it.

"But I think the possibility is that the patient is older, and his pericardial tampon is mainly caused by high congestive swelling of the myocardium, not blood accumulation in the pericardial." Zheng Ren explained, "I analyzed that it should be the heart edema caused by extensive myocardial infarction during your PCI operation."

"Mystery edema in the early stage of myocardial infarction is severe, and its left coronal dominance, and myocardial infarction involves a large range, which leads to this special change."

"That is, it is not pericardial tampon caused by coronary rupture and bleeding, but acute necrosis and pericardial tamponade caused by oozing."

"In this rare situation, all the operations you did afterwards, Director Lang, were wrong." Zheng Ren finally told the truth.

"Although the iabp measures adopted have reduced the afterload of the patient's ventricle, they have not been able to reduce the pressure on their pericardial itself in time, so the symptoms are getting worse and worse."

“…”

Director Lang listened to Boss Zheng's condition, and his judgment on the patient's condition was not the rupture and bleeding of the small coronary branch mentioned by Director Zhang Lin before, but it was another complication.
Chapter completed!