Chapter 313: Dangerous ventricular fibrillation, the only way to break the deadlock! (Added)
Xu Qiu did not hesitate, and pulled open the surgical field when the soft tissue in the precordial area was free of tension.
Then, he picked up the electric knife.
Surrounding the pericardium, from bottom to top, he gradually separated the adhesions of the pericardium and chest wall.
"Ding! Separation proficiency +1!"
"Ding! Smell discrimination ability +1!"
Xu Qiu sniffed his nose.
The air was mixed with the contradictory smell of barbecue and burnt smell.
Can this thing also improve the ability to distinguish smells?
For some reason, Xu Qiu suddenly remembered Wang Fan's thesis...
The corners of his mouth twitched.
Sure enough, he should have less contact with Wang Fan.
...
After the chest wall adhesion was resolved, Xu Qiu put down the instrument and pressed on the heart with his bare hands.
Drum--
The perfect level of hand-to-hand hemostasis allowed Xu Qiu to feel the pulsation of the coronary artery, the impact and ejection of blood in the heart cavity.
Then, he followed the rhythm of the heart and squeezed the heart again and again.
This step made Yang Chenxi and others stunned for a long time.
"Doctor Xu, this is..." Yang Chenxi said, puzzled.
Director Zheng and Ma Qin were also puzzled.
They had been doing heart surgery for so many years, but this was the first time they had seen such an operation.
Xu Qiu gave an explanation: "Ensure blood supply to important organs such as the heart and brain, and reduce the burden of surgery on the systemic circulation."
This was the conclusion he came to after many reviews and experiments in the simulated operating room.
On the real operating table, the conditions of each patient are different, so the different postoperative efficacy and prognosis will be attributed to the differences in the patients themselves.
But the patients provided by the simulated operating room are the same.
Even Xu Qiu can choose to press the heart or not, or use three-point force, five-point force, or eight-point force to press, and only change a certain parameter to perform two groups of exactly the same operations.
Therefore, the effects of the two can be compared very intuitively.
And this has also become the best tool for Xu Qiu to improve various surgeries and find the most suitable and perfect surgical process.
"Can it be done this way..."
"I haven't heard of it, but it makes sense. If the patient's indicators respond well after the operation, it can be promoted to heart surgery across the country."
Everyone was shocked.
When they looked at the operating table again, Xu Qiu had already started pericardial separation.
He freed the anterior wall of the right ventricle, diaphragm, right atrium and ascending aorta in turn.
The right atrium on the right side was also exposed.
Next, he continued to separate to the front of the ascending aorta, directly to the lower edge of the aortic arch, and simultaneously freed and pulled the innominate artery, leaving it for subsequent arterial cannulation and proximal anastomosis of the vascular bridge.
After marking it, the left ventricle was dissected.
This step is also full of dangers, and every action is on the verge of life and death.
"Block the ascending aorta."
"Cardiac arrest."
After Xu Qiu finished speaking, anesthesia, assistants and others cooperated to quickly complete the induced cardiac arrest.
Emptying and arresting the heart is a technique to reduce the difficulty of left ventricular dissection.
Of course, it has more advantages.
For patients like Yan Ziqiang who are undergoing surgery again, the most immediate effect is to prevent the thrombus in the venous bridge from falling off during the first operation and prevent it from causing distal myocardial infarction.
As the cardioplegia was completed, Xu Qiu also quickly moved out of the left ventricle.
Then he began to look for old, occluded and diseased vascular bridges.
Xu Qiu's movements were extremely skillful.
He started from the apex of the heart and went all the way up, and finally found the site where the left internal mammary artery bridge built in the first operation and the anastomosis of the left anterior descending branch were anastomosed.
"Focus!" Yang Chenxi said in a low voice.
Everyone held their breath.
The most critical step of the operation has finally arrived.
And this step will determine the success or failure of this operation!
...
"Prepare small-caliber blood vessels." Xu Qiu's movements did not stop at all, and he spoke to instruct.
He steadily cut the incision of the coronary artery.
Blood immediately overflowed.
After blowing away the blood with carbon dioxide, the coronary anastomosis was exposed.
"Build a vascular bridge."
The atmosphere in the operating room was stagnant to the extreme, and everyone dared not breathe and cooperated with Xu Qiu.
After each distal anastomosis of an artificial vascular bridge, the proximal end will be immediately connected to the perfusion catheter and continuously perfused with low potassium warm blood cardiac arrest fluid.
"Proximal anastomosis." Yang Chenxi reminded.
At this time, the proximal warm blood perfusion stopped immediately.
Xu Qiu dropped the needle, and his hand was so fast that a residual image appeared. The curved needle holding the needle forceps shuttled between the human blood vessels and the artificial blood vessels, and the gap between the blood vessels slowly disappeared.
In the end, the two blood vessels almost merged together, and there was no difference except for the color difference!
"Three minutes!"
The moment Xu Qiu finished the last stitch, the anesthesiologist spoke in astonishment.
For each transplanted blood vessel, if the perfusion time is stopped within fifteen minutes, there will generally be no adverse consequences.
Therefore, most cardiac surgeons will control the suturing time to about ten minutes.
It's not that they don't want to be faster, but they can't do it.
It may take several years of practice to reduce the suturing time from twenty minutes to ten minutes.
And if you practice for several more years, the time will come to nine minutes.
Eight minutes, it will take several more years.
If you want to improve in the future, the energy and training time you spend are immeasurable.
Doctors' time is extremely valuable. If you put this time elsewhere, the benefits you get will be much higher. Naturally, it is impossible for someone to practice surgery.
And Xu Qiu only took three minutes...
This is a bit inhumane.
"Induce ventricular fibrillation." Xu Qiu said.
Yang Chenxi and others were shocked again.
The advantages of ventricular fibrillation are known to everyone present.
It can ensure that the coronary artery is still perfused during the operation, and it is more convenient and accurate to expose and perform vascular bridge anastomosis.
However, it puts a great test on the operation time.
Once the ventricular fibrillation lasts for a little longer, the patient will suffer myocardial ischemic damage, and the consequences are far greater than the advantages brought by fibrillation.
It is an operation with greater risks than benefits.
Therefore, few people use it clinically.
Even big names in cardiac surgery such as Ma Qin and Yang Chenxi rarely take the risk to do this operation.
"You can learn to squeeze the heart, but don't learn this." Xu Qiu reminded while inducing fibrillation.
He practiced hundreds of times in the simulated operating room to have this confidence.
Yang Chenxi and others nodded silently.
There is no need to remind you at all...
No one will do this except you!
Can't learn it!
Dare not learn it!
Taking risks, just to polish the operation to the extreme and improve the patient's efficacy to the best, only a detail maniac like Xu Qiu can do it.
For others, if they dare to do ventricular fibrillation, they will only lose the big picture!
However, before everyone recovered from the shock of ventricular fibrillation, Xu Qiu once again demonstrated a suturing technique that had never been used before.
"This is... sequential anastomosis?!"
Yang Chenxi and others widened their eyes, their faces full of disbelief.
"No wonder you dare to do ventricular fibrillation!"
"I understand, I understand!"
At this moment, the doctors present all felt a sense of sudden enlightenment.
The most feared thing about ventricular fibrillation is that the operation is delayed too long.
But in clinical surgery, there is a way to crack it.
It is the sequential anastomosis that Xu Qiu is currently demonstrating!
——
Five more!
Brothers, happy Chinese New Year!
