Start with an emergency physician

See all

TảDownload time: 0.762s Scan time: 0.055s

"The patient's current physical condition is more suitable for off-pump coronary artery bypass grafting."

Off-pump coronary artery bypass grafting is a bypass grafting procedure performed while the heart is stopped, which requires extracorporeal circulation.

On-pump coronary artery bypass grafting is a procedure performed while the heart is beating, with a fixator fixing the local target blood vessel.

Zhou Yuan explained:"There are many advantages to using off-pump coronary artery bypass grafting.

First, off-pump coronary artery bypass grafting does not require extracorporeal circulation, which can avoid reperfusion injury caused by myocardial ischemia and minimize the risk of surgery.

"

"Moreover, although off-pump coronary artery bypass grafting is not as good as minimally invasive stent technology, compared with off-pump coronary artery bypass grafting, it has a smaller incision and faster postoperative recovery. It can also effectively reduce various postoperative complications, such as myocardial infarction, and can reduce the rate of arrhythmias, etc. The recovery will be fast, the hospital stay will be shortened, and the financial burden on patients can be reduced."

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

The director of the Department of Cardiovascular Medicine nodded and said,"What you said makes sense, but coronary artery bypass grafting is not a cardiovascular department. You should wait for the director of cardiac surgery to come and then talk to him."

"……"

The director of the Department of Cardiology smiled and said,"Interventional stent technology is the job of our Department of Cardiology. Heart bypass surgery is a big deal and is under the jurisdiction of the Department of Surgery."

Zhou Yuan frowned: Then what are you asking?

"I've heard that you're very capable, and today I see that you're indeed capable!" The director of the Department of Cardiology laughed.

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

He brought auxiliary equipment for heart bypass surgery, including a heart stabilizer, a venous retractor, etc.

The same question came,"What surgical method do you plan to use?"

Zhou Yuan repeated his previous answer.

"Well, my diagnosis is also to perform a beating heart bypass... What blood vessels do you plan to use for the bypass?"

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

The great saphenous vein bypass surgery is less damaging and simpler, but the long-term effect is worse than the arterial bypass.

Therefore, the great saphenous vein bypass can be used alone for the elderly over 80 years old, and arterial bypass can be considered for those under 55 years old.

Other ages can use an internal mammary artery plus the great saphenous vein.

Arterial bypass is more damaging, has high technical requirements, and is more difficult to operate, but the long-term effect is better than the great saphenous vein, and is suitable for young patients.

Artificial blood vessels will cost thousands to hundreds of thousands more in material fees, and Qian Wei will definitely not choose

"Arterial bypass surgery."Zhou Yuan said.

The most suitable thing for Zhou Yuan is actually arterial bypass surgery. Master-level vascular transplantation and master-level heart bypass surgery make the high difficulty of arterial bypass surgery unnecessary, and the damage can be compensated as much as possible through technology.

For Qian Wei, who is only in his twenties or thirties, arterial bypass surgery is necessary.

"How is the patient's cardiopulmonary function?"The director of cardiac surgery asked.

If the left ventricular ejection fraction is less than 100%, the left ventricular end-diastolic pressure is greater than 20mmHg or the left ventricular end-diastolic volume is greater than 103ml/, it indicates that the left heart function is significantly impaired. For such patients, drug treatment should be given before surgery to try to improve myocardial blood supply and increase cardiac function reserve before coronary bypass surgery.

Zhou Yuan said,"There is no problem with the cardiopulmonary function. Both coronary artery angiography and left ventricle angiography have been done. The degree of coronary artery stenosis is 80%, and the site of obstruction is also clear. The best way is to perform coronary 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, it would be useless even if you had heard of Zhou Yuan's miracles and heard that Zhou Yuan had superb medical skills.

Which doctor did not improve his skills by spending years and surgeries, one by one, one by one?

It was unbelievable that a surgical master in his twenties suddenly appeared.

But in the end, the director of cardiac surgery nodded and said,"I'll assist you on the side. I have performed many heart bypass surgeries."

Zhou Yuan smiled.

It was as if he saw another intermediate treasure chest waving at him.

"We also need to perform carotid angiography to check for carotid stenosis."Zhou Yuan looked at Qian Wei on the bed.

After all, coronary bypass surgery is surgery on the heart, and preoperative examinations are very cumbersome, such as carotid stenosis examination. Once carotid stenosis is found, it may be necessary to reduce carotid stenosis before or during coronary bypass surgery to avoid cerebrovascular complications.

"Today I am taking analgesics and sedatives, as well as oral coronary dilators and blockers, which will continue until I stop taking them before the operation." Zhou Yuan wrote another prescription.

The role of analgesics and sedatives is to stabilize the patient and prevent emotional tension from inducing angina pectoris.

Giving coronary dilators is to prevent coronary artery spasm. In the case of arterial stenosis, if there is another spasm, the patient's blood vessels will be directly blocked, the condition will become more serious, and may even directly endanger his life.

The role of blockers is to reduce myocardial oxygen consumption and relieve angina pectoris. Since Qian Wei has unstable angina pectoris and irregular heart disease, he needs to take it until one hour before the operation.

To be honest, he was a little hesitant when writing the prescription.

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

Since Qian Wei came to the hospital, he had done seven or eight tests, including blood tests, Coronary angiography, cerebral angiography, carotid angiography, etc....

Then there are morphine, various infusions, and various drug names that most people cannot understand.

However, every medicine Zhou Yuan prescribes and every examination he does is necessary. The lack of any link may cause him to miss an important information, thus leading to a surgical accident.

However, although Qian Wei cares about the cost, he trusts Zhou Yuan very much and completes the examination obediently.

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

Wei's wife cannot visit, so she has been waiting on a chair outside the ward. Seeing Zhou Yuan and others preparing to enter the operating room, Qian Wei's wife immediately stood up

"Dr. Zhou...my husband……"

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

Qian Wei's wife was stunned, lowered her head silently, 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, when you push him out, can you point his head to the end of the corridor, so that he can't see this side of the corridor, and I can see him……"

Zhou Yuan nodded, and entered the ward with He Jianyi, the cardiac surgeon, and others. After a while, an operating table was pushed out.