v3 Chapter 2960： Go all out
"Boss, anesthesia is a big problem." Su Yundao, "The extracorporeal circulation group can only find Lao He to do it, we can't occupy a group of people for so long."
"Well, the old Lao He will look back and forth. When there is any problem between Ecmo and extracorporeal circulation, Lao He will stare." Zheng Ren knew what Su Yun meant.
"Yes, because Lao He can't stare, do you want to call Da Chu and Xiao Chu?" Su Yun asked.
"Is it convenient at home?"
"If you say yes, I will ask again, otherwise Da Chu Xiao Chu comes, you say no, that's awkward."
"Come on, let me tell Director Xu. After all, I have to perform surgery training for about a week. It is difficult to find other people in the anesthesiology department to stay with me." Zheng Ren nodded and finalized the matter.
Tong Linyuan and Gu Xiaoran rubbed their palms, as long as people who have been in clinical work for a while know that this operation will inevitably go down in history.
Clone of autologous stem cells and 3D printed lung transplantation will inevitably write a thick stroke in the history of medicine, and may become an invisible hand to turn the page of modern medical history.
I waited for Yiren and Laohe to go to the community hospital to prepare for surgery training.
The last such exaggerated pre-operative training was the same as the one in which the conjoined baby was separated at the Women and Children's Hospital.
From the perspective of the operation as a whole, the difficulty is less than separating the conjoined heart, but Zheng Ren is still ready to go all out without leaving any effort.
He did not even hesitate to gather the whole team of the medical team again.
Watching Su Yun take Gu Xiaoran and Lin Yuan to move the 3d printed simulator to the operating table in the classroom, to prepare for the operation, Zheng Ren took the opportunity to come to the system space and click to buy surgery training time.
As the system operating room rose to the ground, Zheng Ren silently prayed, and then got in.
Fortunately, as imagined, 3D printed cloned lung tissue is placed in the operating room, and there is no need to go to the system mall to buy it at a high price.
Zheng expressed satisfaction with Zheng Ren.
Surgery, starting with anesthesia. Zheng Ren didn't throw this all to Lao He, after all, the 3D printed simulation person is essentially different from the real person.
Zheng Ren began to try anesthesia and ecmo.
First give the experiment mask a pure oxygen, 100% volume fraction, and monitor the electrocardiogram and blood oxygen saturation. Zheng Ren then performed a right radial artery puncture and catheterization to monitor the invasive blood pressure for blood gas analysis.
Anesthesia was induced with midazolam 1 ～ 2mg, etomidate 0.2 ～ o. 4mg / kg. Sufentanil 0.2 ~ o. 4mg / kg and atracurium cis besylate 0.15 ~ O. 3mg / kg.
After entering the state of muscle relaxation, tracheal intubation is started, and a ventilator is connected to assist breathing.
Maintain anesthesia by intravenous infusion of propofol 0.03 ~ 0.05nag · kg. 1 · min, vecuronium bromide 1 ～ 2ug / kg / · min. And indirect intravenous fentanyl to maintain anesthesia.
Zheng Ren observed the state of the subject for a period of time and intermittently performed blood gas analysis.
The blood gas value is not stable. Because the ventilation method uses pressure control, Zheng Ren adjusts ventilation parameters according to blood gas analysis indicators and vital signs, and decides to perform manual ventilation when necessary.
After induction of anesthesia, the right femoral arteriovenous cannula was intubated. The femoral artery was intubated to the level of the common iliac artery using a 15-17Fr catheter; the femoral vein was intubated to the level of the inferior vena cava using a 19-21Fr catheter. All heparin-coated membrane lungs and pipes, thermostats, centrifugal pump heads and oxygenators are selected. After the catheter is placed, the flow begins.
ECMO maximum flow usually depends on intubation. Each intubation has its own special flow-pressure curve. The larger the intubation, the higher the flow. For example, the 17th arterial cannula can only reach a flow of 4 to 5L per minute, while the 21st cannula can reach a flow of 6L / min without putting extra pressure on the wall.
Considering the age of small stones, Zheng Ren tried many times, and finally chose the most suitable type of intubation.
The initial flow is 50% of the intermittent cardiac output, and it is maintained above 30% during the flow. During the operation, the speed and flow are adjusted according to the oxygenation and cardiac function.
Zheng Ren didn't buy an assistant to help himself with the operation, this time just to explore the experience. Although there is a lot of surgical training time remaining, Zheng Ren is not prepared to "waste".
This operation, Zheng Ren did not think that the 3D printed cloned lung tissue could be perfect. If there is an abnormal situation, he is going to take Su Yun away, then "hide the sky and cross the sea", and replace the 3D printed lung tissue brought by Su Yun's familiar laboratory with the lung tissue in the system space.
This is very risky, but Zheng Ren has made the worst preparations for the successful operation.
The lung tissue that can be taken out for transplantation is worth hundreds of thousands of experience points, which is more expensive than the previous system space.
Come on a little bit, I hope the lung tissue provided by Su Yun can be more reliable.
仁 When the operation was started, Zheng Ren found abnormalities.
前 Before the ECMO flow decreased, he observed "pipe tremor".
This is due to the phenomenon that the negative pressure in the ECMO tube causes the venous cannula to hit the vein wall when the content of the blood vessel is at a low level.
Continuous tremor may cause ECMO alarm or “decrease in suction to flow rate”. Zheng Ren found that the amplitude of tremor can be quickly relieved after reducing the ECMO flow; then he adopted a method of slowly increasing ECMO flow while expanding capacity to solve this problem.
Normally, the pipe tremor phenomenon is not uncommon in the use of ecmo. UU Reading wants to come to Laohe many times. However, Zheng Ren was very cautious in solving the situation of pipeline tremor a little bit, until how to expand the volume, to give a large dose to avoid the occurrence of pipeline tremor is clear.
Only a detail, wasted 30 hours of surgical training time.
The surgery is getting bigger and bigger, and the training time is also getting more and more. Fortunately, there are 3D printed simulators available for training. Otherwise, if you buy an assistant in the system operating room, it is estimated that you cannot train a few times.
However, what makes Zheng Ren more gratified is that the 3d printed cloned lung tissue brought by Su Yun is quite good. After the operation, the system gave 88% completion of the operation.
This degree of completion is relatively low in the surgery that Zheng Ren has done, but one point that Zheng Ren has proved is that there is no essential difference between the 3D printed organization and the organization purchased in the system space.
As long as it's okay, Zheng Ren doesn't want to change the lung tissue and organs like a living person.
Hold a laryngoscope and a razor blade. These are trivial matters, and you can explain whatever you want. Even if Su Yun or others have doubts, they will think that Zheng Ren is obsessive-compulsive disorder, just by chance.
But turned into a lung ...
Do you sell human organs? In that case, the consequences would be unimaginable as long as they are noticed.
Cloning the lungs should work, this is the best news that Zheng Ren got.
After 62 hours of surgical training, Zheng Ren felt that he was really good. Organ transplant specialization, although the big pig hoof did not give instructions, but Zheng Ren is convinced that this specialization skill has played a great role.
"Well, the old Lao He will look back and forth. When there is any problem between Ecmo and extracorporeal circulation, Lao He will stare." Zheng Ren knew what Su Yun meant.
"Yes, because Lao He can't stare, do you want to call Da Chu and Xiao Chu?" Su Yun asked.
"Is it convenient at home?"
"If you say yes, I will ask again, otherwise Da Chu Xiao Chu comes, you say no, that's awkward."
"Come on, let me tell Director Xu. After all, I have to perform surgery training for about a week. It is difficult to find other people in the anesthesiology department to stay with me." Zheng Ren nodded and finalized the matter.
Tong Linyuan and Gu Xiaoran rubbed their palms, as long as people who have been in clinical work for a while know that this operation will inevitably go down in history.
Clone of autologous stem cells and 3D printed lung transplantation will inevitably write a thick stroke in the history of medicine, and may become an invisible hand to turn the page of modern medical history.
I waited for Yiren and Laohe to go to the community hospital to prepare for surgery training.
The last such exaggerated pre-operative training was the same as the one in which the conjoined baby was separated at the Women and Children's Hospital.
From the perspective of the operation as a whole, the difficulty is less than separating the conjoined heart, but Zheng Ren is still ready to go all out without leaving any effort.
He did not even hesitate to gather the whole team of the medical team again.
Watching Su Yun take Gu Xiaoran and Lin Yuan to move the 3d printed simulator to the operating table in the classroom, to prepare for the operation, Zheng Ren took the opportunity to come to the system space and click to buy surgery training time.
As the system operating room rose to the ground, Zheng Ren silently prayed, and then got in.
Fortunately, as imagined, 3D printed cloned lung tissue is placed in the operating room, and there is no need to go to the system mall to buy it at a high price.
Zheng expressed satisfaction with Zheng Ren.
Surgery, starting with anesthesia. Zheng Ren didn't throw this all to Lao He, after all, the 3D printed simulation person is essentially different from the real person.
Zheng Ren began to try anesthesia and ecmo.
First give the experiment mask a pure oxygen, 100% volume fraction, and monitor the electrocardiogram and blood oxygen saturation. Zheng Ren then performed a right radial artery puncture and catheterization to monitor the invasive blood pressure for blood gas analysis.
Anesthesia was induced with midazolam 1 ～ 2mg, etomidate 0.2 ～ o. 4mg / kg. Sufentanil 0.2 ~ o. 4mg / kg and atracurium cis besylate 0.15 ~ O. 3mg / kg.
After entering the state of muscle relaxation, tracheal intubation is started, and a ventilator is connected to assist breathing.
Maintain anesthesia by intravenous infusion of propofol 0.03 ~ 0.05nag · kg. 1 · min, vecuronium bromide 1 ～ 2ug / kg / · min. And indirect intravenous fentanyl to maintain anesthesia.
Zheng Ren observed the state of the subject for a period of time and intermittently performed blood gas analysis.
The blood gas value is not stable. Because the ventilation method uses pressure control, Zheng Ren adjusts ventilation parameters according to blood gas analysis indicators and vital signs, and decides to perform manual ventilation when necessary.
After induction of anesthesia, the right femoral arteriovenous cannula was intubated. The femoral artery was intubated to the level of the common iliac artery using a 15-17Fr catheter; the femoral vein was intubated to the level of the inferior vena cava using a 19-21Fr catheter. All heparin-coated membrane lungs and pipes, thermostats, centrifugal pump heads and oxygenators are selected. After the catheter is placed, the flow begins.
ECMO maximum flow usually depends on intubation. Each intubation has its own special flow-pressure curve. The larger the intubation, the higher the flow. For example, the 17th arterial cannula can only reach a flow of 4 to 5L per minute, while the 21st cannula can reach a flow of 6L / min without putting extra pressure on the wall.
Considering the age of small stones, Zheng Ren tried many times, and finally chose the most suitable type of intubation.
The initial flow is 50% of the intermittent cardiac output, and it is maintained above 30% during the flow. During the operation, the speed and flow are adjusted according to the oxygenation and cardiac function.
Zheng Ren didn't buy an assistant to help himself with the operation, this time just to explore the experience. Although there is a lot of surgical training time remaining, Zheng Ren is not prepared to "waste".
This operation, Zheng Ren did not think that the 3D printed cloned lung tissue could be perfect. If there is an abnormal situation, he is going to take Su Yun away, then "hide the sky and cross the sea", and replace the 3D printed lung tissue brought by Su Yun's familiar laboratory with the lung tissue in the system space.
This is very risky, but Zheng Ren has made the worst preparations for the successful operation.
The lung tissue that can be taken out for transplantation is worth hundreds of thousands of experience points, which is more expensive than the previous system space.
Come on a little bit, I hope the lung tissue provided by Su Yun can be more reliable.
仁 When the operation was started, Zheng Ren found abnormalities.
前 Before the ECMO flow decreased, he observed "pipe tremor".
This is due to the phenomenon that the negative pressure in the ECMO tube causes the venous cannula to hit the vein wall when the content of the blood vessel is at a low level.
Continuous tremor may cause ECMO alarm or “decrease in suction to flow rate”. Zheng Ren found that the amplitude of tremor can be quickly relieved after reducing the ECMO flow; then he adopted a method of slowly increasing ECMO flow while expanding capacity to solve this problem.
Normally, the pipe tremor phenomenon is not uncommon in the use of ecmo. UU Reading wants to come to Laohe many times. However, Zheng Ren was very cautious in solving the situation of pipeline tremor a little bit, until how to expand the volume, to give a large dose to avoid the occurrence of pipeline tremor is clear.
Only a detail, wasted 30 hours of surgical training time.
The surgery is getting bigger and bigger, and the training time is also getting more and more. Fortunately, there are 3D printed simulators available for training. Otherwise, if you buy an assistant in the system operating room, it is estimated that you cannot train a few times.
However, what makes Zheng Ren more gratified is that the 3d printed cloned lung tissue brought by Su Yun is quite good. After the operation, the system gave 88% completion of the operation.
This degree of completion is relatively low in the surgery that Zheng Ren has done, but one point that Zheng Ren has proved is that there is no essential difference between the 3D printed organization and the organization purchased in the system space.
As long as it's okay, Zheng Ren doesn't want to change the lung tissue and organs like a living person.
Hold a laryngoscope and a razor blade. These are trivial matters, and you can explain whatever you want. Even if Su Yun or others have doubts, they will think that Zheng Ren is obsessive-compulsive disorder, just by chance.
But turned into a lung ...
Do you sell human organs? In that case, the consequences would be unimaginable as long as they are noticed.
Cloning the lungs should work, this is the best news that Zheng Ren got.
After 62 hours of surgical training, Zheng Ren felt that he was really good. Organ transplant specialization, although the big pig hoof did not give instructions, but Zheng Ren is convinced that this specialization skill has played a great role.
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