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Chapter 703 Epic Healing (1)

Putting aside the matter of the marriage leave, people are being rescued in the operating room.

Neurosurgeons have removed the first bone flap.Some yellowed skulls were placed on the surgical tray aside, and many neurosurgery doctors gathered to observe the wound.Now is the best stage to determine Zhang Junyi's intracranial pressure level.

When faced with patients with signs of brain herniation, the channel for doctors to know the level of intracranial pressure in the patient does not exist at all.Ordinary people can also obtain a relatively accurate intracranial pressure value by puncturing the lumbar cistern.And the doctors have to roughly judge Zhang Junyi's intracranial pressure in accordance with the procedures and without directly prying open his head...then they can only make a rough estimate by pressing his eyeballs.

Without knowing the patient's intracranial pressure, the anesthesiologist struggled to keep his vital signs within a range acceptable for surgery.After taking out the skull, the job seemed to go much smoother.

From the angle where Sun Lien and the others were standing, they could also see the whitish dura that was about to swell after taking out a skull about 14 centimeters long.

The bulging dura mater means that the patient's intracranial pressure has reached a dangerously high level.But looking at it now, his luck is not bad - if he has not died of brain hernia at this point, then the danger of brain hernia will be basically eliminated.

Although the dura mater has not been completely cut to release the pressure, at least the dura mater itself is much more malleable than the skull—the human skull will not deform due to internal pressure.

The neurosurgery doctors began to prepare to cut the dura mater to release the intracranial pressure, and the abdominal surgery has also been carried out to cut the rectus abdominis muscle.

The abdomen is not a single or double layer of flat skin and muscles.Taking this operation as an example, the hepatobiliary surgeon chose the right side of the rectus abdominis to make an incision for laparotomy.The doctors first cut Zhang Junyi's abdominal skin, and then separated the abdominal subcutaneous fat.Then an incision was made on the external oblique muscle, and it was separated and fixed with retractors.

After separating the external oblique muscles, the rectus abdominis and a part of the internal oblique muscles are exposed to the surgical field.Beneath these two muscles is the larger transverse abdominis.

After dismantling the protection of the four layers of muscle, the peritoneum and omentum can be seen next.

The peritoneum is a thin, smooth surface and a translucent inner serosa.This layer of structure is very sensitive to pain and other sensations because it is innervated by 7 to 11 pairs of intercostal nerves, subcostal nerves, and lumbar nerves.Once some symptoms such as severe inflammation and tracheal perforation appear in the abdomen, the inflammatory substances and stimulation will cause the patient to have peritoneal irritation.The specific manifestations are abdominal tenderness, rebound tenderness and abdominal muscle tension.

The omentum beneath the peritoneum appears as a yellowish layer of scattered fat.In adults, the greater omentum is healed with the peritoneum most of the time.And this layer of ligament structure is specially used to fix the relative position of the gastrointestinal tract in the human body, and also performs the immune defense function in the abdominal cavity-the omentum is rich in fat and phagocytes, and is the backbone of the human immune system in the abdomen. An important part of.

After separating the peritoneum and omentum, the operative field progressed to the intestine.From here, the doctors of the hepatobiliary surgery probably had a general understanding of Zhang Junyi's liver rupture.

"There was a lot of bleeding, at least 800 milliliters." The hepatobiliary surgeon who performed the surgery stopped what he was doing, and asked Hu Jia to help wipe the sweat from his forehead.He motioned to the assistants on the side to pull the retractor in their hands further apart, and at the same time asked the blood transfusion doctor on the side, "Is the blood prepared enough? Do you want to use blood recycling?"

"It's best to use autologous blood." The doctor in the blood transfusion department pushed the autologous blood salvage machine and put the machine in a position where it wouldn't interfere with the work of the surgeons. "However, his bleeding volume is not small, and some platelets and fresh blood need to be added."

The autologous blood salvage machine is an important tool to reduce the amount of blood transfused during surgery.Although the application of autologous blood salvage machines is difficult to fully spread due to the shortage of domestic blood transfusion professionals, it is still an important means to solve the shortage of blood preparation in blood banks.

The bleeding of patients during the operation was originally just medical waste that needed to be discarded.Before the emergence of autologous blood salvage machines, there were only two options for solving bleeding—reducing bleeding or transfusing allogeneic blood products.

Reducing bleeding can reduce the amount of intraoperative blood loss in some patients to a certain extent, but for patients with massive intra-abdominal bleeding such as rupture of the liver and spleen, this strategy has little meaning.Allogeneic blood transfusion is limited by the common problem of the entire medical system-insufficient blood donation.

Blood donation is a noble act of love and donation.Although this kind of behavior can avoid the occurrence of blood selling and disorderly blood collection to a certain extent, we must admit that it is difficult for voluntary blood donation to fully cover the blood demand of hospitals.

This contradiction is especially prominent when there are severe bleeding emergency patients such as rupture of the liver and spleen.If only allogeneic blood is used, just take Zhang Junyi as an example, the total amount of blood transfusion he needs is at least 3000cc.This is all the blood that 8 unpaid blood donors can donate in one blood donation cycle.

According to the current regulations of the blood transfusion department of the Fourth Hospital, the four blood types of ABO and AB are reserved according to the ratio of 2.5:2.5:4:1.The minimum inventory requirement for each blood type is 5U, and the safe blood storage volume must be a week's supply.But in actual work, the blood transfusion department of the Fourth Hospital has never been so rich.Even after signing a blood supply linkage contract with the provincial blood center, the blood transfusion department of the fourth hospital has never seen 5 units of AB suspended red blood cells.The O-type suspended red blood cells with the largest storage capacity are only 6 units.

In order to ensure the operation of Zhang Junyi with type A blood, the hematology department of the fourth hospital gritted his teeth and took out 8 units of type A blood and 6 units of type O blood—a total of 2800cc of suspended red blood cells.This is already the limit of the fourth hospital's current minimum storage conditions.

This batch of Suspended Red has been pressurized and infused over 1300cc before the operation. It is an extremely difficult task to use the remaining 1500cc to complete the operation without an autologous blood salvage machine.

Based on general experience, it is estimated that if only one liver ruptures, the liver will have to reimburse another 3000cc of blood within two hours from entering the operating room to the completion of the operation.The amount of remaining plasma is less than half of the loss. If there is no autologous blood recovery, the doctors of the hematology department of the fourth hospital will have to jump into the ambulance and go to the provincial blood center to rob the blood bank.

And with this kind of baby machine that is expensive and requires a blood transfusion doctor and a blood transfusion technician to operate, the blood demand of this part is reduced a lot.

According to general estimates, autologous blood salvage can probably complete about 60% of blood loss recovery. The blood loss of 1200cc, at least numerically, can be made up by the remaining plasma.

Maybe after the operation, a bag of unprescribed type O blood can be returned to the blood transfusion department.

Sun Li'en looked at the busy doctors in the operating room upstairs, feeling a little emotional.

(End of this chapter)