The lung artery one is narrow to cut _'s treatment of the skill

The lung artery one is narrow to cut _'s treatment of the skill
[Adapt to the card ]1.All lung arteries are a narrow patient, symptom is obvious, the shrink pressure ranks of right ventricle and lung artery are bad in 5.3kPa( 40mmHg) The above person, should carry on the operation. Operation should make early, with suitable.2.Some patient obvious in clinical symptom, but heart electricity illustrationally show the intersection of right ventricle and plump and persons who strain, should consider the operation.3.If the pressure steps are smaller than the 5.3kPa or pressure of right ventricle and lower than 6.6kPa( 50mmHg) badly ,There is not symptom on clinic, see the person who doesn't have obvious change of right ventricle in electrocardiogram and X-ray, seldom need the operation, and should examine and reexamine fixedly at the same time. In view of natural prognosis of this disease being bad, in addition already to perform the operation in recent years had higher security, so therapeutic indication to surgery tends to relax at present.4.The serious lung artery one is narrow, patient's tip circulates obvious cyanosis, even the persons who go into a coma, while failing to respond to any medical treatment through oxygen intake and infusion,etc., very urgent surgery treatment.[Prepare before the skill ]Serious disease patient, if cyanosis is obvious or the heart function is relatively bad, should give oxygen disconnectedly before the skill, limit the activity, fail and polarise the liquid on a small quantity, the heart declines the obvious ones for drug therapy such as strong heart, diuresis, after heart function and general situation are improved, choose date for operation.[Anaesthetize ]Intubate under trachea, suck and vein anaesthetize, body surface lower the temperature, cool to 30 - 32 (oesophageal temperature) . Generally adopt the hypothermic anesthesia heart to look the operation straight, but because of the progress of extracorporal circulatory system operation recently, a lot of authors adopt the lower heart of general low-temperature extracorporal circulatory system to look the operation straight, needn't make body surface and lower the temperature, but the machine lowers the temperature when the heart-lung machine is transferred to flowing.[Operation step ]1.Body posture, cut-out, lie location while being flat, brestbone centre cut-out, column cuts the pericardium, the heart appears.2.Ascertain outside the heart that finds out lung total artery and a ring, the right ventricle flows out one, size of room of every room and amalgamating deformity. Simple lung artery is a narrow patient, reveal the total artery of lung is obviously expanded, the blood vessel wall becomes thin, can lay one's hand on, arrive one coarse systolic phase tremble in the intersection of lung and the intersection of artery and the intersection of root and in the front, can lay one's hand on get the intersection of fish and the intersection of mouth and the intersection of valve and mouth that merge and increase the thick valve while being light to press it. Lung the intersection of artery and ring many development relatively narrow and small bad, the intersection of funnel portion and plump muscle, the right ventricle increases, and the room wall is plump, the atrium dextrum also increases.3.Operation method Cut the skill in a petal of direct-view of lower lung artery of hypothermic anesthesia: Separate the up and down vena cava separately, put and block bringing. The wall sews one up,down,left and rightly respectively with 1-0 silk threads before the lung artery backbone, as drawing the line. The intersection of traction of the underpart and line is stitched to a ring more than about 0.5cm of lung artery, two up and down suture intervals are 3- 4cm [Fig. 1-1 ]. And the wall before gripping the lung artery under the circumstances that 4 draw the line by not damaging the blood vessel pincers is cut [Fig. 1-2 ].After excessively taking a breath, block the lower vena cava first, and then block the superior vena cava, after over blood in of right ventricle is emptied, stop assisting breath manually. Remove and has not damaged the blood vessel pincers, exhaust the blood in the lung artery, the assistant leads to drive the lung artery to cut-out to the side of heart, [Fig. 1-3 ] of making a mouth of lung artery clearly appear.The skill person merges and cuts or cuts off accurately separately along the juncture of valve with the sharp sword, cut some and keep 1 between edge of a leaf adhesion- 2mm is so as not to cut the lung artery wall [Fig. 1-4- 5]. After the valve is cut, the skill person visits and enters the right ventricle and flows out one through a mouth with the index finger, it is narrow whether there is one. When a ring is narrow, can expand with the finger or long blood vessel pincers.After finishing operating in the heart, skill person and assistant draw 4 the line is lifted, open superior vena cava, when the lung artery cut-outs blood and overflows, grip the edge of notch two by not damaging the forceps artery, after treating the heartbeat effectively, open the vena cava gradually. Can finish this operation calmly within 3- 5 minutes generally. Sew up the lung artery to cut-out back and forth continuously with 1-0 silk threads [Fig. 1-6 ]. Extracorporal circulatory system lower the intersection of lung and the intersection of artery and petal cut skill: Set up extracorporal circulatory system. The lung artery backbone [picture 2-1 ] that the column is cut, meet the intersection of mouth of fish and narrow the intersection of lung and the intersection of artery and mouth, cut separately along merging the juncture [Fig. 2-2- 3]. If a ring is relatively little, can expand a ring with the finger or blood vessel pincers. The lung artery runs into physiological saline while cut-outing, discharge the right ventricle and inner air of lung artery, sew up the lung artery to cut-out back and forth continuously [Fig. 2-4 ]. Finish the extracorporal circulatory system.4.Close the chest to wash the pericardium, sew up the pericardium, put mediastinally and pericardium is guided, chase layer and close the chest.[Attentive matters in the skill ]1.Ventricle fine a quiver one prevent from and treatment see more at low temperature looking the intersection of lung and the intersection of artery and petal straight, cutting body temperature drop too low in the skill ' Under 28 ) ,The cardiac muscle is damaged, the lung is insufficient in air exchange amount, myocardium oxygen deficiency, hypotension and electrolytic acid-base balance disorder,etc.. Once happening should press the heart immediately, the Epinephrine of injection in the heart, strengthen and support oxygen, accelerate blood transfusion, improve blood pressure and such as the hypothermia, pour into warm brine of 38 to reply in the pericardium warmly. When the ventricle is fine and quiver effectively, shocking by electricity can succeed to defibrillate. The method that prevents from is that the body surface don't be lowered too low while lowering the temperature, are generally cooled to 33 - block and circulate at 31 , the not incident room is quiver. Paid attention to improving blood pressure before blocking the blood flow, excessively took a breath, made the cardiac muscle have a good stocking the function, in order to tolerate temporary myocardium oxygen deficiency. Should try hard to shorten the blood flow and block time. Lower vena cava open hour should not be too early, in case that it caused the room quiverly that the heart swelled suddenly.2.Block the extracorporal circulatory system of cycle time and play the operation, it is unrestricted to block cycle time, have abundant time to finish the operation. And when hypothermic anesthesia looks the operation straight, blocking cycle time generally can't exceed 8 minutes, in case of special difficulty need, lengthen, block time, can mention all draw the line first, the temporary pincers closes the lung artery to cut-out, the open up and down vena cava blocks bringing, when the heart resumes the good state, block and circulate again, finish the operation. But should try hard to shorten and block cycle time.3.The valve mouth cuts off the intensity and cuts the index finger of persons who pass the skill of the adult smoothly to the valve base according to the juncture of valve, child thinks promptly satisfied through the little finger of toe. Cut off a petal of ridge and adhere to the artery wall, can expand a area of the valve. Pay attention to avoiding cutting the artery wall of broken lung, sew up such as cutting broken application Line 3-0.4.It amalgamates odd-shaped treatment to be lung artery petal narrow to amalgamate right ventricle often funnel part narrow, can with small to draw hook, pull open the lung artery one to appear in the narrow position, excise its loose skin bunch. If funnel one is narrow and serious, Shang Ke cuts the right ventricle, excises the loose skin bunch, can also flow out one on the right room and use to mend one to widen. If it is very difficult to deal with in the above-mentioned situation, but does not have more misgivingses while circulating the operation outside the body, so a narrow majority of lung artery adopts the extracorporal circulatory system to play the operation at present.[Skill aftertreatment ]1.Skill postoperative getting in heart failure should better heart, diuresis treatment.2.Take place ventricle to be fine and getting quiver in the skill look surgery straight at low temperature, postoperative besides strengthening the treatment and nursing of the heart, pay attention to preventing the treatment which is short of complications such as oxygen, edema,etc. of brain.3.Fully give oxygen, avoid oxygen deficiency.4.Notice the respiratory tract wetly, take, encourage coughing, prevent lung complication.
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