Recently, a case of acute aortic dissection (Stanford B type) ruptured massive hemorrhage was successfully treated in the Yantai Affiliated Hospital of Binzhou Medical University. At present, the patient has been discharged from hospital. During the course of treatment, the Affiliated Hospital of Binzhou Medical University, Yantai, comprehensively considered the emergency condition of the patients, and innovatively applied the semi operative operation under local anesthesia. The technique of puncture and pre suture “zero operation” and “chimney” technology were independently and skillfully performed for endovascular repair. The success of the operation was the first example of the Yanwei area, and it was also rare in the province.
With Mr. Zhao from Jiamusi City, Heilongjiang Province, at night due to sudden tearing pain in the chest and the back, rushed to the emergency department by the neighbour Yantai affiliated Binyi, after admission to the CTA examination in the diagnosis of aortic dissection aortic dissection has been from thoracic aorta proximal tear to bilateral common iliac artery, the false lumen of aortic dissection is increasing, compression of the true lumen thin narrow, the disease has been increasing. More dangerous is that the patient’s aortic dissection has ruptured, the high pressure of the thoracic aorta has broken into the mediastinum, and the blood flow begins to leak to the chest. The sudden fall of blood pressure is almost shock. The disease has been on the verge of death or destruction, mediastinal pleura thin cannot withstand the tremendous pressure rupture of the aorta blood flow, blood began to seep into the chest, may burst blood “into the cause of sudden death in patients with pleural breaching of the dike” at any time.
The only hope to save the lives of patients measure is immediate surgery, but the left lung hematoma patients have been deflated, previously there are old chronic bronchitis history, dissection pain can lead to the supine position, and has been unable to tolerate anesthesia, patients began irritability, vital signs of a degree of instability, “must immediately surgery, patients may the loss of life at any time!” Professor Li Naixuan, the director of the Department of interventional angiography, said decisively.
Without general anesthesia, surgical treatment is extremely dangerous. But in order to save patients’ lives, the interventional vascular team has decided to be bold and innovative. Professor Li Naixuan quickly formed an operation team and invited the Li Wei of the Department of anesthesiology to monitor the vital signs of the patient. Once the patient changed, the patient was intubated immediately.
At 23:45 at night, the nursing medical staff nurse in charge in the catheterization laboratory selected shamin under the leadership of the race against time to complete the preoperative preparations, the patient was brought to the catheter room. For patients with severe pain have been unable to prostrate, catheterization room team innovation application of two bed quilt disinfection built semi supine DSA surgical bed for patients, doctors dare to semi supine position in patients with rupture of aortic dissection surgery performed under local anesthesia, not only superior to others technology, also suffer great psychological pressure, innovation and practice of this surgery in China, is also one of the few.
The tension of surgery began, vascular interventional team using femoral artery puncture pre suture technique for the transport of 23F stent delivery sheath, because the proximal crevasse near the left subclavian artery, decided to adopt the domestic advanced “chimney” reconstruction of the left subclavian artery. The time was in a minute and a second, and the operation was carried out in a tense atmosphere.
The next day at 1:50 in the morning, the end of surgery, patients with chest tearing pain significantly reduced, vital signs stabilized, patients in the ICU of Yantai affiliated hospital to continue treatment Binyi. After operation, the patients’ family members took surgical image data, and the experts from vascular surgery Consulting Department of An Zhen Hospital, Beijing, experts informed the critically ill patients that the operation under local anesthesia was extremely rare, and indicated that “the patient picked up a life”.
The operation is successful, but there is still a lot of blood in the mediastinum and the left chest. If there is no timely and correct treatment, it can affect the life of the patient due to chest infection. The Affiliated Hospital of Yantai Binyi timely organize experts joint rescue, ICU physician professor Li Yuzhuo and Hao Xinlei tracking, closely monitoring the treated 6 days and 6 nights; and Yin Rongjiang, director of the Department of thoracic surgery of high Xuejun physician for patients with bold purposes left pleural hematoma drainage, postoperative first day out of breaking into the chest of 1300 ml of blood, patients dyspnea improved obviously. After that, the patient’s condition gradually improved, and recovered from the hospital after the cure. From the hospital, the patients said excitedly, “Binyi Yantai hospital gave me a second life”.
The critically ill high-risk complex surgery and patients successfully completed independent successful treatment and were discharged from the hospital, marks the province and reached the advanced level of the domestic endovascular treatment of vascular disease of Binzhou Medical University Affiliated Hospital of Yantai, but also fully embodies the treatment ability of Binyi multidisciplinary in Yantai Affiliated Hospital of Yantai and Weihai first-class level.
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Post time: Jan-10-2018