in the operating room.

As soon as Li Xiyang walked in, he quickly asked, "How is the patient now?" ”

Xu Menghua shook his head, "It's not optimistic!" ”

Although the pulmonary artery pressure in pregnant women is temporarily stable, it is still in a state of high pressure.

Li Xiyang glanced at the monitor, and the size cycle was getting closer and closer.

Must have surgery right away!

"Oh no, Director!"

At this time, the little nurse of the instrument said in a panic, "Oxytocin is gone!" ”

"What?"

In the operating room, everyone's hearts sank.

Oxytocin, a pro-growth drug, can not only increase uterine contractions, reduce bleeding, but also increase uterine contractions within a certain range, so that the uterus gradually introduces normal regular contractions, and is usually used in early labor induction surgery for pregnant women.

The patient's body is now very fragile and the blood supply to the whole body is insufficient, and the uterine contraction will definitely be weakened during the operation.

Without oxytocin stimulation, it is simply not possible to complete a caesarean section.

"What are you doing in a daze, hurry up and go to the pharmacy to have a look!"

Xu Menghua urged anxiously.

At this time, Li Xiyang waved his hand, "There's no time, just use the uterine cavity to stuff it!" ”

Uterine tamponade?

Xu Menghua thought about it for a while, but it was not a good way.

The so-called uterine cavity gauze tamponade is to use gauze strips to tamponade the uterine cavity, which has the effect of stimulating uterine contractions and compressing and stopping bleeding.

Postpartum hemorrhage caused by uterine atony can be used to temporarily stop bleeding or reduce bleeding when various treatments are ineffective.

"The Point Guard Is Here"

Generally, when the condition is urgent, the conditions are difficult, and the bleeding needs to be stopped urgently, it is still an effective method to fill the gauze strip correctly and in a timely manner, which can be used as an emergency measure.

In addition, with the current physical condition of the pregnant woman, the stimulation of uterine contractions by drugs is likely to cause adverse reactions in the body.

The physical method of gauze tamponade seems to be the most suitable method for patients at present.

Xu Menghua took a deep look at Li Xiyang, and then instructed Dong Lin, "Xiao Dong, you will be responsible for the gauze stuffing later!" ”

"Good!"

Dong Lin nodded, and looked at Li Xiyang with some surprise.

This guy actually really understands obstetric surgery!

Everything was ready, and Li Xiyang looked up at the time.

Then he nodded to the anesthesiologist in the corner, "Let's go!" ”

……

on the operating table.

The anesthesiologist first observed the vital signs of the pregnant woman, and then said, "During the process of heart failure in pregnant women, there may be pulmonary congestion, wheezing, dyspnea, etc.

When lying down, the patient's return blood volume will increase, aggravating the patient's heart failure, pulmonary circulation, and the symptoms of blood stasis will also increase.

Therefore, I recommend that the pregnant woman lie on her side and use a dropper to inject the anesthesia into the spinal canal of the pregnant woman. ”

Li Xiyang nodded, "Yes!" ”

In the current situation of pregnant women, if the anesthetic is injected directly into the blood vessels, the blood vessels will relax, and the blood flow will change, which will inevitably further increase the pressure on the pulmonary arteries. ”

Choosing spinal anesthesia is a perfect way to avoid this.

Xu Menghua also nodded, agreeing with spinal anesthesia.

So Dong Lin and the instrument nurse helped the pregnant woman to lie on her side, and whispered to comfort her and arch her back slightly.

The pregnant woman has very low blood sugar and is in a semi-comatose state all the time.

Lying in his ear, he can still hear it faintly.

Once the pregnant woman is in the right position, the anesthesiologist begins.

Under normal circumstances, pregnant women only need one injection for anesthesia, which can be completed within a few minutes.

But at present, the patient's condition is special, and the body can't withstand the fierce reaction, so he can only use the dropper to inject drop by drop.

Twenty minutes later, the anesthesiologist was relieved as the last drop of anesthetic was injected into the pregnant woman's spinal canal.

But this is not over, the anesthesiologist stared closely at the blood oxygen saturation of the pregnant woman, and his face slowly became a little solemn.

The oxygen saturation of a normal person is usually around 100.

And pregnant women are only less than 60.

Oxygen saturation is the volume of oxyhemoglobin in the blood that is bound by oxygen, as a percentage of the total volume of hemoglobin that can be bound.

It is an important indicator to reflect whether the human body is hypoxic, and it is an important physiological parameter that reflects the respiratory circulation.

If the oxygen saturation of the pregnant woman continues to drop, then it is clear that the operation cannot be carried out.

Fortunately, after the value dropped to 52, it has been in a stable state.

The anesthesiologist nodded at Xu Menghua and the others, "You can continue the operation!" ”

This is an old anesthesiologist with a lot of experience.

However, Xu Menghua did not immediately pick up the scalpel, but looked at Li Xiyang.

"Dr. Li, is your plan to have a laparotomy first, or do you have pacemaker placement surgery first?"

Li Xiyang did not answer directly, but asked rhetorically, "Are you ready for baby medicine?" ”

Caesarean section is not as good as natural birth, and there are many problems.

For example, the child who was born by caesarean section did not go through a certain amount of squeezing, so some fluid will be present in the body, causing this symptom of wet lungs, which will cause the child to have difficulty breathing.

It can even trigger some cases of infection.

Wet lung in newborns is a complication of caesarean section, mainly because the fetus is surrounded by amniotic fluid in the mother's womb, and the lungs and mouth are filled with amniotic fluid.

During labor, the amniotic fluid is passively expelled through the birth canal.

Because the caesarean section newborn does not pass through the birth canal, the amniotic fluid in the lungs is not completely discharged, which leads to temporary dyspnea, which is medically called wet lung.

Amniotic fluid in the wet lungs is generally absorbed within 24 hours, when the newborn's respiratory rate decreases, and the general condition improves, and there are no sequelae.

But now the situation is that the fetus is a premature baby under 7 months of age.

You have to be prepared.

Xu Menghua smiled, "Don't worry, all the medicines are already in place." ”

These are all prepared by Xu Menghua personally, and mistakes are absolutely not allowed.

Li Xiyang nodded, "Then let's have a caesarean section first!" ”

At first, Li Xiyang planned to solve the problem of heart failure in pregnant women first, but in terms of the latter's current vital indications, thoracotomy now will only greatly increase the burden on patients.

If the baby can be removed smoothly, it will also greatly reduce the heart involvement.

At that time, if you do chest opening, the success rate is even greater.

Xu Menghua nodded, "Okay, then caesarean section first!" ”

But

"Do you want to start now?"

Li Xiyang shook his head, "Wait a little longer!" ”

Because heart failure causes abnormal physiological changes in pregnant women, it is necessary to choose the appropriate time for delivery for pregnant women who develop heart failure during pregnancy.

First of all, heart failure directly or indirectly affects the cardiovascular system, increasing blood circulation, increasing cardiac output by 30%~40% in the general resting state, and reaching the peak in the second and third trimesters.

In addition, blood pressure fluctuations and supine hypotension during anesthesia will directly affect the blood supply to the heart.

The neuroendocrine changes caused by hemodynamic changes and the increase in sympathetic nerve excitability will lead to the contraction of the arteriolar system, and the pulmonary arterioles and surrounding small blood vessels will be in a spasmodic state.

In particular, pregnancy-induced hypertension can further aggravate the left and right ventricular resistance load, impair the function of the heart pump, and reduce cardiac output, which can lead to or aggravate heart failure and even cardiac arrest.

Therefore, reducing cardiac anterior and postload is the most critical treatment to ensure that the patient can safely survive the operation.

For a moment, the operating room was quiet.

Li Xiyang stared at the monitoring instrument, while the others all looked at Li Xiyang.

He is the key to this operation.

Success or not, it's up to him!

Finally, when he noticed that the arterial pressure in the small circulation had dropped again, Li Xiyang said loudly, "It's now!" ”

Xu Menghua did not hesitate for a moment, and immediately picked up the scalpel.

The surrounding nurses and assistant doctors also immediately moved.

Xu Menghua has been an obstetrician and gynecologist for decades and is very experienced in doing caesarean sections.

Dong Lin is also an intermediate attending doctor, who was hired from Imperial Capital Wall Hospital some time ago, and has good ability.

Skin disinfection is done almost instantaneously.

Xu Menghua dropped the scalpel about three centimeters above the patient's pubic bone.

The abdomen is then dissected layer by layer.

Li Xiyang noticed that Director Xu Menghua chose a vertical incision.

There are usually two options for caesarean section, transverse and vertical, which have their own advantages and disadvantages in terms of the aesthetics of the scar, postoperative recovery, and operation time.

If the vertical incision is chosen, the incision is longer, the fetus is removed faster, so the operation time is shorter, and the possibility of adhesion of the abdominal wall tissue is lower, and the safety is high.

However, its main disadvantages include slower and longer postoperative recovery, strong pain, and easy to lead to liquefaction of fat.

At the same time, the incision edge is long, the position is high, the scar is obvious, and the aesthetics are poor.

The transverse incision is the most commonly used incision, which has the advantages of low scar location, which is not easy to expose when dressing, and is more beautiful.

At the same time, the recovery of the incision with the transverse incision is relatively quick, and the pain caused by pulling the incision during the wound recovery period is relatively small.

However, its main disadvantage is that the injury is larger, the operation is more complicated, and it is not suitable for first-aid mothers.

The principle of this surgery is to use short and flat as the benchmark.

Therefore, Director Xu decisively chose a vertical incision.

Soon, the fetus was revealed.

Xu Menghua cut open the amniotic membrane that wrapped the fetus, and then put his hand in.

After confirming the position of the baby's head, Xu Menghua carefully grabbed it.

Slowly, the baby was dragged out little by little.

The whole process went very smoothly.

"Quick, remove the foreign body from the fetus's mouth!"

Xu Menghua handed the baby to Dong Lin next to him.

After birth, the foreign body in the mouth must be removed and the airway cleared.

However, Dong Lin slowly discovered that something was wrong, and the baby had not made a sound since it came out.

Although his hands and feet were moving, he just didn't make a sound.

Xu Menghua's face changed, and he said quickly to Dong Lin, "Leave the baby to me, and you will deal with the maternal placenta!" ”

"Good!"

picked up the baby again, Xu Menghua immediately patted the soles of the baby's feet.

Because it is a premature baby, it is very small.

It looks about the size of an adult's palm, and anyone who looks at it will worry about whether the child's cardiopulmonary development is complete.

The worst thing is that the baby has not made a sound since it came out.

The fact that the newborn does not cry means that the lungs are not engaged in gas exchange.

Xu Menghua continued to pat the soles of the baby's feet, but he could not hear the cry.

Li Xiyang immediately stepped forward and stroked the baby's back with his hand, intending to use touch to stimulate the newborn's breathing, but the cry in anticipation still did not appear.

At this time, the baby's face gradually turned red.

At the same time, his hands and feet stopped moving.

Not good!

"Director Xu, you come for endotracheal intubation, and I'll do chest compressions!"

Li Xiyang quickly laid the baby flat on top of the incubator.

Xu Menghua carefully inserted the trachea into the newborn's body as soon as possible, and began to slowly squeeze the gas to carry out the baby's respiratory tract.

Trying to wake up the lungs of a small baby.

At the same time, Li Xiyang also began to perform chest compressions.

Because they are premature babies and are small in size, it is clear that ordinary chest compressions are not feasible.

Li Xiyang quickly brought the index finger and middle finger of his right hand together, and pressed the lower half of the sternum vertically with the tip of his finger.

At the same time, bend the index finger of the left hand and regularly tap the fat breast of the baby.

Xu Menghua squeezed the airway several times in a row, but there was no reaction.

So he gritted his teeth and said, "Xiao Li, inject adrenaline with your heart!" ”

Epinephrine, as the basic drug for cardiopulmonary resuscitation, has a history of more than 40 years in clinical practice in China, and the usage is intravenous injection, which can be repeated every 3-5 minutes.

Epinephrine can enhance the contractility of the myocardium, increase the blood flow of the coronary arteries and the brain, and increase the automaticity of the myocardium.

Clinically, epinephrine is the first-line drug for cardiopulmonary resuscitation and is known as the miracle drug for sudden death.

But

Intracardiac injections may increase the risk of coronary injury, cardiac tamponade, pneumothorax, and delay the onset of cardiac compressions and lung ventilation...

But now there is no other way, and there is no time to hesitate.

Xu Menghua turned his head to look at the operating table, "Xiao Liu, adrenal glands..."

However, before she finished speaking, she heard Li Xiyang's voice sound, "No need, the child has been rescued." ”

Xu Menghua was stunned, how could it be?!

Turning her head again, she saw that Li Xiyang had really stopped compressing.

At the same time, a loud baby cry was heard throughout the operating room......