We put the marriage leave aside first, and people are being saved in the operating room.

The doctors of neurosurgeons have removed the first bone flap. Some yellowed skulls were placed on the surgical tray aside. Many neurosurgeons came over to observe the wound. Now is the best stage to determine the level of intracranial pressure in Zhang Junyi.

When facing patients with signs of brain hernia, doctors can know that the patient's intracranial pressure level does not exist at all. Ordinary people can also obtain a relatively accurate intracranial pressure value by puncture of the large lumbar pond. Doctors must roughly judge Zhang Junyi's intracranial pressure without directly prying open his head... Then they can only roughly estimate it by pressing his eyeball.

Without clarifying the patient's intracranial pressure, the anesthesiologist worked hard to keep his vital signs within a range that could be performed. After removing the skull, the work seemed to be much smoother.

You can also see from the angle where Sun Lien and the others are. After taking out a skull about 14 cm long, the white dura mater that was almost about to expand.

The eccentric dural means that the patient's intracranial pressure has reached a very dangerous level. But now, he is lucky. If he does not die of brain hernia at this point, he will basically relieve the danger of brain hernia.

Although the dural has not been completely cut off and released pressure, at least the ductility of the dural itself is much stronger than the skull - the human skull will not be deformed due to internal pressure.

Neurosurgeons began to prepare to incision of the dural membrane to release intracranial pressure, and the abdominal surgery has also been performed to incision of the rectus abdominal muscle.

The abdomen is not a single or double-layer structure composed of flat skin and muscles. Taking this surgery as an example, the doctors of hepatobiliary surgery chose an incision on the right side of the rectus abdomen muscle for laparotomy. The doctors first cut open Zhang Junyi's abdominal skin, and then separate the subcutaneous fat of the abdomen. Then make an incision on the external oblique muscle and separate it with a hook to separate it and fix it.

After being separated from the external oblique muscles, the rectus abdomen and part of the internal oblique muscles are exposed in the field of surgery. Below these two muscles is a larger range of transverse abdomen muscles.

After the four layers of muscle protection is disintegrated, you can see the peritoneum and omentum.

The peritoneum is a thin and smooth surface with a translucent serosa inside. This structure has 7 to 11 innervations of the intercostal nerve, subcostal nerve and lumbar nerve, so it is very sensitive to pain and other sensations. Once certain severe inflammation and tracheal perforation appear in the abdomen, inflammatory substances and irritation will cause peritoneal irritation symptoms. Specifically, it is tenderness in the abdomen, rebound pain and abdominal muscle tension.

The large omentum under the peritoneum looks like a somewhat yellowed scattered fat layer. The large omentum of adults is most often healed with the peritoneum. This ligament structure is specially used to fix the relative position of the gastrointestinal tract in the human body, and also performs an immune defense function in the abdominal cavity - the large omentum is rich in fat and phagocytocytes, which is an important part of the human immune system in the abdomen.

After separating the peritoneum and the omentum, the surgical field progressed to the intestinal part. From here, doctors in the hepatobiliary surgery department probably had a rough understanding of Zhang Junyi's liver rupture.

"The amount of bleeding is very large, and this is at least 800 ml." The hepatobiliary surgeon who was the chief surgeon stopped working and asked Hu Jia, who was standing by, to help wipe the sweat on his forehead. He signaled the assistants to pull the puller in his hand more open, and also asked the blood transfusion doctor on the side, "Is there enough blood preparation? Should I recover the blood?"

"If you can use autologous, it is best to use autologous." The doctor in the blood transfusion department pushed the autologous blood recovery machine and placed the machine in a position that did not hinder the surgeon's work. "But his bleeding volume is quite large, so he has to add some platelets and fresh blood."

Autologous blood recovery machine is an important tool to reduce blood transfusion during surgery. Although due to the insufficient number of domestic blood transfusion professionals, it is difficult to fully deploy the application of autologous blood recovery machine, it is still an important means to solve the insufficient blood reserve in blood bank.

The bleeding of patients during surgery was originally just medical waste that needed to be discarded. Before the emergence of autologous blood recovery machines, there were only two solutions - reducing bleeding or importing allogeneic blood products.

Reducing bleeding can reduce the intraoperative bleeding volume of some patients to a certain extent, but this strategy is of little significance for patients with large intraperitoneal bleeding, such as liver and spleen rupture. However, heterogeneous blood transfusion is limited by the common problem of the entire medical system - insufficient blood donation for voluntary blood donation.

Free blood donation is a noble act of donation. Although this behavior can avoid the occurrence of blood selling and disorderly blood collection to a certain extent, we must admit that free blood donation is difficult to fully cover the hospital's blood use needs.

Especially when patients with severe bleeding such as liver and spleen rupture occur, this contradiction is particularly prominent. If allogeneic blood is used simply, Zhang Junyi is the example. This is all the blood donations that 8 voluntary blood donors can donate in one blood donation cycle.

According to the current regulations of the Department of the Transfusion of the Fourth Hospital, the four blood types of abo and ab are reserved at a ratio of 2.5:2.5:4:1. The minimum inventory requirement for each blood type is 5u, and the safe blood storage must be a weekly dosage. However, in actual work, the blood transfusion department of the Fourth Hospital has never been so rich. Even if a blood supply linkage contract was signed with the Provincial Blood Center, the blood transfusion department of the Fourth Hospital has never seen 5 units of ab suspension red blood cells. The largest storage capacity of O-type suspended red blood cells is only 6 units.

In order to ensure that Zhang Junyi's surgery for 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 - suspended red blood cells. This is the limit of the minimum storage conditions for the Fourth Hospital to maintain.

, completing the operation, without an autologous blood recovery machine, is an extremely difficult task.

Based on general experience, it is estimated that in the two hours from entering the operating room to completing the operation, the remaining plasma is not enough to be half of the loss. If there is no autologous blood recovery, the doctors from 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.

With this precious machine that costs a lot and requires a special equipment for a blood transfusion physician and a blood transfusion technician to operate, the blood demand for this part of the blood has suddenly decreased a lot.

According to general estimates, autologous blood recovery can complete about 60% of blood loss. The amount of blood loss can be compensated by the remaining plasma at least from the figure.

Maybe after the operation, I can give the blood transfusion department a bag of unopened type O blood.

Sun Lien looked upstairs at the busy doctors in the operating room, feeling a little moved.
Chapter completed!