After Song Zimo’s careful treatment, Yu Shuilian finally did not suffer from liver and kidney failure, her hemoglobin rose to above 90g/l, and her biochemical, liver and kidney functions, and coagulation functions were all within the normal range.
The artificial liver and bedside hemodialysis machine that were always on hand were not put to use, and the wound was always kept clean. More than a dozen drainage tubes were gradually removed.
When I was transferred from the ICU to the general ward, I only had one drainage tube left on my body, which was used for bilateral ureteral catheter stent renal pelvic drainage.
Cleanliness is an important aspect of quality assurance and is also applicable in medical activities. A high degree of cleanliness can reduce the occurrence of infection and prevent bacterial colonization and division. This is the same as removing garbage and water and reducing mosquitoes and flies.
As long as the sheets are contaminated by secretions or excreta, the nurse will change them immediately, changing the sheets more than ten times a day.
If there is leakage from the wound, Song Zimo immediately takes the nurse to change the dressing. Sometimes the dressing change takes up to an hour, and the dressing is changed more than ten times a day, which makes the doctors and nurses unable to straighten their backs.
For every leakage, Song Zimo will keep a specimen for bacterial culture. Once the bacteria are cultured, Song Zimo will accurately use sensitive antibiotics based on the drug sensitivity test to eliminate the bacteria and avoid the escalation of the infection.
In order to allow the remaining liver to gradually adapt to its function, Song Zimo accurately calculated the proportion of intravenous nutrients ingested every day to minimize the load on the liver.
Director Pan of the ICU asked Dr. Meng to make a PPT of Yu Shuilian's ICU treatment process and use it as a classic case to explain it repeatedly to the ICU doctors.
What it means to nip danger in the bud, what it means to observe in detail, what it means to be aware of the subtleties and take precautions, all are explained in this case.
Finally, Yu Shuilian was transferred from the ICU to the comprehensive orthopedics department. Cai Qiaojun prepared a single ward for Yu Shuilian in advance and assigned three nurses to take charge of Yu Shuilian's care. Among these three nurses, one is an ostomy specialist and has obtained the international ostomy specialist certificate.
, has rich experience in stoma management.
Yu Shuilian will soon eat gradually. The excretion of stool depends on the colostomy in the abdomen. However, this fistula has no contraction function and cannot be controlled. Without careful care, stool will be everywhere. The ostomy surgeon’s task is to manage it.
Two fistulas on her body.
Another fistula is the cystostomy, which is the current excretion channel for urine. The drainage tube left in the kidney and ureter will be pulled out after the ureterovesical wound heals.
Before the artificial urethra and anus were reconstructed, her excretion management was the responsibility of the ostomy surgeon.
Song Zimo arranged several people for the medical team. Because Zhang Lin Xiaowu had to take care of patients, Song Zimo transferred Xu Zhiliang and Gao Qiao, and then selected a few graduate students and graduate students to form a full-time medical team.
In the comprehensive orthopedics ward, Yu Shuilian finally met her husband and son again.
Both her husband and son were emaciated, especially the son, who stood beside the bed with a pitiful look, which made Yu Shuilian feel distressed.
"Have you eaten enough these days?" Yu Shuilian touched her son's hand.
The son shook his head: "No, I just eat some cold rice in the morning. At noon and evening, the vegetables my father cooks are either very salty or burnt."
Fu Xiayang was on the side, and was embarrassed by what his son said. What his son said was not true at all. These days, he was distracted and had no intention of doing anything. He was also absent-minded when cooking.
Fire.
"When mom gets better, I'll prepare some delicious food for you." Yu Shuilian touched the child's face, her heart pounding.
Looking at her husband on the side like a child who made mistakes, Yu Shuilian said emotionally: "Thank you for your hard work, Xia Yang!"
"It's okay, we'll wait for you to get better and go back." Fu Xiayang touched his son's head.
"Mom, let me take a look." The son was about to lift the quilt, and Fu Xiayang immediately took his son's hand.
He was afraid of scaring the child, so Yu Shuilian also winked, telling her husband not to let his son know. The son insisted on seeing it, and he would know sooner or later. Paper couldn't contain the fire. Yu Shuilian sighed and motioned for her husband to let go.
Fu Xiayang let go of his son's hand. The son opened the quilt and saw his mother with only half of her body. There were two holes in her belly, followed by the bag.
Not only was the son not scared away, but he also acted like a little man: "Mom, I'm not afraid. From now on, I will carry you on my back. I will carry you wherever you want to go. I will carry you to see the national flag being raised and to climb the Great Wall." p>
"Okay, okay, you will take your mother to watch the national flag raising and climb the Great Wall."
Yu Shuilian was so moved that the warmth of her family strengthened her belief that she must live and never give up on herself.
"Xia Yang, you are sometimes too busy in the morning. You take him to the breakfast restaurant next to our store, or you simply let him have breakfast at school. The rainy season is coming. Close the windows, especially the closet.
Don’t touch the things in the vacuum bag, otherwise they will easily get damp. There is half a black-bone chicken in the refrigerator. Make some longan and lotus seed stew and eat it with your son."
Yu Shuilian told her husband clearly that now she was lying on the bed and could only move her mouth. Even if she moved her mouth, she could still help her husband a little.
Seeing the two of them looking helpless and desolate, Yu Shuilian felt really sad.
Song Zimo, Xu Zhiliang, and Gao Qiao gathered together to discuss the next step of reconstructive surgery when they had time.
The function of the bladder is still there, and the urinary function can be reestablished by rebuilding an artificial urethra.
But for anal reconstruction, Yang Ping plans to reconstruct an artificial anus that can control bowel movements independently. How can it be done?
In order to complete the homework assigned by Yang Ping, the three of them found it very difficult to design the surgical plan separately, so they decided to pool their wisdom and solve this problem together.
Defecation seems simple, but it is a complicated process.
When feces enters the rectum, it stimulates receptors in the rectal wall, and the impulses are transmitted along the afferent fibers in the pelvic nerve and hypogastric nerve to the primary defecation center in the lumbosacral part of the spinal cord.
At the same time, the incoming impulse is also uploaded to the cerebral cortex, causing the urge to defecate.
If defecation conditions permit, the impulse is transmitted through the efferent fibers (parasympathetic fibers) of the pelvic nerve, causing the descending colon, sigmoid colon and rectum to contract, and the internal anal sphincter to relax.
At the same time, the outgoing impulses of the pudendal nerve decrease, the external anal sphincter relaxes, and feces is excreted from the body.
In addition, the nerves that control the abdominal muscles and diaphragm are excited, the abdominal muscles and diaphragm contract, the intra-abdominal pressure increases, and defecation is promoted.
If defecation conditions are not allowed, the cerebral cortex sends out impulses, which descend to inhibit the activity of the primary center of the lumbosacral spinal cord, inhibit the impulses from being transmitted along the efferent fibers of the hypogastric nerve, increase the tone of the anal sphincter, relax the sigmoid colon, and suppress the defecation reflex. In this way, stool is temporarily retained in the body and will not become uncontrollable.
Now the patient has no anal sphincter and no rectum. There are no rectal-like receptors in the wall of the sigmoid colon, so the reflex arc cannot be reconstructed. How can we simulate the normal defecation process?
Xiao Chuanguo's Xiao reflex arc has waste body nerves that can be used, and the bladder and anus are anatomically complete, that is, once connected, they have a complete nerve arc.
This patient's nerve arc has lost its receptors and effectors. The two indispensable terminals are gone, and reconstructive surgery cannot be performed at all.
As an international trauma master, Takahashi racked his brains and could not come up with a surgical plan.
"Dr. Song, Dr. Xu, unfortunately, I can't figure out how to perform this operation at the moment. If I were to perform this operation, the patient would have to defecate through an uncontrollable tube for the rest of his life."
Takahashi put down his pencil and leaned back on his chair in frustration.
There are only three of them in the conference room now.
Xu Zhiliang also shook his head: "Me too, I have boldly imagined taking part of the bladder sphincter to replace the anal sphincter, and then perform rehabilitation training. However, even if this is possible, what nerves are used to complete the nerve connection for muscle contraction?"<
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Song Zimo was very happy. Did he discuss with Yang Ping before when Xu Zhiliang and Gao Qiao didn't come? This guy didn't need to discuss at all, he only wanted to listen to his lectures.
Now, with Xu Zhiliang and Gao Qiao, Song Zimo is finally no longer alone and has someone to start a real discussion with.
"Boy, what if an artificial device with electronic components, such as a silicone device, is implanted at the end of the descending colon to complete the task of the anus? This device can be closed and opened based on certain stimulation?
"Song Zimo stared at Xu Zhiliang and Gao Qiao.
"You mean artificial anus?" Takahashi and Xu Zhiliang asked at the same time.
Song Zimo nodded: "Have we gone astray and entered a dead end? We must use the human body's own structure to complete the reconstruction."
"If we follow this idea, designing an artificial anus will be no less difficult than reconstructing it using human body structures." Takahashi said.
Xu Zhiliang disagreed: "Designing an artificial anus is difficult, but at least it can be done."
Song Zimo, Xu Zhiliang, and Gao Qiao, this trio, closed the door of the conference room and had a heated discussion. Everyone felt that they had found a soulmate.
How lucky it is that a person like this, who usually lives in high places, can find a close friend.
