This is a total lung resection, and this is your expression?
Fortunately, Cheng Zaiming has become accustomed to Fang Le's magic and has passed the age of his son Cheng Yunxing.
"When you get to the consultation room later, don't say anything like this."
Cheng Zaiming warned Fang Le: "Jiang Hailei from the Department of Cardiothoracic Surgery is not easy to talk to."
"Um!"
Fang Le nodded, and he and Cheng Zaiming left the ICU and went to the consultation room next to them.
"Dad, Mr. Sun!"
Entering the consultation room, Cheng Zaiming saw Sun Qingping and Cheng Kangcheng inside and hurriedly said hello.
"Has the patient seen it?"
Sun Qingping smiled and nodded to Cheng Zaiming, then asked Fang Le.
"Well, I've seen it."
Fang Le nodded and said: "The patient is spitting up saliva, has abdominal distension and pain, and is accompanied by high fever that does not subside... the pulse diagnosis cannot be asked..."
"Pulse diagnosis is not possible, high fever persists, abdominal distension and abdominal pain, mixed with deficiency and excess."
After hearing Fang Le's description, Cheng Kangcheng said in a complicated tone.
Generally speaking, if the pulse cannot be asked, the symptoms will not be too mild.
"What do you think?"
Sun Qingping asked Fang Le.
Fang Le said: "The heat and poison are strong in the body. At the same time, the lung, spleen and kidney qi are damaged during the operation. In addition, the patient is old, and the righteousness is too much depleted."
"Well, I just heard that the patient is already in his seventies. At such an old age, the risk factor for a pneumonectomy must be quite high."
Sun Qingping said slowly: "The patient's high fever does not go away now, which means that the righteous and evil qi is still stuck. Once the righteous qi is insufficient, it is easy for the yang qi to explode."
"yes."
Fang Le nodded and said: "Normally, patients over 65 years old should be cautious about pneumonectomy. Patients over 65 years old are actually not suitable for pneumonectomy. The preoperative risk assessment is still a bit insufficient."
Cheng Zaiming, who was standing next to him, suddenly felt a thump in his heart.
He had just warned him, but he didn't expect Fang Le to say it anyway.
Although it was not as direct as when I told him just now, saying something crude and reckless, it was still a bit inappropriate to say it in front of Jiang Hailei.
Sure enough, as soon as Fang Le finished speaking, Jiang Hailei spoke: "The patient is indeed older, but age is not the only criterion for evaluating surgery. The patient's physical condition is relatively good, and judging from the situation at the time,
Pneumonectomy is also one of the best treatment options."
After saying that, Jiang Hailei paused and continued: "I don't know much about traditional Chinese medicine, so I won't discuss it. But as far as the surgery is concerned, I think it went very smoothly. Don't talk randomly if you don't understand."
Cheng Zaiming breathed a sigh of relief.
so far so good.
Fortunately, Sun Qingping and his father were present, and Jiang Hailei was somewhat restrained. Otherwise, Cheng Zaiming would never have been so polite with his understanding of Jiang Hailei.
"Director Jiang is right. In preoperative prediction and evaluation, the patient's age is indeed not the only criterion. Although some patients are older, their cardiopulmonary function is relatively good and they are suitable for surgery. In actual clinical practice, because
Everyone is different and dogma cannot be copied."
Fang Le nodded and said: "Then let's talk about the data. As far as the patient's actual condition is concerned, the patient's preoperative spirometry, lung carbon monoxide diffusing function, arterial blood gas level and other data are only up to standard, and even the patient's lung
The carbon monoxide diffusing function has reached 42, which is greater than 40. Under such circumstances, when performing pneumonectomy, it is necessary to ensure sufficient lung function after surgery..."
Cheng Zaiming and Han Shengxue almost couldn't hold it back and stepped forward to give Fang Le a hand.
What is Fang Le going to do? He wants to discuss pneumonectomy with Jiang Hailei. Is he crazy?
Is it true that newborn calves are not afraid of tigers?
But in front of so many people, even if Han Shengxue and Cheng Zaiming tried to stop them, it was already too late. Jiang Hailei would definitely let Fang Le finish.
But as they listened, Cheng Zaiming and Han Shengxue felt something was wrong.
In the ICU just now, Fang Le just said a few words to Cheng Zaiming, but now, Fang Le said more things. Cheng Zaiming still didn't understand what he heard, but Han Shengxue's jaw almost dropped to the floor.
Although Han Shengxue is not capable of performing pneumonectomy independently, Han Shengxue can attend many surgical operations and understands them to some extent. These points mentioned by Fang Le directly hit the point.
"???"
Jiang Hailei beside him was already full of questions.
It was as if Fang Le in front of him turned into another person in an instant, which made Jiang Hailei a little unbelievable.
If Han Sheng could understand 50% to 60% of what Fang Le said, then Jiang Hailei could understand 90%. It was precisely because he understood that Jiang Hailei was even more confused.
The world's first thoracotomy pneumonectomy was performed in 1933. Although it has been 60 years, the first one in China was 41 years ago, and it has been over 50 years now, but relatively speaking, the level of surgery at this time is still the same.
Relatively rough.
Although Fang Le tried his best to eliminate some advanced things and consider the age as much as possible when he spoke, some opinions and statements are still advanced in this era.
The disadvantages or improvements of any surgery are based on the continuous accumulation of surgeries and the development of the times. The limitations of the times are very terrible.
Although Fang Le's talent is high, he is not good at any surgical operation. But as long as it is in Fang Lehui's field, it is a dimensionality reduction attack in this era.
"Several factors that cause complications after pneumonectomy, such as age, smoking history, etc., are very critical. During the operation, whether the chest is used in turns, drainage time, etc. should be based on chest infection or intraoperative contamination.
It can be judged by expelling microorganisms and balancing intrathoracic pressure changes. Now the patient has persistent high fever and postoperative abdominal pain and distension. Is there any relationship with this?"
Jiang Hailei's mind was filled with questions. Before he could refute, Fang Le had already continued speaking.
Jiang Hailei: "???"
Cheng Zaiming looked at Fang Le, then at Jiang Hailei, and intuitively felt that this scene was a bit strange.
If it had been anyone else at this moment, Jiang Hailei might have started to get angry, but the person speaking now was Fang Le, an intern, and Jiang Hailei didn't say a word.
Looking at Jiang Hailei's expression, he was even a little surprised, a little dull, and a little confused.
Cheng Kangcheng, who came with Sun Qingping, glanced at Fang Le and Sun Qingping, his eyes full of question marks.
Cheng Kangcheng actually wanted to ask Sun Qingping at this moment, Mr. Sun, did you accept the wrong apprentice?
"You keep talking."
Sun Qingping did not look at Cheng Kangcheng, but listened carefully.
As a master, Sun Qingping naturally knew some things about Fang Le in the hospital, such as hemostasis, PDT, and suturing with his bare hands. In the field of surgery, Fang Le had already performed well.
And after talking to Fang Le before, Sun Qingping also knew that although Fang Le's level of Chinese medicine was not low, he was not just a simple Chinese medicine doctor. To be more precise, Fang Le was a doctor. As long as he could save people,
He accepts them all and learns them all.
As for the question of whether a person can learn it and how he can learn it...
Most people who know Fang Le's level won't bother with this issue.
Concentrating on studying is for poor students. For those geniuses who are ranked first in the grade in any random study, both their parents and teachers will be extremely indulgent. This is the reality.
Fang Le said slowly: "Judging from the patient's current situation, the idea should be to strengthen the body, clear the abdomen, resolve phlegm, and expel evil spirits. We should treat the symptoms first and then treat the root cause."
"Well, treat the symptoms first, then the root cause, strengthen the body, clear the abdomen, resolve phlegm, and expel evil spirits."
Sun Qingping nodded, and then asked Cheng Kangcheng: "Where does Kang Cheng feel?"
"Well, the idea is very correct."
Cheng Kangcheng nodded while still a little bit unconscious.
The treatment idea mentioned by Fang Le is correct, and he is very accurate in grasping the pathogenesis. From this point of view, Fang Le's level of traditional Chinese medicine is indeed not low. However, Fang Le's analysis on pneumonectomy just now was not
It made Cheng Kangcheng very dramatic.
"Let's draw up the equation."
Sun Qingping smiled and said to Fang Le.
Fang Le walked to the side, drew up the prescription, and handed it to Sun Qingping and Cheng Kangcheng. After Cheng Kangcheng read it, Cheng Zaiming next to him asked for the prescription again.
When Cheng Zaiming was checking, Han Shengxue also came to the side and looked at it carefully. After looking at it, Han Shengxue let out a long breath.
"Does Director Han understand?"
Cheng Zaiming glanced at Han Shengxue a little strangely.
Han Shengxue obviously knew nothing about Chinese medicine, but he stood on the side and watched it very seriously. After reading it, he breathed a sigh of relief, as if he understood it.
Pretending to be serious.
Han Shengxue was too lazy to talk to Cheng Zaiming.
Naturally, Han Shengxue didn't understand the formula and the ingredients, but what Han Shengxue looked at was the dosage. There were more than ten kinds of Chinese medicinal materials in the whole prescription. Not only did it not contain aconite this time, but it also didn't have a large dose, which made Han Shengxue feel relieved.
For a layman like Han Shengxue, as long as there are no too harsh drugs or excessive doses, he thinks the risk is not great.
From the beginning to the end of drafting the prescription and taking the medicine, Jiang Hailei sat in the consultation room, silent, and only glanced at Fang Le from time to time.
Cheng Zaiming noticed Jiang Hailei's expression and almost couldn't hold it back several times.
People like Jiang Hailei don't care about the doctor's age, but more about the doctor's level. He is confident and domineering, and cannot tolerate others questioning or refuting him. As long as someone questions, Jiang Hailei must convince the other person.
Just such a person was refuted by a young intern like Fang Le today, but he remained silent.
Not to mention Cheng Zaiming, even Han Shengxue and the other two chief doctors beside him found it a bit funny.
"Did you do this on purpose?"
When no one was paying attention, Cheng Zaiming asked Fang Le in a low voice.
In the ICU, Cheng Zai clearly reminded him that Fang Le had said something just now, and as far as the final condition analysis was concerned, Fang Le's analysis of pneumonectomy had no impact at all.