Operation in negative pressure operating room of Wuxi infectious diseases hospital
Dialogue with Chen Jingyu
Surging news: please introduce the situation of this case of lung transplantation.
Chen Jingyu: the novel coronavirus pneumonia case in Jiangsu Province, male, 59 years old, was diagnosed in January 23rd. COVID-19 was diagnosed in January 26th. Tracheal intubation in February 7th, ECMO in February 22nd, and transferred to Wuxi Infectious Disease Hospital in February 24th. After continuous tracheal intubation plus ECMO (extracorporeal membrane oxygenation, commonly known as artificial lung) and drug treatment, continuous nucleic acid test was negative, but the lung function was severely damaged and not. Reversible.
Surging news: novel coronavirus pneumonia patients need to carry out lung transplantation what are the indications of medicine? What is the first novel coronavirus pneumonia lung transplant patient before the operation?
Chen Jingyu: first, the patients respiratory failure is irreversible after ventilator and ECMO maintenance; second, the nucleic acid test is negative for many times in a row; third, other organs function is basically normal, and the general condition can withstand lung transplantation.
Before the lung transplantation, the patient had kept other organs normal through the ventilator and ECMO, but his lung was in a late state, with pulmonary fibrosis and atrophy into a dried bean curd, so the lung transplantation was carried out.
Another situation is that on February 28, because of the continuous bleeding in the right lung of the patient, the amount is estimated to be 2500ml, and the patients hemorrhagic shock is on the verge of death. On February 29, the patient was lucky to wait until the brain dead patient from other provinces donated the lung source with love, so our team can make great efforts.
Surging news: you mentioned that the nucleic acid test is negative for many times in a row for lung transplantation. Whats the reason? This novel coronavirus pneumonia is the first lung transplant patient.
Chen Jingyu: this patients nucleic acid test for five consecutive days was negative before the operation.
The new coronavirus is a respiratory virus, which is very infectious. The research and understanding of this virus are not enough. However, it can be determined that the positive nucleic acid test of the new coronavirus means that the virus is still active in vivo.
So in order to better complete the operation, from the perspective of the safety of medical staff, we hope that the patient is not infectious, and it is better to test the nucleic acid results for several consecutive days are negative, so it is relatively safe.
But the negative nucleic acid test can not rule out that there is no virus in the lungs to be removed during the operation, so we need to do strict protection during the operation to ensure zero infection of medical staff.
News: novel coronavirus pneumonia patients lung transplantation, and other diseases leading to lung transplant patients, what are the similarities and differences in follow-up rehabilitation? Will rehabilitation be more difficult?
Chen Jingyu: the rehabilitation path of this patient after lung transplantation must be longer than that of other ordinary patients with pulmonary fibrosis, because he suffered too much in the early stage, his immune function is very low, and the rehabilitation time must be longer than others. And there may be other accidents we dont know, so this operation is an exploratory operation.
Surging news: why such an exploratory operation?
Chen Jingyu: because the novel coronavirus pneumonia mortality rate is too high. At present, the rescue success rate of patients with ventilator and ECMO is very low. Our team took a lot of risks to do this operation, in fact, it is to give life hope to the critically ill patients and the dying patients.
We also hope that we can get some experience through our case, just like autopsy. Compared with autopsy, I think this operation is more meaningful, because autopsy is to see the patient after death, and we not only need to save the patients life, but also can get the understanding of the disease from his diseased lung.
Surging news: novel coronavirus pneumonia released by Hubei Health Committee today shows that there are 7107 new severe cases of pneumonia in Hubei in February 29th. If lung transplantation is effective, you are also a representative of the National Peoples Congress as a doctor. What are the suggestions for the treatment of severe patients in Hubei?
Chen Jingyu: at present, the patients condition is stable. I mean the success will be a preliminary success when the patients ventilator and ECMO can be completely evacuated and the patient can carry out rehabilitation exercise. At present, it will take a few days to withdraw. Then I can have a prediction.
Chen Jingyu: the risk is very high. I dont know if the patients lung contains residual virus, and whether the virus is active and infectious. So we do this operation under the full set of armed protection conditions, which is a great psychological pressure for doctors.
Its also more difficult to operate. Its not easy for the team to talk, and theres no eye contact. Basically, everyone is sweating. After five or six hours, it can only be done with the close cooperation of the team and a long-term tacit understanding between them.
High difficulty! Zhejiang University first hospital completed the worlds first new crown lung transplantation for the elderly
In fact, the difficulty of operation is beyond imagination: on the one hand, the patients respiratory failure leads to the increase of pulmonary artery pressure, the obvious increase of right heart, the rotation of the whole heart, which increases the difficulty of operation; on the other hand, the patients body is fat, although there is no basic disease, but because the chest is small, the space does not match the size of the lung, which causes the cardiovascular function to be weaker than that of ordinary people, which not only leads to the disease One of the factors of rapid progress also makes transplantation more complicated.