Prof. Xin Chen
Twelve years ago, heart patients in Nanjing and the surrounding areas had to go to Beijing or even farther abroad for heart bypass surgery. Seeing the patients' difficulties and even delays in seeking medical treatment, a young doctor in the Department of Cardiothoracic Surgery of Nanjing First Hospital felt a heavy responsibility on his shoulders. He vowed to master heart bypass surgery in the shortest possible time to relieve the pain of heart patients. Twelve years later, under the leadership of this doctor, the Department of Cardiothoracic Surgery of Nanjing First Hospital has explored and summarized a set of Chinese patients with coronary heart disease suitable for simple, effective and practical coronary heart disease surgical treatment system, the level of surgical treatment of coronary heart disease ahead of Jiangsu Province and among the ranks of the domestic advanced.
This doctor, is recently identified by the Jiangsu Provincial Department of Health as the province's clinical medicine cardiothoracic surgery leading talent of the First Hospital in Nanjing, vice president, director of cardiothoracic surgery, Professor Chen Xin. A few days ago, the reporter interviewed the cardiothoracic surgery experts, close to his twelve years of struggle, to see and hear the splendor of his way.
Running fast on the path of transcendence
Responsibility, pursuit and innovation are the common points of every successful person. Prof. Chen Xin has been engaged in the clinical and basic research of cardiothoracic surgery for more than 20 years, leading his colleagues to never forget the sacred mission of saving lives and helping the sick and injured, and constantly exploring and pursuing in the field of cardiovascular surgery, so that the Department of Cardiothoracic Surgery of the hospital in which he works has grown from a small to a large, from weak to strong, one step at a time, and has continued to develop and grow, from a ward of more than 20 beds to two wards with more than 70 beds, and the number of senior medical staff has grown from 2-3 people to more than 20 people, and all of them have been trained many times in world famous medical units. The senior medical technicians have grown from 2 to 3 to more than 20, and all of them have been trained in world-renowned medical units for many times, and are skillful and capable. The development of the hospital's cardiothoracic surgery technology, driven by cardiovascular medicine, anesthesia, guardianship, cardiovascular ultrasound, testing and inspection and other specialties synchronized with the rapid development of technology, the formation of a high reputation at home and abroad, young, high-quality, high-level team. Following the trajectory of time, the reporter clearly saw the fruitful results obtained by Prof. Chen's unremitting pursuit:
In 1994, Chen Xin went to the U.S. and returned home. At that time, when the working conditions and environment of the hospital were still relatively simple, he was the first one to independently carry out coronary artery bypass grafting surgery in Jiangsu Province. Since then, he has continued to forge ahead, expanding the results, finding and summarizing a set of simple, effective and practical coronary heart disease surgical treatment system suitable for Chinese coronary heart disease patients, and has completed more than 2,000 cases of various types of coronary artery bypass grafting surgeries, with the success rate of the surgery being more than 98.59%.
In 1997, Chen Xin took the lead in carrying out and reporting on emergency coronary artery bypass grafting and application of intra-aortic balloon counterpulsation technology to rescue critically ill coronary patients with acute heart attack, cardiogenic shock and acute myocardial ischemia, which was successful in one fell swoop.
Since 1998, he has carried out a number of new surgeries such as conventional coronary artery bypass with arterial bypass material - internal mammary artery for coronary artery bypass to improve long-term efficacy; coronary artery bypass + heart valve molding/replacement, coronary artery bypass + ventricular wall aneurysm and other new surgeries during the same period, and the conventional "fast channel" technology for cardiac surgery patients. He also used the conventional "fast channel" technology for cardiac surgery patients, which enabled 80% of cardiac patients to be extubated within 2 to 10 hours after surgery, greatly accelerating post-operative recovery.
In 1998 and 1999, Chen Xin successfully performed coronary artery bypass grafting and heart valve replacement surgeries live on TV through Nanjing TV and Jiangsu TV respectively.
In 1999, he carried out clinical and basic research on laser myocardial perforation combined with coronary artery bypass grafting for the treatment of end-stage coronary artery disease; he also carried out endoscopic-assisted saphenous vein preparation in coronary artery bypass grafting, which further reduced surgical trauma.
Since 2000, he has carried out non-corporeal circulation non-stop coronary artery bypass grafting, and in October of the same year, he successfully conducted a live TV broadcast of non-stop coronary artery bypass grafting through Nanjing TV Station. So far, he has completed more than 1,200 cases of non-stop coronary artery bypass grafting and popularized its application in more than 40 hospitals in Zhejiang, Fujian, Hubei, Henan, Shandong, Anhui, Chongqing and other provinces and cities.
In 2001, on the basis of successful animal heart transplantation experiments, Prof. Chen successfully performed an allogeneic in situ heart transplantation for a 51-year-old end-stage dilated cardiomyopathy patient with severe diabetes mellitus in August of the same year, the first case in a local hospital in Jiangsu Province, and the patient has recovered now. At present, 14 cases of heart transplantation have been completed, filling 4 domestic gaps.
He has successfully completed abdominal aortic aneurysm with renal artery stenosis patients with simultaneous abdominal aortic replacement and renal artery bypass grafting; carried out deep hypothermia stop cycle ascending aortic replacement, aortic arch replacement and other techniques for the treatment of aortic aneurysm and acute aortic coarctation, with satisfactory results.
In 2003, he also successfully carried out the first case of secondary coronary artery bypass grafting to treat coronary heart disease; minimally invasive non-corporeal circulation coronary artery bypass grafting under beating heart and carotid artery endarterectomy in the same period of time, filling the blank in China; secondary coronary artery bypass grafting + ventricular wall aneurysm resection intracardiac patch left ventricular molding under extracorporeal circulation; carrying out the treatment of coronary artery left main stem lesions with OPCAB, intra-aortic balloon counterpulsation assisted The treatment of left main stem coronary artery lesions with OPCAB, non-extracorporeal coronary artery bypass grafting under intra-aortic balloon counterpulsation, and hypertrophic septal resection + mitral valve replacement for hypertrophic obstructive cardiomyopathy have all achieved very satisfactory results.
The surgical treatment of arrhythmia during operation has reached the advanced level in China: one is the treatment of combined arrhythmia of pre-coronary heart disease by electric ablation. For congenital heart disease patients with combined arrhythmia, while correcting cardiac malformation, direct electrical ablation is used to treat arrhythmia of the heart, compared with transcatheter ablation, it can save about 15,000 RMB for each patient, which is practical and effective, and it is very suitable for China's national conditions. Second, bipolar radiofrequency ablation with XXX is used in the procedure to treat chronic atrial fibrillation. New breakthroughs have also been made in the surgical treatment of critical heart valve disease, reaching the leading level in China, including: simultaneous combined surgery of three valves of the heart mitral, aortic and tricuspid valves to treat critical heart valve disease; heart valve molding and replacement surgery for patients with huge left ventricle, with very satisfactory results; and animal experiments of combined heart-lung transplantation.
Since 2004, Chen Xin has carried out emergency aortic valve replacement + ascending aortic replacement + coronary artery opening grafting to treat acute type I aortic coarctation aneurysm; emergency Bentall's surgery + coronary artery bypass grafting to rescue ruptured acute aortic coarctation aneurysm, with good results; transcortical belt membrane stent implantation to treat type III aortic coarctation; abdominal aortic coarctation aneurysm resection and artificial blood vessel implantation; normothermia Blockade with blood pump whole blood recovery arterial input technique for giant chronic type III aortic coarctation aneurysm resection with artificial blood vessel replacement; carotid endarterectomy for carotid artery stenosis with cerebral ischemia; minimally invasive non-corporeal circulation non-beating coronary artery bypass grafting for coronary heart disease combined with severe aortic extensive calcification and sclerosis by the Notouch technique; bypass grafting after coronary artery endarterectomy under non-corporeal circulation non-beating heart. Diffuse coronary artery lesions; Bilateral internal mammary arteries for coronary artery bypass grafting; Maze surgery for atrial fibrillation, etc.
Every day of his life belongs to his patients.
Heart surgery is more time-critical and risky than other surgeries. Many heart attacks often occur at night, especially in the early hours of the morning. This requires cardiothoracic surgeons to be not only skillful and proficient in dealing with all kinds of unforeseen situations, but also to be on call and available every second. As one of Prof. Chen Xin's mantra: "Time is life, and every day of my life belongs to the patient!" It is this kind of dedication and devotion that interprets a thrilling story.
Emergency bypass after 48 minutes in cardiac arrest
Henan Luoyang 80-year-old Mr. Pang suffered from coronary heart disease for 20 years, during which there were two episodes of acute infarction, angina pectoris recurring in the past year, accompanied by arrhythmia, the local hospital coronary angiography suggests that the left main stem of the heart with three branches of the blood vessels with serious lesions, including anterior descending branch, the gyration branch stenosis of 90% or more, the right coronary artery is completely occluded, the left ventricle due to the apical part of the huge ventricular mural tumors contraction function is severely reduced, the left ventricular ejection fraction of only 30%. The left ventricular ejection fraction was only 30%. The old man who could not endure the torture of the disease repeatedly asked for euthanasia, and his family was anxious, and after many inquiries, they escorted him to the Department of Cardiothoracic Surgery of Nanjing First Hospital.
At noon on the 2nd day after admission, Mr. Pang, who had just finished lunch, suddenly felt discomfort in his precordial region, and a few seconds later, he suffered from loss of consciousness, twitching of limbs, and respiratory arrest. Prof. Chen and other medical staff immediately performed cardiopulmonary resuscitation (CPR), and in response to the patient's persistent ventricular fibrillation, repeated external defibrillation 11 times, and after 48 minutes of resuscitation, the patient finally regained his heartbeat and respiration. Prof. Chen and other medical staff immediately performed cardiopulmonary resuscitation and repeated external defibrillation 11 times for the patient's persistent ventricular fibrillation, and after 48 minutes of rescue, the patient finally recovered his heartbeat and breathing.
The thoracic cardiothoracic surgery department led by Chen Xin is an efficient team. anesthesia was completed within 15 minutes, and it took only 25 minutes from the notification of the operating room to the surgical incision of the skin. The patient's blood pressure was low and cardiac arrest could occur again at any time. Prof. Chen quickly set up extracorporeal circulation, successfully removed the fist-sized left ventricular ventricular wall tumor, and then built three vascular bridges. The patient's heart resumed beating again. However, the heart still contracted weakly after repeated blows, and after placing an intra-aortic balloon counterpulsation catheter, the patient finally returned to the care ward smoothly. The next day, all physiological indicators have turned normal, and can use their own breakfast. It is reported that the cardiac arrest of such an elderly patient 48 minutes of successful rescue is rare in the country.
The reporter learned that among the patients who had heart bypass surgery in Nanjing First Hospital, those who were over 75 years old accounted for one quarter of them, and the oldest one was 86 years old. Among these elderly people, in addition to heart disease, often combined with diabetes, chronic bronchitis, emphysema, renal insufficiency, had a stroke and many other diseases, the difficulty and risk of the operation is self-evident. The overall level and success rate of the anesthesia, postoperative monitoring and nursing care team led by Prof. Chen has reached the international advanced level in the same industry.
Successful heart transplant in 41 minutes
Mr. Wang, 54 years old, lives in Nanjing Ruijin Xincun. he was diagnosed with dilated cardiomyopathy at the end of 1999, and tried various treatments for several years, but his condition became more and more serious. in February 2004, he came to the Department of Cardiothoracic Surgery of the First Hospital of Nanjing for medical treatment. After Prof. Chen Xin's examination, he found that the patient had developed into an end-stage heart disease, and his heart had basically lost its contraction function, and the effective treatment path was heart transplantation. Through the efforts of Chen Xin and other parties, a heart donor matching Mr. Wang was finally found in the neighboring area of Nanjing, and an allogeneic in situ heart transplant was immediately performed for Mr. Wang. During the operation, the patient was first fitted with an artificial heart-lung machine, and after a few minutes, the patient's heart stopped beating. Director Chen then removed the "bad heart", took out the heart donor from the special protective fluid, trimmed off the excess fat and small blood vessels, and anastomosed the donor to the patient's left atrium, right atrium, aorta and pulmonary artery. In close cooperation with colleagues, only 41 minutes, "heart" surgery ended successfully.
According to reports, since 2001, Prof. Chen successfully completed 14 cases of heart transplantation, creating a number of technical breakthroughs in this field: donor - recipient body weight difference is the largest (general requirements for the donor - recipient body weight difference of less than 20%, the group's maximum of 61%) The maximum weight of the patients (the heaviest patient weighed 113 kilograms); the highest age of the patients (the oldest patient was 64 years old); heart transplantation for patients with insulin-dependent diabetes mellitus and heart transplantation for patients with cardiac and respiratory arrests prior to the operation. Surgical innovations include: the use of complete external continuous suture for anastomosis of the heart and great vessels; the use of non-invasive ventilation technology to treat postoperative right heart insufficiency, avoiding the pain and discomfort of secondary tracheal intubation. 30-40% of heart transplant patients over 55 years old require continuous hemofiltration at the bedside due to acute renal failure, and Prof. Chen's patients have included A 62 years old patient with preoperative risk factors such as underlying renal insufficiency, developed acute renal insufficiency after surgery. After timely CRRT treatment, his renal function basically recovered to the pre-surgery level after one week, and he was successfully discharged from CRRT and cured.
On October 30, 2006, which is the traditional 9th day of the 9th lunar month, Chen Xin, together with some of the recovered heart transplant recipients who underwent heart transplant surgery by him, climbed up to the China Gate Castle in Nanjing with great excitement, and Ms. Wang, who was at the front of the line, who had been having a heart transplant for more than 5 years, said excitedly, as she took Prof. Chen's hand, "I am more than 5 years old this year, and I would like to thank you for giving me a second life!
Disease has no mercy, but people have mercy.
On a Sunday in April 2005, a college student in his 20s suddenly suffered from severe chest pain while playing basketball, and was sent to the emergency room of Nanjing First Hospital, where he was diagnosed with aortic coarctation aneurysm after examination. This kind of aneurysm is known as "human time bomb", usually can not have any symptoms, when the aneurysm once ruptured, blood will be in the body from the diameter of 3 centimeters of the large blood vessels, the mortality rate is as high as 99.9%. The mortality rate is 99.9%. Even in emergency surgery, the mortality rate is as high as 30% to 40%. Without any hesitation, Prof. Chen Xin decided to operate immediately and make every effort to save the patient's young life. He decisively pushed the patient into the operating room, when he opened the patient's pericardial cavity, he found that the most terrible thing had happened, the patient's pericardial cavity is full of blood, the aortic dissection has ruptured, and its rupture is on the right side of the coronary artery openings, and the patient's aortic valve has a severe closure of the insufficiency. The patient's aortic valve was also severely closed. The condition was very dangerous. Prof. Chen calmly and quickly took a piece of blood vessel from the patient's leg and gave him a bypass between the right coronary artery and the artificial blood vessel. The operation was performed using the deep cryogenic shutdown technique, which drained all the blood from the patient's body (but this condition could only last for 20 minutes at most, otherwise the patient would either not be able to regain his heartbeat or would become a vegetable). After just 11 minutes, the replacement and other key surgeries were successfully completed, and at 12:00 p.m., the surgery was over. Chen Xin, who came down from the operating table, couldn't even bother to eat, and stayed in the guardianship ward until the patient woke up, and only then did he breathe a long sigh of relief, with an easy smile on his face ......
People's representatives must truly represent the people
With the passing of more than twenty springs and autumns, Chen Xin has grown from an ordinary doctor to a discipline leader and vice president of a tertiary hospital. The Party and the people have also awarded him the honors of National People's Congress, National Top 100 Doctors, Nanjing Science and Technology Meritorious Person, Nanjing Model Worker, and so on.
He often said, "Times have changed, the purpose of serving the people can not be changed; the position has changed, the responsibility to do practical things for the masses is greater; more honors, the mission of relieving the pain of patients is heavier." This is what he said, and this is what he did, simple still, down-to-earth, heart for the patients.
In March 2006, Professor Chen went to Beijing to participate in the Fourth Session of the Tenth National People's Congress before, many times in-depth community people's families, to understand the general public on the "difficult to see a doctor, expensive to see a doctor," the issue of the specific views. In June last year, Nanjing City, the introduction of medical examination and test results of mutual recognition of the provisions of the same city, Prof. Chen felt that it is an initiative for the people to reduce the burden, it is worth promoting the country. To this end, he specifically to the Nanjing Municipal Health Bureau of the relevant leaders and supervisors to understand the specifics of the provisions, and personally to his hospital's medical department, financial services to understand the first-hand information. After thorough investigation and research, wrote to the country to promote the mutual recognition of the results of medical examinations and tests between hospitals, that is, usually referred to as "a single pass", to the National People's Congress motion group.
Professor Chen proposed that medical imaging examinations, testing programs can be divided into four categories: the first category is the imaging examination of X-ray films, CT films. The second category is the dynamic results of radiography, ultrasound, electrocardiography and other imaging examinations. The third category is hepatitis B, bone marrow smear cytology examination, etc. can only issue test reports, can not provide objective results of the clinical test category. The fourth category is blood, urine routine and other less stable clinical test items. "A single pass" should be implemented in different categories, the first category of inspection items between hospitals should be mutually recognized, the third category of test items because of the relative stability of the results, within a certain period of time do not need to repeat the examination. The second and fourth types of checks, test orders, due to the impact of its results of more factors, whether to recognize the "one single pass" results, should be determined by clinicians. He also suggested that to promote the "one single pass", the health sector needs to develop a good assessment and evaluation methods. This proposal was immediately resonated by the delegates at the meeting and was reported by CCTV's Focus Interview and many other media programs.
As a famous thoracic cardiothoracic surgery expert, a high-profile surgeon, looking for Chen Xin to see a lot of people, open the knife, send "red packets" are also a lot of people. Mr. Fu of Henan Province and his mother accompanied his father to stay in Professor Chen's ward to prepare for heart bypass surgery. Before the operation, they discussed how much money to Chen Xin sent to the appropriate time, living next to the two patients told them not to send, because they were sent, were returned. Mr. Fu and his mother half-believe, think it is better to send the heart of the solid, so the envelope with 10,000 yuan, specially waited until no one in the office, Mr. Fu stuffed the money to Professor Chen, turned around and went back to the ward. But before he sat down, the head nurse arrived and returned the money to him, and conveyed the words of Prof. Chen: "Do not tell his father, for fear that the old man's heart is not solid." Prof. Chen also wrote on the envelope, "Please rest assured that we will provide XX-quality service for every patient!" According to the statistics reflected by the patients afterwards, only in recent years, Prof. Chen Xin has refused to accept hundreds of thousands of dollars in red envelopes.
转载自“365医学网”
