事件记录
面试官: Treating chronic thromboembolic pulmonary hypertension, also known as CTEPH. We're going to find out more about that surgery next on 范围.
播音员: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is 范围.
面试官: You've been diagnosed with CTEPH and we've already learned about the condition, 它的症状, and stuff like that in our earlier podcast. But today, we want to talk about the surgery that treats it. Dr. 克雷格Selzman是一名心脏外科医生，也是犹他大学医疗保健中心慢性血栓栓塞性肺动脉高压项目的主任之一. So in case somebody didn't hear the first podcast, just briefly sum up what's going in the heart that causes this disease?
Dr. Selzman: 它实际上是, 信不信由你, 它在肺里，所以肺夹在心脏的左边和右边之间. 那么CTEPH是什么, 大发娱乐就叫它CTEPH吧, it is a form of what we call 肺动脉高压. 肺动脉高压是指肺动脉循环中的高血压. And there are a number of causes for it for which CTEPH is one of them.
This particular situation is a form of PAH, 肺动脉高压, 这与血液凝块有关，这些凝块通常来自腿部或下肢，并卡在肺部. 大发娱乐称之为肺栓塞. It's very highly morbid, causes a lot of problems, and it's lethal. 这是导致急性心肺死亡的主要原因之一.
所以在肺内部发生的是肺实际上开始重塑. 你几乎可以想象你的水槽里有一些东西它进入排水管，它就在那里, but you could imagine that a year or two later, it kind of forms and becomes part of the wall of the pipes. 这就是在你的肺里发生的事情，这对它们来说很难完成它们的工作, which is to take in oxygen and get rid of carbon dioxide.
面试官: 随着时间的推移, is it the stiffness that's causing that problem, that build-up of stuff in there that's causing the stiffness?
Dr. Selzman: 这是正确的. 大发娱乐想要大发娱乐的肺, 你知道, 你想让你的肺看起来像你刚从商店买回来的海绵. You open it up, it's this very light, airy, and it's just . . . you could kick it and it would maybe go up in the air, 但它不是你刚洗完盘子用的这块又重又湿的海绵. That's what you want your lungs to look like. 你需要这些小洞因为这些小洞允许氧气来回移动. But if you don't have good blood vessels that go to all those little holes, all of the ability of your lungs to do that work become compromised.
面试官: So during this surgery, what do you do to fix it when you go in there?
Dr. Selzman: So 信不信由你, this is a roto-rooter operation. 大发娱乐必须这么做, 这是一个主要的心脏手术，因为大发娱乐必须打开你的胸骨. We do have to open up the pulmonary arteries. 然后大发娱乐要做的就是打开肺动脉大发娱乐实际上剥离了血管壁的内层.
所以, 有时, 你要移除的是血块, 但这不仅仅是血块的问题. 这是一层很厚的表皮沿着血管壁层层延伸你必须把整个表皮切除才能让血液流动到肺的外围在那里它完成所有的工作. 为了做到这一点，这是一个大手术，你必须使用心肺机.
实际上，大发娱乐必须把体温降到很低，因为当你做这件事的时候，会有很多血液挡在路上，所以你需要能够看到. 所以, 有时, 大发娱乐甚至需要停止病人的血液循环唯一的方法就是测量血液温度, very low to protect the brain and other organs. So it's not something that we take lightly. 这是相对概念化的, straightforward operation but has some pitfalls if you don't do a lot.
面试官: How long does it take for an average for you to do the procedure?
Dr. Selzman: 大概三到六个小时.
面试官: 好吧.
Dr. Selzman: 很多时候都是这样, the nitty-gritty work is actually only maybe less than an hour, 但是准备时间，把温度降下来，然后再把它调上来, 这确实需要一些时间.
面试官: 你可以进去把大部分，如果不是全部，通常都清除掉?
Dr. Selzman: 大发娱乐很幸运，因为大发娱乐有很好的术前检查，所以可能所有的肺都受到了影响, 但有时, 只剩下一半的肺或者, 你知道, three-quarters of the right lung and two-thirds of the left lung. 大发娱乐可以以此为目标.
有一些疾病过程与肺栓塞和CTEPH是大发娱乐无法修复的东西. 这就是大发娱乐要做的事情, way deep out into the periphery of the lung and we just physically can't do it. When people have pulmonary hypertension related to that kind of disease, 在医学治疗之外只有一种方法，那就是肺移植.
面试官: 让你. So I think you just answered who makes a good surgery candidate. 如果它对肺外部的影响不大，但如果它对肺的主要部分的影响更大.
Dr. Selzman: 是的，我认为这是一个很好的思考方式，你知道，从技术方面来说. 离周围越近或者离周围越远就会定义一些大发娱乐甚至不会考虑的病人.
面试官: 让你. What kind of preparation does the patient go through leading up to it? Is it just typical surgery preparation, you just want to be healthy?
Dr. Selzman: 是的. Unfortunately, 你知道, some of these patients aren't so healthy.
面试官: Because they have a hard time breathing, right? 这使得运动和活动变得困难.
Dr. Selzman: 完全. 还有一些风险因素，导致他们的腿上有血块. 你知道, 有时血凝块是典型的乘飞机穿越国家的旅行者他们没有移动他们的腿，他们在腿上有血凝块，然后他们那天晚些时候他们四处走动，然后他们呼吸急促，他们甚至可能不知道他们发生了什么.
事实上是这样的, 大约40%的肺栓塞患者甚至不知道自己患有肺栓塞，而且很多CTEPH患者之前没有肺栓塞的诊断. And it's just something that happened that nobody . . . 你只是不知道你有. 有点像无声的心脏病发作. "Oh, I didn't know I had a heart attack, doc.“这是一回事. "I didn't know I had a pulmonary embolism, doc." 所以 that can happen and it can be kind of very sublime, 如果你愿意, 疾病的发展.
面试官: 让你. And then what's the recovery time look like after the procedure normally?
Dr. Selzman: 通常，在重症监护室呆两三天，然后在地板上呆几天. Everybody is a little bit different how they do this. 在更严重的情况下, 你可能会在医院里呆上几个星期因为肺的一部分不习惯血液流动大发娱乐会迅速移除这些东西然后大发娱乐会得到所谓的再灌注损伤, 这意味着没有大量血液流动的肺突然有了大量的血液涌向它. 这叫做再灌注有时处理起来很麻烦.
所以, yeah, this is not an easy physiologic process for the patient. 我的意思是, the lungs are going through a lot of stuff. Obviously, it's very central and core, 你知道, heart and lungs. 所以, 你知道, if the lungs are working good, then the heart works good. 但如果肺部工作不正常，就会影响心脏，这可能是个问题.
面试官: So you're taking a little bit of time off from work?
Dr. Selzman: 哦,是的.
面试官: 可能.
Dr. Selzman: 这是一次大的心脏手术, 但最酷的是, 你知道, 虽然这是个大手术, we just have some great stories that come back. 我的意思是, you see these people that are on oxygen at home and then two weeks after surgery, they come and see you in clinic and they're off of oxygen and they say that, “哇. I haven't been able to take a deep breath like this in years.“然后一年后你看到他们，他们非常感激，因为他们可以呼吸，因为大发娱乐在肺移植中看到了这一点.
你知道, 犹他大学的教授, we're kind of lucky because we're one of the, we're really the only lung transplant center in the entire region. 你知道, you have to go to Denver or Phoenix or in California. 所以 we see great stories and when you see people that can't breathe, 你知道, just imagine you're down swimming and you're underwater. 我是说，这些人就是这样. 所以当你让人们深呼吸的时候，塑料氧气管就会变得很旧. 所以 it can be an incredibly gratifying thing to do for a patient.
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