MTLNOVEL I can see the status bar
Chapter 271 Weighing
Chapter 271 Weighing
Of course, Wang Lin's treatment has not yet started.Sun Lien tried his best to suppress the immunosuppressive treatment plan first.
"Staphylococcus aureus was found in the samples sent to us." Zhao Jianguo took the report and handed it to Zhou Jun with a serious face. "I read the report of the pathology department. This is a patient with pulmonary hemorrhage-nephritic syndrome. However, he has Staphylococcus aureus infection, and immunosuppressants cannot be used casually. This matter is more difficult, so I am here to tell you specifically."
Zhou Jun had heard of the little conflict between Zhao Jianguo and Sun Li'en.He glanced at Zhao Jianguo in surprise, then took the report, nodded after a moment, "I'm sorry to trouble you."
Zhao Jianguo, an old fox, knows very well that it will not be a matter of overnight to reverse the previous conflict and hostility.Anyway, the current Sun Li'en has no direct threat to him, as long as he slowly releases his goodwill, the conflict between the two sides can be resolved.He nodded to everyone in the room, then turned and left the conference room.
"Please consult the Department of Intensive Care Medicine, Nephrology, Respiratory Medicine, and Rheumatology and Immunology." Sun Lien rubbed his face, feeling exhausted and powerless rising from the bottom of his heart one after another.The patient's situation is too complicated, and he can't think of any treatment method that is more suitable for the patient.After much deliberation, I had no choice but to call experts from other departments to come and make suggestions—anyway, I can’t have a headache alone.
Zhou Jun said, "Let me get in touch. This patient is troublesome. I might have to ask their director for consultation." He looked at Dr. Pascal, and then said, "I will not invite the chief director of the Department of Rheumatology and Immunology. Come here, as long as Professor Pascal is here."
Dr. Pascal smiled wryly. He had seen two patients with the same disease before, but that was many years ago.It was so long that he almost forgot whether the two patients were male or female.But Pascal remembered their ending clearly.Neither made it through, and one patient died after being diagnosed with the disease in the rheumatology and immunology department at Massachusetts General Hospital.The other died of DIC on the second day of treatment.
The prognosis of patients with pulmonary hemorrhage-nephritic syndrome is generally poor.Before the medical profession generally adopted blood replacement plus immunosuppressants, combined with high-dose glucocorticoids, and received long-term dialysis treatment, the general five-year survival rate of patients with pulmonary hemorrhage-nephritic syndrome was less than 10%.More than 80% of patients die within one year of onset.But with the gradual advancement of medicine, the five-year survival rate of this disease has been increased to 70%.
But these patients are pure pulmonary hemorrhage - nephritic syndrome.They did not come with S. aureus infection.
Staphylococcus aureus is a ubiquitous bacterium.They are most likely to enter the blood from the patient's body surface wound, or infect the surrounding tissue to cause purulent infection, or settle in the heart and lungs with the blood, causing pericarditis or pneumonia.More terrifying than ordinary Staphylococcus aureus is its evolutionary form, Methicillin-resistant Staphylococcus aureus (MRSA).
Sometimes we can often see reports of so-called "super bacteria" on TV.This report refers to methicillin-resistant Staphylococcus aureus infection.Because the medical community did not pay enough attention to bacterial drug resistance before the 70s, a large number of antibiotics were abused, which led to the rapid evolution of Staphylococcus aureus.The newly evolved Staphylococcus aureus is extremely insensitive to methicillin, and is resistant to β-lactam antibiotics and cephalosporin antibiotics with the same structure as methicillin.And because of the modification of the antibiotic target, they even have varying degrees of resistance to antibiotics such as aminoglycosides, macrolides, tetracyclines, and fluoroquinolones.Among the antibiotics currently available to humans, only vancomycin is effective against methicillin-resistant Staphylococcus aureus.
But whether Wang Lin was infected with this terrible bacterium is still unclear.There is no clear indication in the status column, and the testing department needs at least four hours to confirm the presence of MRSA in the sample by PCR.
"The first thing is to control the infection." Wu Faxian, director of the Department of Critical Care Medicine who came to participate in the consultation, made a speech, "For patients with GMB nephritis, kidney damage has already formed. To put it bluntly, people can still live without kidneys. , but if the infection develops to the point of sepsis, it will be difficult to save."
Tian Huaguang, chief director of the Department of Nephrology, pondered for a while, and asked with a frown, "The condition of the patient's kidneys is not bad. If the anti-infection treatment can be ended as soon as possible and the immunosuppressive treatment can be switched to, his kidneys will still be damaged." I hope to save it." He looked at Dr. Pascal and asked, "I remember that in the current mainstream treatment plan, double nephrectomy is no longer a routine strategy?"
"Indeed not." Dr. Pascal nodded. "In addition to plasma exchange, the commonly used drugs are the combination of methylprednisolone, prednisone and cyclophosphamide. It is probably similar to the immunosuppressive regimen after organ transplantation. However, a large-scale treatment with glucocorticoids alone is required. Dosage shock therapy to relieve pulmonary hemorrhage."
"How about adjusting the treatment plan a little bit?" Listening to the discussions of many big bosses, a bold plan suddenly popped up in Sun Lien's little heart that had some spooky ideas. "Is it possible to use plasma exchange to reduce the amount of GMB antibodies in his blood while anti-infection treatment, delay the progression of lung and kidney damage, and then perform immunosuppressive treatment after confirming that the infection has been eradicated?"
Zhou Jun opened his eyes wide, and was about to criticize Sun Li'en for not following the routine.Dr. Pascal called out first, "Good idea!"
Plasma exchange is to draw the patient's blood from one side of the vein, and divide the drawn blood into plasma and blood components through a centrifugal pump.After discarding the patient's own plasma, inject fresh plasma, albumin solution, or a plasma substitute such as balance solution at the same speed.
The fundamental purpose of using this treatment in this case is to reduce the absolute amount of GMB antibody in the patient's blood.
Antibodies floating in the blood will be separated from the human body along with the plasma, and this method alone can reduce a considerable amount of GMB antibodies-plasmapheresis can generally replace about one-third of the plasma in the human body at a time.In other words, without the use of immunosuppressive drugs, plasma exchange can reduce the antibody in the patient's body by about 30% within a certain period of time.
Of course, the replacement volume of plasma exchange can be adjusted according to demand, and it is not impossible to replace all the plasma in the patient's body in one go.However, such extreme plasma exchange can easily cause more troublesome situations such as systemic hemolysis.Considering that Wang Lin's lungs were still bleeding, whole body plasma exchange was obviously inappropriate.Therefore, after additional discussion with experts from Director Li of the Department of Hematology, everyone agreed that Wang Lin should undergo plasma exchange of 50% of the total blood volume first, and immediately start anti-infection treatment after the plasma exchange was completed.
The head of the hospital infection department came uninvited after hearing that there might be MRSA infection.Before the PCR test results came out, the hospital infection department resolutely opposed the direct use of vancomycin to treat patients.
The reason for hospital infection is simple, "Even if it is MRSA infection, a considerable part of non-drug-resistant bacteria can be eliminated by using traditional antibiotics. The true methicillin-resistant Staphylococcus aureus reproduces slowly, and all MRSA colonies have There are both methicillin-resistant and methicillin-susceptible strains. After the first use of antibiotics, a large number of sensitive bacteria will be killed within a few hours. When the resistant strains grow slowly and proliferate, it will be a few hours later ——At that time, the PCR test results of the clinical laboratory will definitely come out. According to the judgment of PCR, then consider whether to use vancomycin.”
Anyway, in the medical records of patients suspected of MRSA infection, the hospital infection department has the highest decision-making power on the use of antibiotics.Moreover, their reasons are indeed sufficient, and treatment according to their plan can also ensure the safety of patients.Naturally, Sun Li'en and the others would not have any objections.
But no one expected that the most fierce opposition came from Wang Lin's daughter.
"You all know that my dad may be infected with superbugs, why not use vancomycin?" She looked very angry, and her sharp voice directly penetrated the door of the conference room.
Sun Lien plucked his ears in distress, and persuaded in a harmonious voice, "The current antibiotics are not completely ineffective. Regardless of whether he is infected by super bacteria or not, the most appropriate solution is to use safer antibiotics first."
"I don't care!" She slapped the table hard, "It's not that we don't have money, why don't you give my dad the best medicine?"
"Where is the best medicine?" Sun Lien smiled wryly, "As long as it works, it is the best medicine. We doctors can't just use a certain medicine indiscriminately just because it's new or famous."
Hu Jing, the head nurse, heard the voice approaching, and she winked at Sun Lien, signaling Xiao Sun to get out of the way and let the professional come.Sun Lien also stepped aside obediently. Yu Gong and Hu Jing are the head nurses, so she will definitely not be able to stop Sun Lien if she wants to get started.Yu Si, as Hu Jing's prospective niece and son-in-law, and he was sure he couldn't beat Hu Jia's natal aunt, he could only obediently step aside.
"Little girl, the medicine is three-point poisonous." Hu Jing began to persuade in a homely tone, "Vancomycin has serious side effects, do you really think doctors are reluctant to use it? This medicine is precious, according to our Song'an Province According to regulations, vancomycin is not included in the medical insurance. It is a self-paid drug. If the doctor refuses to use it, it must not be because of money..."
A little far away, Sun Li'en felt a little heartbroken listening to the head nurse's explanation.It is obviously for the benefit of the patient, why do you have to pour some dirty water on yourself before explaining it clearly?
(End of this chapter)
Of course, Wang Lin's treatment has not yet started.Sun Lien tried his best to suppress the immunosuppressive treatment plan first.
"Staphylococcus aureus was found in the samples sent to us." Zhao Jianguo took the report and handed it to Zhou Jun with a serious face. "I read the report of the pathology department. This is a patient with pulmonary hemorrhage-nephritic syndrome. However, he has Staphylococcus aureus infection, and immunosuppressants cannot be used casually. This matter is more difficult, so I am here to tell you specifically."
Zhou Jun had heard of the little conflict between Zhao Jianguo and Sun Li'en.He glanced at Zhao Jianguo in surprise, then took the report, nodded after a moment, "I'm sorry to trouble you."
Zhao Jianguo, an old fox, knows very well that it will not be a matter of overnight to reverse the previous conflict and hostility.Anyway, the current Sun Li'en has no direct threat to him, as long as he slowly releases his goodwill, the conflict between the two sides can be resolved.He nodded to everyone in the room, then turned and left the conference room.
"Please consult the Department of Intensive Care Medicine, Nephrology, Respiratory Medicine, and Rheumatology and Immunology." Sun Lien rubbed his face, feeling exhausted and powerless rising from the bottom of his heart one after another.The patient's situation is too complicated, and he can't think of any treatment method that is more suitable for the patient.After much deliberation, I had no choice but to call experts from other departments to come and make suggestions—anyway, I can’t have a headache alone.
Zhou Jun said, "Let me get in touch. This patient is troublesome. I might have to ask their director for consultation." He looked at Dr. Pascal, and then said, "I will not invite the chief director of the Department of Rheumatology and Immunology. Come here, as long as Professor Pascal is here."
Dr. Pascal smiled wryly. He had seen two patients with the same disease before, but that was many years ago.It was so long that he almost forgot whether the two patients were male or female.But Pascal remembered their ending clearly.Neither made it through, and one patient died after being diagnosed with the disease in the rheumatology and immunology department at Massachusetts General Hospital.The other died of DIC on the second day of treatment.
The prognosis of patients with pulmonary hemorrhage-nephritic syndrome is generally poor.Before the medical profession generally adopted blood replacement plus immunosuppressants, combined with high-dose glucocorticoids, and received long-term dialysis treatment, the general five-year survival rate of patients with pulmonary hemorrhage-nephritic syndrome was less than 10%.More than 80% of patients die within one year of onset.But with the gradual advancement of medicine, the five-year survival rate of this disease has been increased to 70%.
But these patients are pure pulmonary hemorrhage - nephritic syndrome.They did not come with S. aureus infection.
Staphylococcus aureus is a ubiquitous bacterium.They are most likely to enter the blood from the patient's body surface wound, or infect the surrounding tissue to cause purulent infection, or settle in the heart and lungs with the blood, causing pericarditis or pneumonia.More terrifying than ordinary Staphylococcus aureus is its evolutionary form, Methicillin-resistant Staphylococcus aureus (MRSA).
Sometimes we can often see reports of so-called "super bacteria" on TV.This report refers to methicillin-resistant Staphylococcus aureus infection.Because the medical community did not pay enough attention to bacterial drug resistance before the 70s, a large number of antibiotics were abused, which led to the rapid evolution of Staphylococcus aureus.The newly evolved Staphylococcus aureus is extremely insensitive to methicillin, and is resistant to β-lactam antibiotics and cephalosporin antibiotics with the same structure as methicillin.And because of the modification of the antibiotic target, they even have varying degrees of resistance to antibiotics such as aminoglycosides, macrolides, tetracyclines, and fluoroquinolones.Among the antibiotics currently available to humans, only vancomycin is effective against methicillin-resistant Staphylococcus aureus.
But whether Wang Lin was infected with this terrible bacterium is still unclear.There is no clear indication in the status column, and the testing department needs at least four hours to confirm the presence of MRSA in the sample by PCR.
"The first thing is to control the infection." Wu Faxian, director of the Department of Critical Care Medicine who came to participate in the consultation, made a speech, "For patients with GMB nephritis, kidney damage has already formed. To put it bluntly, people can still live without kidneys. , but if the infection develops to the point of sepsis, it will be difficult to save."
Tian Huaguang, chief director of the Department of Nephrology, pondered for a while, and asked with a frown, "The condition of the patient's kidneys is not bad. If the anti-infection treatment can be ended as soon as possible and the immunosuppressive treatment can be switched to, his kidneys will still be damaged." I hope to save it." He looked at Dr. Pascal and asked, "I remember that in the current mainstream treatment plan, double nephrectomy is no longer a routine strategy?"
"Indeed not." Dr. Pascal nodded. "In addition to plasma exchange, the commonly used drugs are the combination of methylprednisolone, prednisone and cyclophosphamide. It is probably similar to the immunosuppressive regimen after organ transplantation. However, a large-scale treatment with glucocorticoids alone is required. Dosage shock therapy to relieve pulmonary hemorrhage."
"How about adjusting the treatment plan a little bit?" Listening to the discussions of many big bosses, a bold plan suddenly popped up in Sun Lien's little heart that had some spooky ideas. "Is it possible to use plasma exchange to reduce the amount of GMB antibodies in his blood while anti-infection treatment, delay the progression of lung and kidney damage, and then perform immunosuppressive treatment after confirming that the infection has been eradicated?"
Zhou Jun opened his eyes wide, and was about to criticize Sun Li'en for not following the routine.Dr. Pascal called out first, "Good idea!"
Plasma exchange is to draw the patient's blood from one side of the vein, and divide the drawn blood into plasma and blood components through a centrifugal pump.After discarding the patient's own plasma, inject fresh plasma, albumin solution, or a plasma substitute such as balance solution at the same speed.
The fundamental purpose of using this treatment in this case is to reduce the absolute amount of GMB antibody in the patient's blood.
Antibodies floating in the blood will be separated from the human body along with the plasma, and this method alone can reduce a considerable amount of GMB antibodies-plasmapheresis can generally replace about one-third of the plasma in the human body at a time.In other words, without the use of immunosuppressive drugs, plasma exchange can reduce the antibody in the patient's body by about 30% within a certain period of time.
Of course, the replacement volume of plasma exchange can be adjusted according to demand, and it is not impossible to replace all the plasma in the patient's body in one go.However, such extreme plasma exchange can easily cause more troublesome situations such as systemic hemolysis.Considering that Wang Lin's lungs were still bleeding, whole body plasma exchange was obviously inappropriate.Therefore, after additional discussion with experts from Director Li of the Department of Hematology, everyone agreed that Wang Lin should undergo plasma exchange of 50% of the total blood volume first, and immediately start anti-infection treatment after the plasma exchange was completed.
The head of the hospital infection department came uninvited after hearing that there might be MRSA infection.Before the PCR test results came out, the hospital infection department resolutely opposed the direct use of vancomycin to treat patients.
The reason for hospital infection is simple, "Even if it is MRSA infection, a considerable part of non-drug-resistant bacteria can be eliminated by using traditional antibiotics. The true methicillin-resistant Staphylococcus aureus reproduces slowly, and all MRSA colonies have There are both methicillin-resistant and methicillin-susceptible strains. After the first use of antibiotics, a large number of sensitive bacteria will be killed within a few hours. When the resistant strains grow slowly and proliferate, it will be a few hours later ——At that time, the PCR test results of the clinical laboratory will definitely come out. According to the judgment of PCR, then consider whether to use vancomycin.”
Anyway, in the medical records of patients suspected of MRSA infection, the hospital infection department has the highest decision-making power on the use of antibiotics.Moreover, their reasons are indeed sufficient, and treatment according to their plan can also ensure the safety of patients.Naturally, Sun Li'en and the others would not have any objections.
But no one expected that the most fierce opposition came from Wang Lin's daughter.
"You all know that my dad may be infected with superbugs, why not use vancomycin?" She looked very angry, and her sharp voice directly penetrated the door of the conference room.
Sun Lien plucked his ears in distress, and persuaded in a harmonious voice, "The current antibiotics are not completely ineffective. Regardless of whether he is infected by super bacteria or not, the most appropriate solution is to use safer antibiotics first."
"I don't care!" She slapped the table hard, "It's not that we don't have money, why don't you give my dad the best medicine?"
"Where is the best medicine?" Sun Lien smiled wryly, "As long as it works, it is the best medicine. We doctors can't just use a certain medicine indiscriminately just because it's new or famous."
Hu Jing, the head nurse, heard the voice approaching, and she winked at Sun Lien, signaling Xiao Sun to get out of the way and let the professional come.Sun Lien also stepped aside obediently. Yu Gong and Hu Jing are the head nurses, so she will definitely not be able to stop Sun Lien if she wants to get started.Yu Si, as Hu Jing's prospective niece and son-in-law, and he was sure he couldn't beat Hu Jia's natal aunt, he could only obediently step aside.
"Little girl, the medicine is three-point poisonous." Hu Jing began to persuade in a homely tone, "Vancomycin has serious side effects, do you really think doctors are reluctant to use it? This medicine is precious, according to our Song'an Province According to regulations, vancomycin is not included in the medical insurance. It is a self-paid drug. If the doctor refuses to use it, it must not be because of money..."
A little far away, Sun Li'en felt a little heartbroken listening to the head nurse's explanation.It is obviously for the benefit of the patient, why do you have to pour some dirty water on yourself before explaining it clearly?
(End of this chapter)
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