Of course, Wang Lin's treatment has not started yet. Sun Lien tried his best and finally suppressed the immunosuppressive treatment plan first.
"The sample sent to us was found to contain Staphylococcus aureus." Zhao Weiguo took the report and handed it to Zhou Jun with a serious face. "I looked at the report from the pathology department. This is a patient with pulmonary hemorrhage-nephritis syndrome.
.But if you have Staphylococcus aureus infection, you cannot just use immunosuppressants. This matter is more difficult, so I am here to tell you specifically."
Zhou Jun had heard about the little conflict between Zhao Weiguo and Sun Lien. He glanced at Zhao Weiguo in surprise, then took the report, paused for a moment, nodded and said, "Sorry to trouble you."
Zhao Weiguo, an old fox, knew very well that reversing the previous conflicts and hostility would not happen overnight. Anyway, Sun Lien was not a direct threat to him now. As long as he slowly released his goodwill, the conflicts between the two sides could be resolved. He nodded at everyone in the room.
He nodded, then turned and left the conference room.
"Invite the Department of Critical Care Medicine, the Department of Nephrology, the Department of Respiratory Medicine and the Department of Rheumatology and Immunology for consultation." Sun Lien rubbed his face, feeling tired and powerless rising from the bottom of his heart one after another. The patient's condition was too complicated.
He couldn't think of any treatment method that was more suitable for the patient on his own. After much deliberation, he could only call experts from other departments to come up with suggestions. I couldn't have the headache alone.
Zhou Jun said, "Let me contact you. This patient is in trouble. You may have to ask their director to come over for consultation." He looked at Dr. Pascal, and then said, "I won't ask the director of the Department of Rheumatology and Immunology.
Come on, just have Professor Pascal here."
Dr. Pascal smiled bitterly. He had seen two patients with the same disease before, but it was many years ago. It was so long ago that he almost forgot whether the two patients were male or female. But their
Pascal remembers the ending very clearly. Neither of them could survive. One patient died after being diagnosed with the disease in the Department of Rheumatology and Immunology at Massachusetts General Hospital. The other patient died of DIC on the second day after treatment.
die.
The prognosis of patients with pulmonary hemorrhage-nephritis syndrome is generally poor. Before the medical community generally adopted blood replacement plus immunosuppressants, combined with high-dose glucocorticoids, and long-term dialysis treatment, the prognosis of patients with pulmonary hemorrhage-nephritis syndrome was poor.
The general five-year survival rate is less than 10%. More than 80% of patients will die within one year of onset. However, with the gradual advancement of medicine, the five-year survival rate of this disease has been increased to 70%.
But these patients had simple pulmonary hemorrhage-nephritis syndrome. They did not have accompanying Staphylococcus aureus infection.
Staphylococcus aureus is a ubiquitous bacterium. They are most likely to enter the bloodstream from the patient's surface wounds, or infect surrounding tissues to cause purulent infection, or settle in the heart and lungs with the blood, causing pericarditis or pneumonia. Compared with
Compared with ordinary Staphylococcus aureus, what is even more terrifying is its evolved form, methicillin-resistant Staphylococcus aureus (mrsa).
Sometimes we often see reports on the so-called "superbugs" on TV. This report is talking about methicillin-resistant Staphylococcus aureus infection. Because the medical community did not pay enough attention to bacterial resistance in the past, there were a large number of them before the 1970s.
The misuse of antibiotics has led to the rapid evolution of Staphylococcus aureus. The newly evolved Staphylococcus aureus is extremely insensitive to methicillin and is also sensitive to beta-lactam antibiotics and cephalosporin antibiotics with the same structure as methicillin.
Resistance. And because the target site of antibiotics has been modified, they are even resistant to varying degrees to aminoglycosides, macrolides, tetracyclines, fluoroquinolones and other antibiotics. The antibiotics currently available to humans
Among them, only vancomycin is relatively effective against methicillin-resistant Staphylococcus aureus.
However, it cannot be confirmed whether Wang Lin is infected with this terrible bacteria. The status column does not clearly state it, and the testing department will need at least four hours to use PCR to confirm whether there is MRSA in the sample.
"First of all, we must control the infection." Wu Faxian, director of the Department of Critical Care Medicine who came to participate in the consultation, gave a speech. "For patients with gmb nephritis, kidney damage has already been formed. To put it harshly, people can still live without kidneys.
, but if the infection develops to the point of sepsis, it will be difficult to save."
Tian Huaguang, the chief director of the Department of Nephrology, pondered for a while. He frowned and asked, "The patient's kidney condition is not bad. If the anti-infective treatment can be ended as soon as possible and transferred to immunosuppressive treatment, his kidneys will still be healthy."
I hope to save it." He looked at Dr. Pascal aside and asked, "I remember that in the current mainstream treatment plan, double nephrectomy is no longer a routine strategy, right?"
"Indeed not." Dr. Pascal nodded. "In addition to plasma exchange, the commonly used combinations of methylprednisolone, prednisone and cyclophosphamide are similar to the immunosuppressive regimen after organ transplantation.
.However, a large-dose shock treatment with glucocorticoids alone is required to alleviate the pulmonary bleeding."
"How about slightly adjusting the treatment plan?" Listening to the discussion of many big guys, a bold plan suddenly came to Sun Lien's little heart with some weird ideas. "Can we use anti-infection treatment first?
Plasma exchange reduces the amount of gmb antibodies in his blood, slows down the progression of lung and kidney damage, and then carries out immunosuppressive treatment after confirming that the infection has been eliminated?"
Zhou Jun opened his eyes wide and was about to criticize Sun Lien for not following the routine. But Dr. Pascal shouted first, "What a great idea!"
Plasma exchange is to extract the patient's blood from a vein on one side, and divide the extracted blood into plasma and blood components through a centrifugal pump. After discarding the patient's own plasma, fresh plasma, albumin solution, or balance solution, etc. are injected at the same speed.
Plasma substitutes are a treatment option.
The fundamental purpose of using this treatment in this case is to reduce the absolute number of gmb antibodies in the patient's blood.
The antibodies floating in the blood will be separated from the human body along with the plasma, and this method itself can reduce a considerable amount of gmb antibodies. Plasma exchange can generally replace about one-third of the plasma in the human body at one time. In other words,
, without the use of immunosuppressive drugs, plasma exchange can reduce the antibodies 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 needs. It is not impossible to replace all the plasma in the patient's body at one go. However, this extreme amount of plasma exchange can easily cause systemic hemolysis and other more troublesome situations.
Considering that Wang Lin's lungs are still bleeding, whole-body plasma exchange is obviously not suitable. Therefore, after additional expert discussion with Director Li of the Department of Hematology, everyone agreed that Wang Lin should first undergo plasma exchange of 50% of the total blood volume.
After the operation, anti-infective treatment is started immediately after the completion of plasma exchange.
The boss of the hospital's infection department came uninvited after hearing that there might be MRSA infection. Before the PCR test results came out, the hospital's infection department was firmly opposed to directly using vancomycin to treat patients.
The reason for hospital infection is simple, "Even if it is an MRSA infection, the use of traditional antibiotics can eliminate a considerable part of the non-resistant bacteria. The truly methicillin-resistant Staphylococcus aureus reproduces slowly, and all MRSA colonies have
There are both methicillin-resistant and methicillin-sensitive strains. After the first use of antibiotics, a large number of sensitive bacteria will be killed within a few hours. It will take a few hours for the resistant strains to slowly grow and multiply.
The PCR test results from the laboratory will definitely be available by then. Based on the PCR judgment, we will consider whether to use vancomycin."
Anyway, in the medical records of patients with suspected mrsa infection, the hospital infection department has the highest decision-making power on the use of antibiotics. And their reasons are indeed sufficient. Treatment according to their plan can also ensure the safety of the patient. Naturally, Sun Lien and others cannot
What opinions would you have?
But no one expected that the fiercest opposition would come from Wang Lin's daughter.
"You all know that my father may be infected by super bacteria, why not use vancomycin?" She looked very angry, and her sharp voice penetrated directly through the door of the conference room.
Sun Lien dug his ears in distress and advised harmoniously, "The current antibiotics are not completely ineffective. No matter whether he is infected by super bacteria or not, using safer antibiotics first is the most appropriate solution."
"I don't care!" She slammed the table hard, "We don't have money, why don't you give my dad the best medicine?"
"Is there any best medicine?" Sun Lien said with a bitter smile, "As long as it is useful, it is the best medicine. We doctors cannot use it indiscriminately just because it is newly released or because it is famous."
The head nurse Hu Jing heard the voice and came over. She winked at Sun Li'en and signaled Xiao Sun to get out of the way and let the professionals come. Sun Li'en also obediently gave up his position. Yu Gong, Hu Jing was the head nurse, and she wanted to attack Sun Li'en.
There was definitely no way to stop him. Yu Zi, as Hu Jing's prospective niece-in-law, and he definitely couldn't defeat Hu Jia's aunt, he could only obediently give up his position.
"Little girl, the medicine is 30% 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 valuable. According to our Song'an Province's
According to regulations, vancomycin is not covered by medical insurance. It is a self-paid drug. If the doctor refuses to use it, it must not be because of money issues..."
A little further away, Sun Lien felt a little heartbroken as he listened to the head nurse's explanation. It was obviously for the patient's benefit, so why did he have to pour some dirty water on himself before he could explain clearly?