I can see the status bar

Chapter 1083
The half-life of glucocorticoids is shorter than that of ordinary chemical drugs, but the human body still needs some time to metabolize them.The hormone Liu Pingchuan used during the rescue was prednisone, which has a half-life of about one hour in the body.

An hour and a half has passed since the transfer from He'an Hospital to the high-tech park of Tongde Hospital.The glucocorticoid level in Liu Lianzhi's body has dropped to a level approximately equal to that of 90 mg of prednisone.

Due to the high level of interleukin-2 in the body, the blood level of the drug is approximately equal to the effect of intravenous infusion of 90 mg of prednisone... For Liu Lianzhi, it is basically nothing.

"No matter what the outcome of the discussion between these two people is, we still have to deal with it as soon as possible." Sun Lien said to Chen Tianyang after a few seconds of silence, "But... why did Zhu Minhua come here?"

"He came directly from the capital, and it seems that he will arrive on the [-]th." Chen Tianyang explained, "Both the chief directors of the critical care department and the emergency department of the Tongxie have come, but the chief director of critical care seems to be in the red zone now. inside."

In many hospitals, emergency and severe cases are actually "not separated".Doctors in the intensive care medicine department need to rotate to the emergency department, and emergency doctors also need to enter the intensive care medicine department ward for further training.The relationship between the two parties is much closer than that between other departments—these two departments are essentially the same, and both were set up to treat urgent and critically ill patients.However, in the specific implementation process, the two departments have their own emphasis.

The emergency department tends to deal with "emergency", while the intensive care department prefers to deal with "severe".And neither side cares about the specific disease of the patient—they care about everything.

The reason why the words critical and severe illness are often used together is very simple. Critical illness, emergency, and severe illness are often mixed together.Systematic and comprehensive monitoring and treatment are required for all patients, so that it is possible to snatch them back from Lord Yama.

Therefore, in many hospitals, the emergency department and the intensive care medicine department are actually like a pair of twin brothers. Not only do the doctors in the two departments have to rotate with each other to keep up job rotation.

However, the reason why Sun Lien was "swept out" by the intensive care medicine department of his own hospital was also because of the special positioning of Ningyuan No. [-] Hospital.As a major emergency center, the relationship between the Department of Critical Care Medicine and the Emergency Department of the Fourth Hospital is not so balanced—the level and level of the emergency care unit of the Emergency Department itself is similar to that of others.

The result is that severe cases need to often send their own department doctors to the emergency department for advanced training, while in emergency cases, only the doctors and chief physicians who are responsible for managing the emergency care unit need to go to intensive care for advanced training.

Now that the director of the critical care department from the Tongxie is working in the red zone, it is not a big problem to hand over the relevant discussions to Zhu Minhua.But... Sun Lien blinked, feeling that the current atmosphere is still a bit strange.

Liu Pingchuan usually has a good temper. Although Zhu Minhua has a short temper like all other emergency doctors, he is still a good person.What's more, the two are still brothers and colleagues, so they should have a pretty good personal relationship.

Then... these two people are like anxious roosters now, what's the situation?
"Okay, let's discuss the matter." Song Wen obviously felt that the smell of gunpowder between the two people was a bit strong, so she interrupted their argument.When Sun Lien came in just now, Song Wen had already seen the sneaky figure of this kid, so it would be good to use him to change the subject now, "Director Sun, have you checked the patient's condition?"

"I've seen it." Sun Lien was used to things like being called out suddenly.He replied calmly, "But I haven't seen the patient yet. It's not easy to grasp the overall situation if we only look at the test results."

"The matter of entering the red zone can be discussed later." Song Wen did not prevent Sun Lien from entering the red zone to go directly to see Liu Lianzhi.She knew very well that Sun Li'en was good at business, but the price was such a "habit" - it was not enough to just read the relevant inspection reports and reports from subordinate doctors, the patients he took over had to be seen by himself. "The current situation is that the patient's blood oxygen is not getting up, and there is an inflammatory storm."

"According to past experience, inflammatory storm and blood oxygen deficiency are actually two sides of the same problem - the core point is still the new coronavirus infection." Sun Li'en nodded, "Actually, the core points of the opinions of Dean Liu and Professor Zhu are both The same, nothing more than one focuses on suppressing the inflammatory storm, and the other still focuses on protecting the circulatory system."

"Don't meddle with the work of our internal medicine department." Zhu Minhua muttered, "How can there be such a way to ignore the circulatory system and do plasma exchange first?"

"Plasma exchange is actually a good way." Sun Lien looked at Zhu Minhua and said, "It's just that it should be combined with some other treatment plans."

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Sun Lien's design of the treatment plan is like this.

First of all, ECMO must be used.While on ECMO, Liu Lianzhi should start plasma exchange as soon as possible.At this time, plasma exchange has three meanings: lowering blood potassium, lowering blood interleukin-2 levels, and protecting Liu Lianzhi's kidneys.

Hypoxemia will have a serious impact on the kidneys. Sun Lien even suspected that Liu Lianzhi might have had acute kidney injury caused by hypoxemia.Although plasma exchange can not quickly increase blood oxygen saturation like ECMO, it can replace part of the original plasma that is full of metabolic waste due to insufficient filtration by the kidneys.This is of great therapeutic value.

But Sun Lien's plan is not just a simple suture monster of Liu Pingchuan and Zhu Minhua's plan, he also proposed a new treatment direction - after completing the plasma exchange, immediately use convalescent plasma, total glycosides of paeony and phosphoric acid for Liu Lianzhi Hydroxychloroquine combination therapy.

"I can understand the use of plasma from convalescents, but what about total glucosides of paeony and hydroxychloroquine phosphate?" Not only Zhu Minhua, but even Liu Pingchuan and Song Wen were puzzled.

"These two drugs themselves are immunomodulatory drugs, and they can work when glucocorticoids are not very effective, or when we cannot accurately estimate the level of immune regulation by glucocorticoids." Sun Lien explained, "At the same time, we have previously It was found in a single case that these two drugs may have a certain hindering effect on the replication of the new coronavirus."

As soon as this remark came out, the entire meeting room was in an uproar.Song Wen asked anxiously, "Why are you talking about this kind of thing now?"

"Because we are not really sure." Sun Lien said with a sigh, "It is a complete accident to find that total glucosides of paeony and hydroxychloroquine phosphate may be effective."

He described Zhang Min's situation in the ICU in detail before, "We have analyzed the medicines used for her treatment after infection, and the other medicines are conventional treatments, but these two medicines are for other new coronaviruses. Patients infected with pneumonia have not used it."

"After ruling out all possibilities, the suspicion of these two drugs is the biggest - but to confirm that these two drugs may have the effect of inhibiting virus replication, more clinical trials are needed to prove it." Sun Lien said earnestly, " Dean Liu himself also meets the conditions of 'selecting immunosuppressive drugs other than glucocorticoids'. My opinion is that since immunosuppression is needed, try using these two drugs. Even if they do not have the effect of inhibiting virus replication, they themselves The immunosuppressive effect it has is also what Liu Lianzhi urgently needs."

"This is still equivalent to conducting unapproved clinical trials of drugs on patients." Zhu Minhua was the first to object, and his attitude seemed very conflicted, "If you don't say that these two drugs may have a certain effect on hindering virus replication, then We can just give the medicine a try..."

"I can't lie." Sun Lien said very sincerely, "This violates clinical ethics and does not meet moral requirements. It is impossible for me to conduct experiments on uninformed patients just to see if this drug is effective. "

"Make it effective in vitro first, and then apply for clinical trials as soon as possible." Zhu Minhua sighed, "Fortunately, all kinds of experimental approvals are relatively fast now, and these two drugs are old clinical drugs, and their safety is still guaranteed. Yes. After the approval, if it’s really not possible, Liu Lianzhi will be treated as a sympathetic drug test subject and declared.”

"But we still need an immunosuppressive drug that is different from glucocorticoids and Xenipex." Liu Pingchuan coughed lightly and asked, "These two drugs are common immunosuppressive drugs, and at least one of them It should be fine, right?"

Sun Li'en blinked, this is... All in all, do you want to try it first?
"Don't meddle with your surgeons." Zhu Minhua glared at Liu Pingchuan, and then said to Sun Lien, "Doctor Sun...Director Sun, do you think...which drug is more suitable for Liu Lianzhi as an immunosuppressive drug?" He He emphasized the words "immunosuppression" and asked, "I have to use it anyway, so choose the one you think is suitable."

There was silence in the entire conference room, and Sun Lien also hesitated.

Total glucosides of paeony and hydroxychloroquine phosphate showed a certain antiviral effect on Zhang Min, but the effect was not too strong.At least not as well as ribavirin for respiratory syncytial virus (RSV) infection in infants and young children.

This may be due to mutual interference between the two drugs, or it may be because neither of them has antiviral effects, but the metabolites produced after the two drugs are taken at the same time play a role in hindering virus replication.

This is undoubtedly a big gamble, and the cost of losing the gamble is likely to be a life.

Sun Lien was silent for a long time, his brain was running at full speed, hoping to find a safer route.But after more than a minute, he still couldn't find a solution that could convince him.

"When hydroxychloroquine phosphate is used in immunosuppressive effects, it can reduce the dosage of glucocorticoids. A small amount of glucocorticoids can also achieve the same immunosuppressive effect as high-dose glucocorticoids." Sun Lien thought about it and decided to start from the shortcomings Starting with the analysis, "Dean Liu Lianzhi still has relatively high levels of glucocorticoids in his body, and the use of hydroxychloroquine phosphate may lead to enhanced hormone effects..."

Thinking of this, Sun Lien made a decision, "After completing the plasma exchange, use total glucosides of paeony."

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"His condition is not very good, and he may not be able to answer your question." Sun Lien changed into the protective clothing and was about to enter the cabin. Chen Tianyang followed behind with a little worry, checked Sun Lien and put it on, and he exhorted, "Old Liu is very good." , I usually do things very seriously. But because of the influence of hypoxemia, my consciousness is not very clear."

"Understood." Sun Li'en nodded, he probably guessed what Chen Tianyang wanted to say.

When Liu Lianzhi refused to accept the ventilator before, Liu Pingchuan was able to use diazepam without saying a word, so there is no doubt that there was a problem in the middle.For example... agitation or agitation.

Coupled with Chen Tianyang's phrase "he's a good person" that came out of nowhere, Sun Li'en had already guessed what kind of patient he would probably face.But it doesn't matter, isn't it just being scolded by the dean, he can still get used to this kind of thing.

After entering the ward, Sun Li'en quickly met this Dean Liu and began to observe his treatment.

Sun Lien has seen the ECMO operation itself, but the previous group performed V-VECMO, that is, blood is drawn from the patient's vein into the tube, and reinjected into the vein after being oxygenated by the machine.This process increases the oxygen content of the blood and replaces the function of the lungs.But now Liu Lianzhi is receiving V-AECMO. After blood is drawn from the vein, it is oxygenated and pressurized by the machine, and then injected into the artery.

This process can reduce the burden on the heart of a large number of patients and at the same time play a certain role in extracorporeal circulation.However, under the combined effects of tranquilizers and anesthetics, the torrential scolding that Sun Lien was prepared to face did not come as expected - Liu Lianzhi even seemed a little helpless with his eyes closed.

Sun Lien was looking at Liu Lianzhi's status bar, but suddenly heard a soft cry from a little distance away.

Turning his head following the voice, Sun Lien saw a person in protective clothing lying on top of another medical worker in protective clothing in front of the nurse's station.The one holding the person in his arms is patting his colleague gently with his hand.

"That's...President Liu's wife." The doctor who was changing gloves after completing the ECMO catheterization shook his head in a Beijing accent. In a ward, the identities are the patient and the head nurse..."

"I've seen enough of similar things." Sun Li'en said firmly, "Anyway, the superior also said, regardless of the consequences and the cost, let's let go, and we must keep the head nurse's partner no matter what. OK."

Although he said "we must keep it", Sun Lien knows better than anyone how big Liu Lianzhi's problem is now.

The status bar indicated a myocardial injury lasting about 51 hours, as well as four symptoms of hyperlactic acidemia, acute kidney injury, and acute liver injury.This means that Liu Lianzhi has already developed MODS (Multiple Organ Dysfunction Syndrome) caused by ARDS (Respiratory Distress Syndrome).His body is already on the verge of collapse, and his age of [-] has become the core factor affecting the treatment.

Although he yelled loudly, Sun Li'en looked at Liu Lianzhi lying on the bed with his eyes closed, and felt... not very good.

(End of this chapter)