Chapter 2077

For the uninvited boss Zheng, ringer is still full of hope.

Boss Zheng is really a cow, but can he have any good methods for such a clueless consultation? I hope so.

Ringer looked at boss Zheng with expectant eyes.

"I agree with Professor Gu that the diagnosis of systemic lupus erythematosus is relatively clear." Zheng Ren said in a deep voice.

"Boss Zheng..." the director of gynecology was stunned.

The doctors of gynecology and obstetrics are a team in smaller hospitals. Although there are different departments in 912, gynecology has a deep understanding of obstetrics.

The intrauterine intervention operation just completed by boss Zheng is no less than a fantasy for gynecologists and obstetricians.

But that's not an error. Boss Zheng is full of confidence and even dares to do live surgery directly.

It's a great power. Even the gynecological director of 912 has the deepest worship and even awe for boss Zheng.

Professor Gu said the same thing with an attitude. But from boss Zheng's mouth, it became another attitude.

The director of gynecology hesitated for a moment. Instead of condescending and scolding boss Zheng, he put on a posture of listening.

"I think the course of disease records recorded that after the application of immunotherapy, the patient had the symptoms of panic and shortness of breath.

Considering acute left ventricular dysfunction, after diuretic and cardiotonic treatment, the patient's asthma and suffocation improved, but the palpitation gradually aggravated. The reexamination of UCG showed that LVEF was 36% and pulmonary artery pressure was 35 mmHg. "

Zheng Ren did not look at the medical records and said with a smile: "so far, systemic lupus erythematosus is still considered in the diagnosis. There is no evidence that heart valves, cardiac conduction system and coronary artery are involved, so heart failure may be caused by systemic lupus erythematosus involving myocardium."

"It can be treated according to systemic lupus erythematosus. The patient's condition has worsened." Asked the gynecological director.

Ringer was also puzzled. The doctors in the office were puzzled.

"I have several considerations about the aggravation of cardiac function damage under the application of hormones and immunosuppressants.

First, the strength of the original treatment plan is not enough. I agree with Professor Gu that shock therapy can be given to save the function of important organs.

Second, * water and sodium retention and weight loss after application of hormones may also present similar symptoms.

Third,... "

The whole room was silent.

Rheumatic immune diseases are indeed difficult to diagnose and treat. Even old clinicians for many years may not even be exposed to rheumatic immunity.

Related diseases are complex and have various treatments, which is why Su Yun said that he went directly to rheumatism immunity in case of diseases he can't understand.

As for the high-level doctors in the rheumatology and Immunology Department, most of them will despise standing on the peak of medical technology, overlooking other disciplines and say, "they will also see a doctor?"

Boss Zheng, a doctor in the intervention department, sits here talking and talking, firm and confident. It's really a trance.

"There seems to be something wrong with the lungs." I don't know who asked in a low voice.

"The texture of both lungs of the patient is significantly thickened, which is an imaging manifestation." When Zheng Ren heard the question, he had already said it.

"At this time, we need to judge whether the lung texture layer thickness is the lung infection induced by hormone application or the manifestation of systemic lupus erythematosus in the lung.

Of course, I just went to see the patient.

The patient retained a nasogastric tube due to intestinal obstruction, still had vomiting and choking cough, and was bedridden, used hormones and inhaled by mistake. Therefore, inhalation pulmonary infection cannot be excluded. "

This is the whole story. It is similar to what the previous professor of respiratory medicine said. It is suspected of avoiding the important and taking the light.

However, Zheng Ren changed his words and said, "but fever, pulmonary symptoms and aggravation of cardiac insufficiency occur at the same time, and chest high-resolution CT does not indicate that there is a clear infection focus in the lung, so the anti infection is ineffective. It is more likely to be caused by the activity of systemic lupus erythematosus."

"It is written in the medical record that the patient is suspicious of Reynolds phenomenon. I think this is one of Professor Gu's judgment bases."

"If you worry..." Zheng Ren began to pursue the rationality of clinical diagnosis.

In general, the diagnosis of rheumatic immune diseases is relatively erratic. In the case of patients, it is best to do cystoscopy to take tissue biopsy. But the urology department also said that the condition of the bladder wall is not suitable for biopsy.

The best way is renal biopsy.

"I suggest persuading the patient's family members to do renal biopsy." Zheng Ren said firmly, "after biopsy, we can determine the problem."

Ringer felt a big black pot coming at him.

The reason for diagnostic treatment is that the family members of the patients believe that nausea, vomiting and diarrhea have nothing to do with the kidneys, so they insist that it is a problem of gynecological surgery.

Do you want a biopsy?

If someone else said it was necessary to have a biopsy, ringer would not believe it. This kind of operation is a fuse that may lead to the intensification of contradictions. Once there is no positive finding, it is hard to say how the mood of the patient's family changes.

But if boss Zheng said, ringer began to figure out how to explain to the patient's family.

"If the patient's family members agree with renal biopsy, the result is positive and can be treated in a more radical way." Zheng Ren thought for a moment and said, "methylprednisolone 1g, once a day, pulse therapy + intravenous immunoglobulin 20g, once a day. Then he was given cyclophosphamide 1.0g, pulse therapy, hydrocortisone succinate 300mg, every day."

This dose

If you misjudge, it's enough to die.

Ringer looked at boss Zheng with a sad face. The dosage was so large.

After using 0.2g cyclophosphamide for one day, the patient's myocardium was seriously damaged. But boss Zheng even gave 1g. This... This

It's not easy to explain.

Ringer was thinking about lightning. When he thought of lethal dosage, he should be more careful.

He looked up at boss Zheng. His gentle and steady smile gave ringer almost unlimited confidence.

There was silence in the office. Professor Gu looked at Zheng Ren with surprised eyes. This dosage was the most extreme dosage in his imagination.

Although he just said that he would need high-dose shock therapy, Professor Gu knew that he could hardly use such a limited amount to give drugs to patients.

Shock therapy with this amount is usually performed after biopsy to determine systemic lupus erythematosus. Before that, boss Zheng definitely said the dosage

Boss Xiao Zheng is too brave. Is he a doctor in the interventional department or an expert in rheumatic immunity.

After pondering for a while, ringer closed his notebook and reluctantly smiled, "well, let's ask the patient's family to go to the medical office. I'll discuss with them about doing renal biopsy."

Ringer was forced.

It is estimated that there will be an arduous battle on the side of the medical office.