This doctor has a system

Chapter 494 558. The curse really gave us a brain hemorrhage

"Who are you trying to scare?" the auntie was very angry. "I think you are cursing our baby!"

"Why would I curse a child for no reason?" The pediatrician was speechless.

"Who knows? I think you just can't bear to see us get along well!" the aunt accused, "You cursed us to bleed and break bones, and now you're talking about life and death!"

"What on earth do you want to do!"

The baby's mother frowned. She tried to speak several times but was interrupted by her mother-in-law. She had no choice but to turn her head and give her husband a look.

But her husband seemed like a fool at this moment, not saying a word. Director Zhang who was seeing the patient began to doubt whether the child was his.

"Mom! Listen to the doctor!" The child's mother couldn't help but said, "I saw on the news that many children have problems after falling."

She is the person who has taken care of the child for the longest time. The child's condition is indeed different from before. He eats much less and is sleeping all the time.

My mother-in-law said that sleeping more is a good thing because it helps children grow.

But as a mother, she was a little worried.

"CT scans have radiation! How can you be so ignorant!" the old lady said angrily, "He just wants to cheat you out of your money!"

"It doesn't matter whether it's money or not. If such a young child is exposed to radiation, he will become stupid in the future!"

"Do you know?"

"You've never been to school! You don't even know as much as I do!"

"Sister, who told you that a CT scan will make you stupid?" Pediatrician Director Zhang said with a wry smile, "That's complete nonsense!"

"Of course you said that, but your child didn't do it!" said the aunt angrily.

"Mom, let's do one!" The baby's mother made a decision, "Since we are in the hospital, we must listen to the doctor."

Seeing that her daughter-in-law didn't listen to her, the aunt became even angrier.

"Baosteel! What do you think?" she asked her son.

"I think," the man hesitated, "anything is fine."

"Then do it!" The baby's mother stood up and said, "Doctor, please give us a prescription."

Director Zhang breathed a sigh of relief. Finally, there was someone who understood the situation.

"The child is too young, so he definitely won't be able to actively cooperate when we do it." He explained, "If he cries a lot, we will routinely use some sedatives."

"Oh my God!" The aunt's exaggerated voice sounded again, "Sedative? ! ! Oh my God!"

"What do you want to do!"

"You sedated such a young child! Are you still a human being?!"

"I'm going to report you for taking human life lightly!"

"quack!"

"Sister, please don't do this." Director Zhang felt that he had never been wronged as much as he had today. He took a deep breath and said, "This is a very common operation. Many children do this."

"It can also be used on children younger than your baby."

"I don't care! We don't want to use sedatives!" The aunt said, "I won't listen to you. If you insist, we won't do it!"

"In that case, you guys should think about it first." Director Zhang was also annoyed and decided to respect the family's opinion.

It is enough to inform the risks, the child is not his.

Thinking of this, my heart instantly calmed down.

"Let's do it now." The baby's mother said, then ignored her mother-in-law's yelling, picked up the child and walked out.

"What a sin! Why did I marry someone like you?"

Hearing the old lady's cursing outside the door, Director Zhang gave a helpless smile.

The child's mother is also unlucky to have such a mother-in-law.

"Did you see the male family member just now?" He said to the two female students standing behind him, "Remember, you should not marry a man who becomes dumb after encountering such a situation."

"Lao Zhang, what kind of man is unmarriageable?" Director Fan pushed the door open and walked in. "Why, are you talking to a student?"

"Talking about trivial matters." Director Zhang of the Pediatric Department said unhappily, "I just met a weirdo. I'm so angry."

"What do you want? Tell me now!"

"Look at what you said. If nothing happens, can't I come over to see you?" Director Fan said with a smile.

"You will come to see me?" Director Zhang snorted disdainfully, "Do you have such good intentions?"

"Look at you, you're always so impolite." Director Fan said cheerfully, "But you're right, I really have something to talk to you about."

"I have a patient with idiopathic pulmonary hypertension. I want to see if you have any good solutions."

"Oh, how old is the patient?" asked Director Zhang.

"29." Director Fan replied.

"29 months?"

"29 is old."

"Did you kick yourself in the head?" Director Zhang looked up at him, "This is pediatrics! Are you blind?"

"I know you're in the pediatric department." Director Fan said speechlessly, "Just listen to me talk about the situation first."

The patient is Qin Mengying, female, 29 years old.

Some names sound very amazing. Many people would imagine in their hearts before meeting Qin Mengying that with such a nice name like Mengying, its owner should also be a beauty, right?

It really is.

Qin Mengying is an absolute beauty, and it is no exaggeration to say that she is so stunning that she can captivate fish and geese.

With the blessing of beauty, Qin Mengying's first half of life can be described as smooth sailing.

But perhaps because she was so beautiful, she was envied by God. Four years ago, she found that there seemed to be something wrong with her body.

She gets tired easily, and sometimes gets out of breath after walking a short distance. At first she thought she was tired, not from work, but from dealing with several high-quality suitors, which made her feel more tired mentally.

"Doctor, am I sub-healthy?"

"Not really. How can the symptoms of sub-health be so serious?" The doctor quickly wrote her a few checkup orders and said, "Go do it."

Qin Mengying is very compliant. She attaches great importance to her beautiful body. She even asked the doctor to prescribe more tests since she was here anyway.

But the subsequent examination results made her fall into great panic.

"You," the doctor said in embarrassment, "need to be hospitalized."

Qin Mengying sensed something was wrong from his furrowed brows.

"Doctor, what's the problem? Is it serious?"

"Your pulmonary artery pressure is too high. This is very abnormal." The doctor explained, "We need to find the cause."

Pulmonary hypertension is a pathophysiological state of abnormally elevated pulmonary artery pressure caused by a variety of known or unknown reasons. The hemodynamic diagnostic criteria are: at sea level and in a resting state, the mean pulmonary artery pressure measured by right cardiac catheterization is ≥25 mmHg.

Isn’t it good to be too high?
It is not only bad, it is extremely harmful.

Initially, patients present with exertional dyspnea and fatigue. Symptoms gradually worsen, and patients may eventually develop severe pulmonary hypertension with overt right ventricular failure, chest pain or syncope on exertion, and congestion, as well as peripheral edema, ascites, and pleural effusions.

The final result is death.

According to statistics, before 2009, the average survival time of patients with idiopathic pulmonary hypertension was only about two years.

After hearing what the doctor said, Qin Mengying was so frightened that she lost her mind and went to complete the hospitalization procedures while crying.

"Don't worry so much, let's check it out first." The attending doctor comforted him, "If it is secondary, you may be cured after the cause is eliminated."

Apparently Qin Mengying was not so lucky. After further examination, she was eventually diagnosed with idiopathic pulmonary arterial hypertension.

The so-called idiopathic refers to isolated pulmonary hypertension without a clear cause, characterized by a persistent increase in pulmonary vascular resistance, while the left atrial and pulmonary venous pressures are roughly normal.

There is no epidemiological data on idiopathic pulmonary arterial hypertension in my country, but overall, the incidence of idiopathic pulmonary arterial hypertension is very low and it is one of the first rare diseases announced in my country.

It is common in young and middle-aged women, with an average age of onset of 30-39 years old, but it can affect infants and the elderly. Male patients have a worse prognosis than female patients.

The current treatment level has made great progress, and the 5-year survival rate of patients with idiopathic pulmonary hypertension has been greatly improved.

But there are also some people who are not very lucky.

Qin Mengying's luck was probably used up when she chose her beautiful appearance. Her treatment was not effective. Even though she had been taking oral medications regularly, her condition continued to worsen.

A lot of things have changed in four years. Qin Mengying is in a very bad condition now. Her severely declined cardiopulmonary function makes it difficult for her to carry out daily activities.

A specialist evaluated her and found that if her condition could not be controlled, she might lose her life soon.

This is undoubtedly a very cruel fact for a 29-year-old girl.

With a desire to survive, she came to Xhe Hospital accompanied by her family.

As a rare disease, idiopathic pulmonary hypertension naturally attracted the attention of Director Fan.

Qin Mengying's diagnosis was very clear. He carefully looked through the previous medical records and found no problems. The basis for the diagnosis was very sufficient.

The most important thing now is what treatment to do next? Which treatment can improve the patient's condition, slow down the progression of her disease, and thus prolong her survival.

As an incurable disease, the initial treatment of idiopathic pulmonary arterial hypertension is generally targeted drug control.

Currently available targeted drugs for pulmonary arterial hypertension mainly involve the following three signaling pathways: 1. Endothelin pathway (bosentan, etc.), 2. Nitric oxide pathway (sildenafil, vardenafil, and tadalafil, etc.) and 3. Prostacyclin pathway (epoprostenol, treprostinil, etc.).
Some friends may be more familiar with the drugs of the second pathway. Yes, it is the little blue "Yao Wan" that you often take!
As the saying goes, "one pill is enough" to be swallowed, and the fate of your second brother is up to you.

The second drug is strong!
But such a strong drug is not very effective for Qin Mengying. According to the standard treatment process, she has tried targeted drug treatment, but her symptoms are still getting worse.

Last year, she started a combination of three targeted drugs for treatment. Even though it came at a high cost, her chest tightness symptoms did not improve, and her daily activities became increasingly difficult, making it almost impossible for her to lead a normal life.

This is clearly a sign of disease progression.

After arriving at Xhe Hospital, Director Fan quickly reassessed her physical condition and found that Qin Mengying had developed severe right heart failure.

In a six-minute walk test to measure her cardiopulmonary function, she walked only 6 meters.

The 6-minute walk test is a commonly used method to assess exercise tolerance in patients with chronic heart failure.

Simply put, it is to let patients walk as quickly as possible in a straight corridor to walk as far as possible within 6 minutes. The degree of heart failure is assessed based on the distance the patients walk.

This experiment is very simple, easy to perform, highly safe, convenient and practical.

如果6分钟步行距离＜150米，表明患者存在重度心功能不全；如果距离在150-425米，则是中度心功能不全；如果距离在426-550米之间，则是轻度心功能不全。

Qin Mengying was only 29 years old, but she only walked 197 meters.

Subsequent cardiac catheterization examination showed that her pulmonary artery pressure had exceeded the systemic blood pressure, which was severe pulmonary hypertension.

In this case, relying solely on oral medication is definitely not enough. The only option left for Qin Mengying is surgical treatment.

There are currently three surgical options available, namely atrial septostomy, lung transplantation/heart-lung transplantation, and Potts shunt.

Atrial septostomy is a procedure that opens a "window" in the atrial septum of the patient's heart to form a blood flow channel between the left and right atria. Like the Potts shunt, it can also relieve pressure on the pulmonary artery.

However, the operation will cause hypoxia in the patient's upper and lower body, and the heart and brain will not get sufficient oxygen supply, affecting the patient's long-term quality of life.

For lung transplantation/heart-lung transplantation, firstly, lung transplant donors are very limited and it is very difficult to find lung transplant donors.

In addition, after lung transplantation, the patient's airway is connected to the outside world, which increases the risk of infection, making perioperative management of the patient difficult and reducing the postoperative survival rate.

For patients with pulmonary hypertension and severe heart disease, combined heart-lung transplantation is required, which further increases the technical difficulty, surgical risk, and difficulty in obtaining donors.

The Potts shunt operation was pioneered in 1946 by Willis J. Potts, a famous American pediatric cardiac surgeon. It was first used to treat children with cyanotic congenital heart disease and oligopulmonary anemia. By performing a side-to-side anastomosis between the descending aorta and the pulmonary artery, a shunt between the systemic and pulmonary arteries is created, which can increase the amount of blood circulating in the lungs and ultimately improve the systemic hypoxic state.

As an innovative treatment for pulmonary hypertension, reverse shunt between the systemic and pulmonary arteries is used to decompress the pulmonary arteries.

In 2004, Dr. Blanc from Necker Children's Hospital in Paris, France, used it for the first time to treat two children with severe pulmonary hypertension after congenital heart disease surgery. After the surgery, pulmonary artery pressure dropped significantly and right heart function was significantly improved.

"Didn't you study at Necker Children's Hospital in Paris?" Director Fan stated the purpose of this trip. "I remember hearing you say before that you participated in Potts shunt surgery there."

"That's right." Director Zhang said proudly, "My instructor at the time was Dr. Blanc's most proud disciple. He has now succeeded Dr. Blanc and become an authority in this field!"

Director Fan was overjoyed and was about to continue questioning when a middle-aged woman rushed in holding a baby. She kicked the door open and started yelling.

"You are so proud now! You really cursed us and gave us a brain hemorrhage!"

(End of this chapter)