Chapter 487 Incomprehensible doctor's advice!

How did I find the cause of pancreatitis?

And... is hypertension related to these? There is no literature showing that hypertension is directly related to pancreatitis and hypoxia!

Xu Qiu took out the instructions for hydrochlorothiazide tablets and showed them to everyone.

"This is..."

Director Xiao stared at the area Xu Qiu pointed out, which was the "adverse reactions" column.

The first few items were nothing special.

For example, it may cause water and electrolyte disorders, hyperglycemia patients are prone to reduced glucose tolerance, hyperuricemia patients are prone to interfere with the excretion of uric acid by the renal tubules, etc.

But soon Director Xiao's eyes widened, and on the last few items, he mentioned in a relatively small font: "This drug can also cause cholecystitis, pancreatitis, sexual dysfunction... etc., but it is relatively rare."

Pancreatitis? !

The clinical gastroenterology department has not treated a single patient with pancreatitis caused by hydrochlorothiazide, but this is clearly mentioned in the drug instructions.

"In other words, the cause of the patient's pancreatitis is because of the use of this antihypertensive drug?" Director Xiao felt as if he had suddenly realized something.

He looked at Xu Qiu in astonishment.

Director Jiang sighed: "Doctor Xu, you are wasting your talent if you don't become a policeman..."

It's obviously a disease diagnosis, but there is a sense of déjà vu of solving a case!

"So, the hypoxia you mentioned, Doctor Xu... is also related to hypertension and hydrochlorothiazide?" Director Xiao asked.

Xu Qiu returned to his desk, clacking on the keyboard for a while, confirmed the new treatment plan, and said: "We will know soon."

...

In theory, when people are sent to the ICU, they will be under the care of special doctors and nurses, and other departments generally dare not interfere with the treatment in the intensive care unit.

But Xu Qiu is obviously an exception.

Director Jiang took Director Xiao and others back to the ICU and couldn't wait to open the computer to check the doctor's orders.

"Low molecular weight heparin anticoagulation?"

Everyone was shocked.

Why did an anticoagulation measure suddenly come? This is a means of treating thrombotic diseases such as coronary heart disease, stroke, pulmonary embolism, etc. Analyzing from Yuan Yu's situation, could it be that she has pulmonary embolism?

But the problem is... if Xu Qiu judged that she had pulmonary embolism, the common clinical treatment would be thrombolysis + anticoagulation.

Thrombolysis is to remove the emboli that have already been produced by the patient.

Anticoagulation is to prevent the formation of new emboli.

Theoretically, for an emergency such as pulmonary embolism, the core is to dissolve the thrombus as soon as possible and relieve the blockage of the pulmonary artery, which should be ranked before anticoagulation. Why did Xu Qiu only do embolism and not thrombolysis?

"I can't figure it out." Director Xiao and others were a little confused.

Even in the respiratory department, pulmonary embolism is a high-level disease that only the director can touch. In addition to a few directors of the respiratory department, only Wang Ping in the emergency department has a chance to save her.

Of course, Xu Qiu, who has a 100% survival rate, is too abnormal. It will increase the survival rate of patients in the clinical department. It is unfair and will not be included in the statistics.

"What are you still standing there for? Hurry up and give him a low liver!" Director Jiang yelled at the attending doctor who was watching the excitement behind him.

"Oh..." The attending doctor hurriedly followed the doctor's instructions.

Seeing this, Director Jiang breathed a sigh of relief.

Fortunately, he was fast, otherwise the boy would ask him why he only used anticoagulation. If he said he didn't know, the director's authority would be discounted.

He is different from the shameless Director Xiao.

However, although everyone present had only a vague understanding of this newly added treatment plan, it did not prevent the front-line doctors from implementing the doctor's instructions.

After all, Xu Qiu had long been the final word in Linyi. Believe first, then question!

...

Yuan Yu, the patient, first attracted everyone's attention because of his complicated condition.

Later, the mystery was peeled off layer by layer, and pancreatitis was locked on the antihypertensive drug hydrochlorothiazide. Now everyone is curious about the treatment method of anticoagulation without thrombolysis.

Many people in Linyi are paying attention to this medical record.

Xu Qiu doesn't have so many thoughts.

He is busy studying the colon replacement bladder surgery for Xun Yu.

Every time she makes rounds, this girl will ask again. When she hears the answer that it will take some time, her shining eyes are sad.

However, applying a gastroenterology surgery to urology is almost like crossing over, and it can't be rushed.

In a few days, Xu Qiu, in addition to the usual outpatient clinics and surgeries, turned down all unnecessary meetings, and devoted himself to the operating room in his mind, and finally made considerable progress.

"The first stage is roughly completed..."

The general process of the operation has been determined, and the next step is to enrich the details and make detailed adjustments to the replaced colon and bladder functions.

Xu Qiu's expression is a little solemn.

The real difficulty lies in the details.

If Xun Yu was a man, it would be simpler.

The female urethral sphincter and nerve control mechanism are more complicated, and the medical understanding of them is relatively low. Therefore, the difficulty and success rate of this operation have gender differences.

After dozens of attempts, Xu Qiu really tried something new.

For example, according to conventional thinking, this operation must cut the urethral pubic ligament, and then perform colon replacement surgery.

However, after repeated surgeries, Xu Qiu found that retaining the urethropubic ligament would significantly improve the prognosis and functional recovery!

After careful analysis, he realized that this ligament plays an important role in maintaining the stability of the urethra and maintaining the normal vesicourethral angle of the new bladder.

Not only that.

Xu Qiu also integrated a high-position ligation of the dorsal venous complex operation, allowing the vaginal wall to participate in the support and maintenance of the new bladder, which further improved the success rate.

In addition to these details, Xu Qiu also made improvements to the major surgical procedures.

For example, Xun Yu's condition is neurogenic bladder, that is, the original bladder has lost the ability to store and discharge urine. Since a new one is needed, whether it is an ordinary person or a urologist, the first reaction must be to remove the entire original bladder.

This is exactly what Xu Qiu did at the beginning.

However, he found that retaining a part of the bladder neck can help the new bladder adapt to the body and restore normal function faster...

This is a pleasant surprise. As for whether to apply it to real surgery, Xu Qiu is still struggling.

After all, this is a risky move. If you retain too little, you will have urinary incontinence. If you retain too much, it will cause the new bladder to be over-controllable. In short, you still have to find a balance between the two. If you retain too much or too little, there will be problems.

"It will take some time to polish..." Xu Qiu entered the simulated operating room again.

At the same time, there was good news from the ICU.

After three days of treatment, Yuan Yu is out of danger!

In fact, on the first day of anticoagulant therapy, the patient's upper limit of blood oxygen saturation began to loosen, from 89 after several drops, slowly rising to 95, has entered the range of normal people.

On the third day, the hypoxia symptoms were completely improved. After the ventilator was removed, the patient's blood oxygen saturation was still controlled at around 99, completely offline and pulled back from the edge of danger!

After two hours, after the last assessment, Yuan Yu can be transferred back to the general ward.

It was at this time that Director Xiao, Director Jiang and others finally couldn't hold back and rushed to the office.

Seeing that Yuan Yu was about to get better and be discharged from the hospital, they still didn't understand the internal logic of Xu Qiu's doctor's advice!