Chapter 610 Iron metabolism and neuronal autophagy

However, the situation now has suddenly changed.

Even Xu Qiu didn't expect that S+ surgery would reduce the surgical damage to 50%!

Coupled with the bonus to prognosis, control of complications, etc. in the additional rewards, the patient's recovery effect may be much better than Xu Qiu expected.

He promised to bear more money than the medical insurance limit, and it is very likely that he will not be able to spend it...

…

"Doctor Xu, this patient's postoperative surgery..." After leaving the operating room and dealing with the patient's family, the director of the brain surgery department hurriedly found him.

Generally, patients with subarachnoid hemorrhage can follow routine postoperative care.

In addition to close monitoring of changes in vital signs and neurological signs, there is also specialized care such as dehydration to reduce intracranial pressure, blood pressure control, circulation improvement, and nerve nutrition.

But taking blood pressure control as an example, it has always been quite controversial clinically, and there is no accurate conclusion until now.

First, hypertension and hypervolemia are one of the most important measures to reduce vasospasm and prevent ischemia; but at the same time, increased blood pressure can also cause systolic blood pressure to exceed the transmural pressure of blood clot compliance,

This is similar to the replantation of severed fingers in hand surgery.

After replantation of a severed finger, if the rehabilitation exercise is carried out too early, the sutured tendons, muscles, nerves, etc. are at risk of tearing; but if it is carried out too late, the tendons and other tissues in the healing state will become adhesions.

If it was just a general aneurysm clipping operation, the blood pressure would probably be under control. However, in the face of such a dangerous condition, there is a high probability that the medical insurance will exceed the limit, so Xu Qiu still needs to finalize the specific care details.

The director of brain surgery said: "According to the recommendations of the European Stroke Management Organization, systolic blood pressure less than 180mmHg can reduce the risk of rebleeding..."

Xu Qiu shook his head: "With systolic blood pressure less than 140mmHg, it is still difficult to offset the risk of early rebleeding."

The director of the brain surgery department was shocked: "Where is this research, the Country of Berry? Or the Country of Little Japan?"

Xu Qiu couldn't give an answer... These were lessons learned from simulated operating rooms and master-level experiences. Without evidence-based medical evidence, authoritative research data would naturally not be available.

"Continue to press down and control the blood pressure at around 130mmHg." Xu Qiu said.

The director of brain surgery's face changed slightly: "Clinically, it is generally controlled at around 160... If it is too low, the incidence of vasospasm and ischemia will be greatly increased!"

"No." Xu Qiu said firmly.

The incidence of re-bleeding is directly related to high blood pressure. When blood pressure is high, blood vessels will be broken. This is difficult to avoid even with the additional bonus of S+.

However, vasospasm and ischemia can be controlled with the help of various amplification effects.

Therefore, the best way is to lower blood pressure as much as possible. As for other complications caused by lower blood pressure, they can be avoided by the addition of S+...

Thinking of this, Xu Qiu added: "The blood pressure control of 130 is limited to this patient and should not be used clinically."

He has systematic help that other doctors don't have.

The director of the brain surgery department wiped his sweat... Even if they were asked to follow such a bold blood pressure control plan, they wouldn't have the courage!

"By the way, there's one more thing."

After the office was silent for a long time, Xu Qiu suddenly spoke.

The director of the brain surgery department immediately stood up and said, "Doctor Xu, tell me!"

"An additional monitoring after surgery is iron metabolism level."

"Iron metabolism?" The director of brain surgery was a little confused.

Clinical iron metabolism monitoring is mostly used for the diagnosis of blood diseases, such as iron deficiency anemia.

But if you really want to connect it with neurosurgery, some theories can indeed be involved - for example, iron is an essential trace element during the growth and development of nerve cells. It plays a role in neurotransmitter synthesis, DNA synthesis, and even affects the normal function of nerve cells. play an important role in its maintenance.

However, monitoring iron metabolism after brain surgery was unheard of for him.

Xu Qiu gave the answer: "It has nothing to do with growth and development. The key is that iron metabolism produces neurotoxic oxygen free radicals, which play an important role in EBI."

EBI stands for early brain injury, and the director of brain surgery naturally understands it.

He was a little surprised: "What is the principle of this?"

Xu Qiu asked: "What is the mechanism of brain damage in patients after subarachnoid hemorrhage?"

This was the director’s research direction, and he blurted out: “Microvascular dysfunction, and cortical depolarization.”

Xu Qiu nodded: "I also overlooked one point, the damage to the brain caused by bleeding itself."

The director was suddenly startled: "You mean... red blood cells can damage brain tissue?!"

"No, red blood cells themselves have no effect on brain tissue. However, hemoglobin is released during the dissolution of red blood cells. If hemoglobin continues to dissolve, iron ions and reactive oxygen species will be produced...both of which are highly neurotoxic."

The director's expression changed completely, and he stared at Xu Qiu in disbelief.

The latter continued: "If iron ions are allowed to accumulate, nerve cells will induce the autophagy mechanism."

The director of brain surgery said seriously: "Okay, I will immediately notify the nursing department to monitor the cerebrospinal fluid iron metabolism level and reduce it to the lowest possible level!"

"No."

Xu Qiu shook his head: "The induction of autophagy mechanism in nerve cells by iron ions can protect damaged neurons to a certain extent, and can even fight brain damage."

The intelligence of the human body far exceeds that of the most sophisticated machinery. Its own phagocytosis mechanism can eliminate damaged organelles and degradable cellular materials. This is one of the body's self-stabilizing abilities.

What Xu Qiu needs to do is to maintain the autophagy mechanism at a critical point where it can just devour damaged neurons, but not be too excited and cause damage to normal nerve cells.

The doctrine of the mean runs through medicine, and "just right" is the most essential three words.

"I understand..." The director of neurosurgery let out a long breath, his expression was extremely solemn, and his eyes looked at Xu Qiu with more respect and gratitude.

In just a few days, he has learned a lot of incredible clinical experience from Xu Qiu. Just monitoring the level of iron metabolism can greatly improve the prognosis of neurosurgery in Greentown First Hospital.

...

Fourth hour after the operation, neurosurgery and ICU were still guessing whether the patient could wake up within the golden 72 hours, and the news of the patient's awakening came from the ward.

For a time, the director of neurosurgery, the director of ICU, and others were shocked.

What is this outrageous recovery speed?

For critical subarachnoid hemorrhage, which also affects the brain stem, after an operation, it is considered good if the patient can wake up within three days. Many patients may even develop into a vegetative state to varying degrees...

He woke up in three hours? !

"No wonder Dr. Xu can give lectures..."

"Four hours! Even if it is an ordinary abdominal surgery under general anesthesia, you can't say that the patient will wake up in four hours!"

"Have you recorded the video of the operation? Hurry up, find an expert group and ask all the brain surgeons in the province to jointly analyze what improvements have been made to this operation compared to ordinary operations!"