Chapter 982 Infection after liver cancer? Challenge the treatment plan of the guide!

"Three minutes are up."

While Shi Lian and others were still wondering, the ending bell rang.

All the assessment venues fell silent instantly, and all the contestants looked at the invigilator at the same time.

In the clinical examination room, the invigilator took out a record sheet and asked at the same time: "What is your diagnosis?"

As the captain, Shi Lian replied: "Septic shock."

The condition was so clear that there wasn't even a second diagnosis.

A septic shock can kill you in seconds.

Even if there are other diseases, they are nothing in front of septic shock, and all treatment measures must be focused on this disease.

Hearing the answer, the invigilator nodded, recorded it, and waited for the instructions in the headset.

After waiting for a minute, new content appeared on the screen in front.

This time it is about the diagnosis and treatment measures after admission.

Including inspection methods, inspection results and disposal plans, etc.

Shi Lian read it one by one and extracted the key points.

1. The patient’s blood concentration of tacrolimus and other drugs has increased several times compared with before.

2. In routine blood tests, white blood cells increased and lymphocyte levels were extremely low.

3. Coagulation test showed that there were only 36 platelets left, while the normal value is about 100 to 300 units.

4. Liver function test showed that the patient's bilirubin was 137 units, which was much higher than the normal value of 3.4 to 21.

5. The patient's Glasgow Coma Scale score is 8, which is considered severe coma.

Based on the above admission examination, the hospital also gave corresponding treatment plans.

One is to use invasive ventilators and CRRT.

The latter, in particular, is known as a life-saving artifact in the ICU and a heavy weapon that ignites the life of critically ill patients.

It can effectively remove macromolecular toxins, has a strong adsorption function, and can ensure hemodynamic stability, precise control of volume balance, etc., and is suitable for severe patients, especially septic shock and other diseases that cause acute multi-organ failure. fruitful.

In addition, we need to maintain the original antibiotic regimen, continue to use immunosuppressants after liver cancer surgery, etc...

…

After reading all the messages, the participating teams began to discuss.

"The patient has frequent diarrhea, and the current antibiotic regimen has no obvious effect. There is no way to confirm the source of infection, and it is impossible to control the infection..."

"Whether there is a more serious secondary infection or the original infection is not under control, this is very important!"

"The next step should be to increase the level of the antibiotic regimen?"

"Immunosuppressants also need to be considered here. The patient has developed sepsis. At this time, the body's immunity is very precious. Isn't it unreasonable to use immunosuppressants at this time?"

"Immunosuppressants will definitely be used after liver transplantation..."

The focus of discussion varies from hospital to hospital.

Some focus on identifying the direct cause of the worsening of the condition, while others believe that the level of antibiotics should be directly increased.

However, more people are paying attention to immunosuppressants.

This stuff is a necessary drug after organ transplantation and cannot be stopped.

But the patient himself had a serious infection and his immunity was already very weak, and he used immunosuppressants to suppress the last bit of immunity.

After the immune cells strike, the patient's life can only be left to CRRT and antibiotics.

Xiehe Assessment Site.

Liudera tapped the table with his index finger and said while thinking: "It is mentioned in the guide that it can be partially deactivated, as long as it is not completely removed."

The invigilator glanced at him with a slightly surprised expression.

Except for liver transplant specialists, few people can take into account these medication details.

At this time, Chen Qiao added: "The patient has liver cancer and needs a liver transplant, and the risk of tumor recurrence must also be considered."

The recurrence of liver cancer is not only related to the aggressiveness of the tumor itself, but also closely related to the body's immune function.

When a patient is in a state of strong immunosuppression, the body's immune surveillance system will be damaged, and the tumor will easily relapse and metastasize.

However, insufficient doses of immunosuppressants can easily lead to rejection reactions.

This balance has always been a difficult problem in organ transplant surgery, and it is rarely managed well.

Of course, severely infected people are also included.

Chen Qiao thought for a while and said: "The level of the antibiotic regimen used by the patient is already very high. There is no need to increase it, and it cannot be increased, otherwise the gain outweighs the loss.

"Furthermore, patients should maintain immune balance at this time, and it is more appropriate to withdraw all immunosuppressive drugs."

After saying this, Liu Si looked over and asked, "Has Director Xu Qiu ever performed a liver transplant?"

Chen Qiao was stunned for a moment... What does her opinion have to do with her teacher?

But she didn't say much, shook her head and said: "I have never done a liver transplant alone. But the teacher can do combined heart, liver and lung transplants."

This is the surgery Xu Qiu performed in the World Championships.

In the current medical world, only Miaoyou Clinic can perform this state-of-the-art multi-organ combined transplant, and there are only two doctors in the world who can handle it.

Even Omid, the surgical genius at Miaoyou Clinic, can only perform surgery under various strict favorable conditions.

"this……"

Liu Si suddenly fell silent.

He originally wanted to yell at Chen Qiao, because after all, Xu Qiu had not completed a lung transplant.

As a result, I forgot that Xu Qiu once performed a combined heart, liver, and lung transplant in the World Championships.

But at that time, everyone's attention was focused on Xu Qiu's ranking in the top ten, and most people ignored this miraculous operation.

"... The guidelines in the United States are different from ours. If we completely withdraw immunosuppressants, even if we can control the infection, the patient will die from the rejection reaction... And can it be controlled?" Liu Si was choked and said.

Medicine is about weighing the pros and cons.

If the immunosuppressants are not withdrawn, the patient will definitely not have rejection.

The price is to bear the decline of the function of their own immune cells.

However, the patient's own immune function is actually not much, even if it recovers, it is almost nothing.

But if the immunosuppressants are withdrawn, the increased immunity is not much, but they still have to face the dangers brought by the rejection reaction, which is not worth the loss.

"This..." Chen Qiao still wanted to argue.

But after three minutes of discussion and voting, the group finally gave another answer.

Maintain the level of the antibiotic regimen unchanged.

Modify the idea of ​​using immunosuppressants, changing "maintaining the original dose" to partial withdrawal.

Chen Qiao opened her mouth and wanted to say something.

My teacher is very good at treating severe acute pancreatitis, a disease with a very high mortality rate, and the most troublesome thing is severe infection.

Chen Qiao has been following for so long, and actually has a lot of experience in dealing with patients with such complex infections.

But she still said nothing in the end.

Although Chen Qiao is the deputy captain, with Liu Si around, her voice will be much smaller.

…

At the same time, inside the clinical medical competition venue.

Everyone is still arguing.

"Antibiotics definitely don't need to be moved, but I think all immunosuppressants should be removed." Shi Lian said.

Jiang Mai and others are a little unsure.

"I have followed the surgery of our liver transplant department. The "Daxia Liver Cancer Liver Transplantation Clinical Practice Guidelines" actually has clear regulations that do not recommend the full withdrawal of immunosuppressants." Jiang Mai said.

Shi Lian stood up, she came to the front of the screen, pointed to one of them and said: "You have overlooked a key point... This is also the key to the withdrawal of immunosuppressants."