I can see the status bar

Chapter 1091 Reincarnation (Blood Donation Plus Series 068069)

本章是为了感谢书友“墨洛丝薇瑟”在2020年6月14日以及2021年1月3日所捐献的全血而加更。他之后还有两章成分血加更以及五章盟主加更等待更新。

Life passes away and new life is born.Passing and birth make up this river called life.We are often unable to restore the past, but the new life can always dilute the grief and sadness in our hearts time and time again.Because that is new life, and new life often represents hope.

Guan Guxue and Zhao Jian's child has a name.The young couple discussed it for a while, and then decided to tell the news to the doctor who took care of them.

"Yes, his name is Zhao He'an." Zhao Jian said to the nurse station through the beeper, "otherwise you would have to call him 'Guan Guxue's son' every time, this... sounds weird, and it is inconvenient for you to call him .”

"Yeah, that's right, Yunhe's crane is safe and sound." Zhao Jian added, "I hope our Yunhe can be safe and sound..."

Little Zhao Hean's inspection began.And this time the inspection will determine whether he will continue to receive treatment or start using ECMO for life support.

After seeing Zhao Hean's test results, Qian Hongjun's first reaction was also viral myocarditis.But he quickly put a question mark on that judgment.

If it is viral myocarditis, it seems to progress slowly.

The two main indicators that can support the judgment of viral myocarditis are Zhao Hean's muscle phosphorylase-isoenzyme (CK-MB) and a very high level of N-terminal pro-B-type natriuretic peptide (NT-proBNP).Among them, the increase of CK-MB indicates myocardial injury, while the N-terminal B-type natriuretic peptide precursor indicates that the heart has already experienced heart failure.

However, Zhao He'an has not had breast milk since he was born. It is theoretically speculated that the immune level in his body is relatively poor.And the time point when he was most likely to be infected should be when he was in the same room with his parents on the day of his birth-judging from this point in time, Zhao Hean has been infected with the new coronavirus for as long as his birth day.

After such a long-term infection, if it weren't for the newborn's tolerance to hypoxia is stronger than that of adults, he may have developed more serious symptoms long ago.

It can be known from the medical records that Zhao Hean's N-terminal B-type natriuretic peptide precursor first increased on February 2, when the N-terminal B-type natriuretic peptide precursor level was 1pg/ml.

For the first time after birth, a newborn relies entirely on its own circulatory system to survive. This is a very difficult test for his immature heart.In fact, when a completely healthy newborn is just born, his serum N-terminal B-type natriuretic peptide precursor may be as high as 1991.53±916.99 pg/ml, and this level will gradually decrease after birth.

If this understanding is applied to Zhao Hean, it is not difficult to find that he was admitted to the hospital again on the fifth day after birth, and the level of N-terminal B-type natriuretic peptide precursor detected at that time was 541pg/ml... This clinical significance is not very big.After all, the research on the level of N-terminal pro-B-type natriuretic peptide in newborns is not enough, and there is a lack of a standard value for comparison.Under the circumstances at the time, this value did not necessarily mean that Zhao Hean had heart failure—it might just be a birth peak that had not yet been metabolized.

But the problem is that after excluding the clinical significance of the increase of N-terminal B-type natriuretic peptide precursor, there is no explanation for the increase of CK-MB level.For other patients with novel coronavirus pneumonia, the rise of CK-MB generally occurs after severe respiratory distress syndrome, but Zhao Hean does not have such a problem.

Qian Hongjun thought about it, and decided not to put the child on ECMO, and now he has to figure out what's wrong with him.

Like...was there a congenital heart defect?
With such a big child, and a new type of coronavirus infection, it is more difficult to perform a CT examination on him.Once he was out of oxygen support, Zhao Hean's finger pulse oxygen level dropped rapidly all the way to about 77%, which means that any movement of him now may be very risky.After hesitating for a while, Qian Hongjun decided to have a bedside ultrasound first.

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"Guess what I found?" Sun Lien heard Qian Hongjun's call from the mobile station. If it weren't for the fact that the upstairs and downstairs wards were not allowed to visit each other casually, Sun Lien felt that Qian Hongjun might come and dance on the spot. "It's much easier now!"

"What? Who? What's the matter? What happened?" Sun Lien expressed his confusion with a series of phrases with a Northeast flavor, "Director Qian, don't be so surprised, it's scary!"

"Only Zhao He'an, I found the reason why his heart failure marker went up!"

"Who is Zhao He'an?" Sun Li'en looked confused again. He has seen all the patients in the North Sixth District, and he has an impression of everyone's name. At present, there are only two patients surnamed Zhao in the entire North Sixth District. It is a recovered person who has been negative for nucleic acid once and has been certified by the status column, and the other is Zhao Jian.

"It's the one you helped transport here in the morning!" Qian Hongjun said in a tone of "Is your kid's brain broken?" "Didn't you just meet him in the morning?"

"That kid? I don't know what his name is!" Sun Li'en said helplessly again, "I didn't know his name when I went to pick him up."

"In short, his problem has been clarified." Qian Hongjun ignored Sun Lien's explanation, and he said excitedly in the mobile station, "It's not viral myocarditis, it's the ventricular dilatation caused by viral pneumonia combined with cardiopulmonary insufficiency, this child has atrium. septal defect."

Atrial septal defect is a relatively common heart defect and the most common congenital heart disease in adults.When a birth defect is common in adults, it's not hard to see why it's less fatal in children most of the time.

Most children with atrial septal defect basically have no symptoms. Apart from being prone to symptoms such as colds and respiratory infections, they even have no problems with activities most of the time.Patients often have to wait until adolescence for symptoms such as palpitations and fatigue.At this time period, the patient's condition will start to deteriorate rapidly, and it will worsen after the age of 40.Atrial fibrillation, atrial flutter and other arrhythmias and manifestations of congestive heart failure often occur.

The bedside B-ultrasound test showed that Zhao Hean's atrial septal defect was about 6.9mm, and there was a slight enlargement of the right atrium and right ventricle.Based on general clinical experience, doctors will advise parents to perform heart surgery repair on such children before school age.After the surgical repair, due to the improvement of hemodynamics, the symptoms of the children will be significantly reduced or even disappeared.The long-term survival rate in the future will not be significantly different from that of normal people.

In other words, the most frightening situation for doctors has been lifted—Zhao Hean does not have viral myocarditis, and there is no need to worry that he will develop severe acute myocardial injury.As long as the fluid intake is controlled and the pressure on the heart is relieved by active diuresis, his circulatory system will begin to improve rapidly.

His biggest problem now is only one-new coronavirus infection.

Zhao Hean, who was only [-] days old, is likely to be the youngest patient with pneumonia caused by the new coronavirus.Many of the treatments that work well for adults don't work very well for him.

"Anyway, there should be no point in using triple therapy for such a young child." Sun Lien knew it in his own mind. He is really not good at pediatric internal medicine. It is relatively weak, and there is no need to worry about immune storms. Use interferon to fight the virus, and then can you consider letting mothers start breastfeeding as soon as possible?"

"We have already taken a breast milk sample to send for PCR, but I don't think it is necessary." Qian Hongjun said, "Mothers with confirmed breastfeeding their confirmed children don't have to worry about infection anyway. The immune substances contained in breast milk can also Help sick children recover."

There is no content related to breastfeeding confirmed patients in the current relevant guidelines.But out of an abundance of caution, doctors generally don't recommend that mothers who have been diagnosed breastfeed their babies -- it's not yet certain whether there will be live novel coronavirus in breast milk.After all, it is now certain that the new coronavirus can attack human intestinal cells, causing diarrhea and abdominal pain.In order to prevent confirmed mothers from transmitting the virus to their children, the current recommendations are all "formula feeding".

But for two cases that were both confirmed by nucleic acid, such risk does not exist at all.It would be better to say that Guan Guxue, who is gradually recovering, has become Zhao Hean's greatest hope for recovery.

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Qian Hongjun concentrated on adjusting the treatment plan for Zhao Hean, while Sun Lien was a little melancholy about Sister Pan's case.

Although it was known from the beginning that the essence of triple therapy and other supportive treatments was still only "symptomatic treatment", when most patients responded well to triple therapy, Sister Pan's condition has not improved, which made Sun Lien very worried.

Sister Pan's course of illness was too long.

From the moment the medical team arrived at the Yunhe City Infectious Disease Hospital, Sister Pan became one of the most worrying patients in the hospital.Even Mr. Shen, who was on ECMO, has been safely offline, while Brother Peng, who has a tumor, failed to persist.Sister Pan's vital signs started to recover pretty well, but then she began to slide toward the abyss again and again.

Patients who have lived in the ICU for a long time often have a layer of dead skin with a layer of fish scales on their legs.Sister Pan is like this now-her legs are covered with dead skin, which looks particularly shocking.

It has been more than [-] days since she received mechanical ventilation, and Sister Pan's indicators are still not very good.The inflammation index has dropped, but no matter how many antiviral drugs are used, the lesion area on her lungs has not disappeared.

The blood oxygen saturation is also gradually decreasing, and her blood oxygen saturation has dropped to 91%.The means of mechanical ventilation have reached their limit, and there is no room for adjustment.

"It may be necessary to transfer her to the ICU upstairs." At the case discussion meeting hosted by Director Lu, everyone came to such a conclusion-the medical team has almost exhausted all the treatment methods for Sister Pan.If you want to go further...then you can only go to ECMO.

But the situation was different from Mr. Shen's. None of the doctors present had the confidence to let Sister Pan withdraw safely.She has not responded well to all the current treatments, and the only way left is to use the plasma of convalescents.

But... the blood plasma of all the recovered patients in North Fifth District has been transferred to use on Zhang Min in the ICU ward.When the next batch of plasma will arrive... is yet to be known.

The number of recovered patients is increasing, but they still have to wait 14 days before it is safe to donate plasma.

"This matter... Director Sun, can you communicate with Dean Zhang?" At the end of the discussion, there was still no clear result.Director Lu Zhimin can only hand over this headache to Sun Lien to continue to have a headache, "We can only think of a few treatment options now, go to ECMO to continue to support the treatment, and then increase the amount of interferon inhalation treatment... the last The method is still plasma from recovered patients. Director Sun, why don’t you go and communicate with Dean Zhang to see if other wards can support at least one unit of plasma?”

At the beginning, the plasma of the convalescents handed over to North Fifth District was only 200ml, but the plasma was useless at all.Instead, during the ICU shift, the medical team decided to use convalescent plasma on Zhang Min after several discussions.

It's not a big deal to use the trump card in his own department on other patients.But now comes the painful thing for everyone—today is February 2th, and patients who are discharged 12 days from today are eligible to donate plasma.In other words, only patients who recovered before January 14 can donate plasma.

On January 1, there were only 29 cured and discharged patients in Quanyunhe City.More than half of these patients have underlying diseases and are not suitable for donating plasma.

Zhang Zhifu is not a god, and it is impossible for him to conjure a large amount of plasma from convalescents out of thin air for use by various departments.Sun Li'en didn't need to guess to know what the consequences of going to Lao Zhang to fight the autumn wind this time.But... the responsibility lies, and he can't do it if he doesn't go.

"Okay, let me ask." Sun Lien sighed, "But I have to give you a good vaccination in advance-there are only so many recovered patients now, and those who are suitable for donation may have already donated a round and haven't yet. When you can donate for the second time. This time, you may not be able to get it back.”

"We all know this." Lu Zhimin nodded towards Sun Li'en, meaning to urge him to go now, "Go to Dean Zhang and ask, if you really can't find plasma, then we will contact the ICU. Get in touch and see if you can transfer her up."

Once Big Sister Pan leaves the North Fifth District, the temporarily established ICU in the North Fifth District can be officially declared closed.Although Lu Zhimin is an expert in intensive care medicine, he himself hopes that this temporary ICU will disappear from the North Fifth District as soon as possible - without this intensive care unit, the allocation of doctors and nurses will be more flexible.When the time comes to adjust the schedule, maybe everyone can have an extra half day of rest every two weeks.

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Bearing the hope of the entire ward, Sun Lien wandered to the door of Zhang Zhifu's office.After knocking on the door, Sun Lien suddenly found that Lao Zhang seemed to be in a good mood today.

"We sent plasma from four units of recovered patients from Guangdong to our hospital." Seeing that Sun Lien had arrived, Zhang Zhifu immediately waved and shouted, "Xiao Sun, you came just in time. There is good news!"

"What good news can make you so happy?" Sun Lien sat down curiously, but he hasn't seen Zhang Zhifu so happy for a long time.

"Four units of convalescent plasma were airlifted from Guangdong!" Zhang Zhifu looked really happy, and he repeated what he had just said, "I've also heard that the plasma was distributed to North Fifth District earlier. You have lent the plasma of recovered patients to the ICU, right? The plasma sent from Guangdong this time will be given priority to you, Corey! Now it is said that there are three types: A type, AB type and O type, which one do you want?"

(End of this chapter)