I can see the status bar

Chapter 660 Evaluation

Wang Ge's parents finally rushed to the hospital.After communicating with their son for a few minutes, they were also frightened by this state of constant bickering.

"This child...couldn't be something upper body?" Although they were all born in New China and grew up under the red flag, Wang Ge's parents saw a sudden change in the temperament of the child they knew well. Still a little bit guilty psychologically.Sun Lien heard the couple muttering in low voice outside the door, "Do you want to find some master to exorcise evil spirits?"

Sun Li'en could only smile wryly by the side, and when Wang Ge's parents had almost communicated, he said, "You two come to the office with me, it's not convenient to talk here."

In the conference room, Sun Lien found a stool and sat down, and began to tell Wang Ge's parents the current situation, "He was sent to the hospital when he was playing basketball and his chest suddenly became weak. After we The examination confirmed that the three main blood vessels in his coronary arteries are all narrowed - 99% narrowed, which is very serious."

In order to show the severity, Sun Lien specially prepared a color map of the anatomy of the heart, "Here, here, and here are the areas of Wang Ge's disease. These three blood vessels are responsible for about 70% of the blood supply to the heart of ordinary people. He After three lesions, 70% of the blood cannot be supplied normally." Sun Lien put down the picture and said seriously, "But in the emergency examination, we found that he was different from traditional coronary heart disease patients. His blood lipids were normal. "

"Normal blood lipids mean that it is not atherosclerotic plaque that causes coronary artery stenosis. It is something else... From the current point of view, the most likely ones are vasculitis and immunoprecipitation substances." Sun Lien took out from the side "According to this inspection report, we think he has systemic lupus erythematosus, but this alone cannot explain all his symptoms—including his personality changes."

Wang Ge's parents looked at each other and asked cautiously, "Do you think...he became like this because of illness?"

"Of course." Sun Li'en nodded with a wry smile, "If it's a ghost strike, we doctors can't rule it out."

Sun Li'en explained the similarities and differences between granulomatous vasculitis and systemic lupus erythematosus for a long time. I don't know if Wang Ge's parents understood.

"In short, we believe that he has two very similar but slightly different autoimmune diseases." Sun Lien finally spoke plainly, "Both of these diseases may pose a direct threat to his life, and the treatment The method is hormone shock."

"Then use it." Wang Ge's father gave the decision very happily, "As long as it can cure diseases, we will use it."

"But there is something I have to tell you up front." Sun Li'en took out the informed consent form for hormone shock treatment, "hormone shock may have a negative impact on his current cardiovascular system. If hormones are used, his current Normal blood lipids are likely to rise rapidly - and at worst a myocardial infarction."

"Ah?" Wang Ge's father suddenly changed his color, "Isn't that particularly dangerous?"

"Yes." Sun Li'en nodded, "Although we will put him on life monitoring, in case of myocardial infarction, we will definitely do our best to treat him. But this risk still exists - some serious myocardial infarctions are treated In the end, the crisis can be turned into safety, but some patients with myocardial infarction just cannot be saved.”

In all fairness, Sun Lien himself felt that this was a very difficult choice to make.If hormone shock therapy is not carried out, but traditional immunosuppressant regimens such as hydroxychloroquine are simply used, granulomatous vasculitis will continue to develop, and Wang Ge may not be able to survive being discharged from the hospital.But with hormone shock and immunosuppressant, Wang Ge may have another myocardial infarction, or die during hospitalization.

"I have a suggestion." Sun Li'en thought for a while and suggested, "If you both agree, I'll call a cardiac surgery consultation first. Let the cardiac surgery doctor evaluate and see if Wang Ge can be given a bypass surgery first. Do it After the bridge is completed, the hormone shock will be given. Although this will increase the risk of infection, at least his heart is safe."

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"As long as the kidney thinks that the patient can tolerate surgical trauma, then we can try it." The Department of Cardiac Surgery attaches great importance to the consultation of the comprehensive diagnosis center. Director Tong Chunlai personally came to the comprehensive diagnosis center to participate in the consultation. "But there is a question... how is the quality of the other blood vessels in this patient?"

There are generally three routes for heart bypass surgery, each of which requires a section of blood vessel to be taken directly from the patient and then sutured to the proximal and distal ends of the narrowed coronary artery.The traditional method uses the great saphenous vein, but because there is a venous valve in the great saphenous vein, the blood flow will be blocked.Therefore, the possibility of postoperative obstruction is much higher than that of internal thoracic artery bypass surgery and radial artery bypass surgery.

Internal thoracic artery bypass surgery and radial artery bypass surgery, as their names suggest, are arteries removed for bypass suturing.From the effect point of view, the effect of internal thoracic artery bypass surgery is the best.The ten-year patency rate is greater than 90.00%, and it can even regulate blood flow according to the physiological needs of myocardial blood supply.

The history of radial artery bypass surgery is almost as old as saphenous vein bypass surgery.Although the radial artery is more prone to spasm, which leads to functional closure, it was once abandoned.However, with the application of calcium antagonists to relieve spasticity and prevent spasms, this program, which was once abandoned by doctors, has returned to the scope of first-line clinical use.

For patients with three-vessel disease, it is unrealistic to use only radial artery bypass surgery and internal thoracic artery bypass surgery. internal artery.Therefore, in current coronary artery bypass surgery, a composite method is generally adopted.The saphenous vein, internal thoracic artery, and radial artery were also used.

However, not all patients are able to remove suitable vessels for bypass grafting.This kind of problem has become especially real in Wang Ge's body.

Granulomatous vasculitis affects blood vessels throughout the body, it involves arteries, veins and capillaries.There may even be aortic involvement.In the presence of granulomatous vasculitis, Wang Ge may not even be able to remove a usable blood vessel.

"His granulomatous vasculitis... We haven't been able to fully diagnose it yet." Sun Lien was a little embarrassed, "The quality of the blood vessels is really hard to say, do you think it's necessary to do a biopsy to evaluate the availability of the blood vessels?"

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(End of this chapter)