NOVEL WEB I can see the status bar
Chapter 1175 Complicated System
Chapter 1175 Complicated System
It is said that in order to prevent the members of the isolation medical team from being too bored, other medical teams arranged various colorful entertainment activities for them.Of course, in order to ensure that the team members are isolated from each other during the isolation process, these activities are basically carried out online and through the Internet.
At this moment, the Internet is not just as simple as "having an advantage".It is simply the only driving force that supports everyone to continue to adhere to isolation.
With the help of the Internet, medical team members can contact their families in the isolation hotel.Chatting with medical team members from other provinces who have also fought together in Yunhe, who also started to isolate.You can even pass the time with content such as games and movies.
The younger players have basically completely turned into a dead house style.In other words, the belief that "it's too bad not to soak in hot springs" can still support them to take a bath on the balcony. Other than that, the young doctors and nurses have all turned into perennial sleeping bugs.
If staying at home is a basic respect for isolation regulations, then sleeping at least 12 hours a day when not working is a minimum respect for the medical industry.
The older doctors and nurses have other things to do.The hotel provided them with a lot of "hobby goods" for entertainment.In addition to basic newspapers, books and magazines, the hotel also specially provides you with puzzles, Rubik's cube and a lot of small toys like Nine Links.
Most of the elderly doctors don't like to stare at the computer screen for a long time, but during the isolation period, they can't find old friends to set up a chess game and kill a few games, and it is impossible to make enough four-player mahjong.These means are the limit of what the hotel can do.
As for Sun Lien... Although he also wanted to pay tribute to the medical industry, the reality did not allow him to do so.While other colleagues are trying to rest, Sun Lien has gradually started to resume work.
Not being able to stay idle is on the one hand, and on the other hand, it is because there are indeed a lot of accumulated problems.
Two months after leaving the Comprehensive Diagnostic Center, many patients and their family members who made appointments and planned to come to the Fourth Hospital for medical treatment were forced to temporarily cancel their travel plans.What is even more worrying is that some of the appointments have been directly cancelled.
When the staff staying behind in the comprehensive diagnostic center called to inquire, the answer they got was often helpless—the patient had passed away due to illness, so the appointment was canceled.
There is still a week before the end of the quarantine, but Sun Lien is ready to gradually resume work in the first and second departments of general medicine.In particular, Zhang Zhifu estimated that he would not be able to return to Ningyuan in a short time, and the Second Department of Comprehensive Clinic urgently needed a leading third-line doctor to take over the place.
Before he found a third-line doctor who could control the situation, Sun Li'en could only take the lead by himself.
The case currently in front of Sun Lien... is not too complicated in nature.It's just a neonatal hemolysis.But the problem is, what causes hemolysis in newborns is somewhat troublesome.
Since she has settled overseas all the year round, the woman did not undergo regular check-ups during her pregnancy in accordance with domestic regulations.In the 25th week of pregnancy, the mother decided to return to China to prepare for childbirth.After returning to China in the 32nd week, during the first routine check-up on the parturient, the Laboratory Department of the Fourth Central Hospital of Ningyuan City found that there was a problem with the parturient's blood type identification.
Her positive blood type is B, but her negative blood type is O.
Although the mainstream of human blood types is divided into "A, B, AB, O" four blood types.But this classification does not fully describe the blood type characteristics of all people.In fact, in addition to the ABO blood group system and the RhD blood group system, there are eleven other blood group systems discovered by humans.
And there are as many as seven subtypes of blood type A in the ABO system.Different subtypes show different results in positive and negative determination of blood type.
The results of the positive and negative blood typing of the parturient did not match, which made it difficult for the doctors in the laboratory department.Although they do know that there are many types of human blood type systems, with the technical level of the laboratory department of the Fourth Hospital, there is currently no way to directly determine the specific blood type of the mother who returned from overseas.
The task of identifying blood types was handed over to the Ningyuan City Blood Center.After a series of serological identification and gene sequencing by the staff of the blood center, the blood type of the final parturient was determined to be B blood type, CCDee, MM, p phenotype - this is the ABO system, RhD system, The MNS system and the P1 blood group system performed the most accurate results for multiple identifications.Among them, p phenotype is the rarest type among the four blood group systems.
P1血型系统中一共有五类分型，分别是占比最多的P1型和P2型，以及非常罕见的P1K、P2k和p型血。
Just figuring out this blood group system is enough for Sun Lien to have a headache - the antigens on the red blood cells and the antibody performance in the serum simultaneously determine what blood type a person is in the P blood group system.And these relationships together form a lot of long and wide tables.
The form of the P1 system is not only long, but also has a feature of "just not letting you understand".Doctors in the blood transfusion department may not be able to figure out this blood type without looking at the watch, and Sun Lien is even more confused.
Anyway, all in all, this woman was identified as a No.10p blood carrier registered nationwide.The rarity of her blood type directly aroused the great attention of the blood transfusion doctors of the Fourth Hospital.
Maternal bleeding will occur during childbirth, and it is difficult for doctors to accurately estimate the amount of bleeding.
If it is only RH-negative "panda blood", in case something happens, the doctors can directly contact other panda blood carriers through the blood station, and then ask them to donate blood urgently.Although it is troublesome, at least there is still a way to think about it.
But... p-type blood, there is really no way.Since the number of registered p-type blood carriers is too small, it is impossible to ask them to donate blood urgently.What's more, he is a p-type carrier of blood type B - in the case of ensuring the matching of other blood group systems, he must also ensure the matching of ABO blood group system before blood transfusion.
All in all, it is impossible for this woman to receive blood support from free donations.
In order to deal with possible maternal hemorrhage, the Blood Transfusion Department of the Fourth Hospital proposed two plans—prioritizing the cesarean section with more controllable damage, and actively using the autologous blood purification and reinfusion system during the operation.And preoperative autologous blood storage.
The autologous blood purification reinfusion system is easy to understand, it is a huge special purifier.During the procedure, all body fluids mixed with blood are drawn through a tube into the purifier.After being separated and purified by the purifier, the blood that can be safely returned to the patient is separated from it.Although this technology is very mature, it is not widely promoted in the country. At least in the entire Song'an Province, only the Fourth Hospital has the ability to purify and reinfuse autologous blood.
Preoperative autologous blood storage is an important insurance measure for rare blood type carriers before elective surgery.
Elective surgery means that the bleeding time can be controlled.Then, doctors who are good at "tearing down the east wall to make up the west wall" should naturally make good use of this "controllable".The patient's blood was drawn about two weeks in advance and then stored in a cryopreservation.In this way, at the time of operation, at least one unit of blood can be ready for retransfusion at any time.
With the close cooperation of the blood transfusion department and the obstetrics department of the fourth hospital, the woman was sent to the operating room for cesarean section at 40 hours due to premature rupture of membranes at 16 weeks of pregnancy.There was very little blood loss during the operation, and the 300ml of blood prepared by the parturient was not transfused back—you don’t need to guess, this blood was hidden by the blood transfusion department as a treasure.
P phenotype of rare blood type blood, and there are 300 ml!And this is a good thing that can at least come out of Shui San's attending doctor.
At this point in the story, a little other problem suddenly appeared.
The baby responded well after birth, but then she started developing severe jaundice.
Transcutaneous bilirubin (TcB) levels were measured, and the bilirubin levels in the child rose rapidly.From the level of 70~104μmol/L at birth, it rose all the way to 251μmol/L.
If considered according to the conventional plan, this child can undoubtedly be diagnosed as hyperbilirubinemia caused by neonatal hemolysis.But... If things were that simple, this medical record would not have been sent to Sun Lien by the blood transfusion department and neonatology department.
It is a difficult problem to determine the blood type of a newborn baby.Newborns and the elderly have low serum antibody levels, and it is difficult to produce clinically meaningful results.Therefore, it is generally done by taking more positive detection.In the case of knowing that the mother of the child has P phenotype blood, doctors have to take into account the possibility that the child is also a rare blood type.
However, in order to find evidence of rare blood types, positive and negative determination of the ABO blood group system is a must.
This is only the first problem.
The infant who has just been born on the third day must still have a large number of blood cells from the mother.These p-phenotype blood cells are likely to cause false negatives or false positives in the blood group identification of children.
In other words, at this stage, although doctors can speculate that the hemolytic hyperbilirubinemia in the child is due to the incompatibility with the mother's blood type.But conclusive evidence is still lacking.
The doctors of the blood transfusion department and the blood department together with the staff of the blood station discussed online several times, and finally came to a conclusion - as long as hemolysis caused by other factors is excluded, it can be judged that the child is of the same species caused by blood type incompatibility. Immune hemolytic disease.
As for Sun Li'en... he is the unlucky ghost who was used to "eliminate other factors".
Of course, Sun Lien has long been used to being an unlucky ghost.Anyway, being idle is idle, and it would be nice to find something to do.His current "office" not only has a big bed, but also has a hot spring and a balcony - working in such a good environment makes him feel better.
So... First of all, it is necessary to determine whether the elevated bilirubin level in the child is pathological or physiological.
Newborns will have a physiological increase in bilirubin.Most newborns experience a bout of jaundice right after birth—it doesn't mean there's something wrong with them.The cause of physiological jaundice is simple - the child's digestive system has not yet started to work normally.The total amount of bilirubin produced in the human body is greater than the amount excreted, which will lead to a rise in physiological bilirubin.
In other words, as long as the newborn can excrete normally, such jaundice can be controlled naturally after about a week or two.
The mainstream scheme for the folk treatment of neonatal physiological jaundice is to let the child bask in the sun.Stripping off the newborn baby, and then putting it in the sun for a while, can help the children fade away the yellow stain as soon as possible.
The principle of this treatment plan is actually not difficult to understand.The blue light contained in the sunlight spectrum can convert bilirubin in the superficial layer of the child's skin to its water-soluble isomer.This process can promote the disappearance of jaundice.
But sunlight also contains many light waves that may cause damage to the human body, such as ultraviolet rays.Therefore, the current mainstream treatment plan still allows newborns to receive blue light exposure directly in the hospital.
For pathological jaundice, the main treatment methods are drug therapy and blood exchange except for blue light irradiation.Hepatic enzyme inducers such as phenobarbital or luminal sodium can speed up bilirubin metabolism.The hormone slows down the production of bilirubin.
Needless to say, blood exchange is a "big killer" for the treatment of immune diseases and blood diseases, and this method has a remarkable effect.But it's also very risky -- for newborns, exchange transfusions are risky.Even with the smallest tubing, a lot of blood will still be drawn before the machine starts, which will cause the child to face hypovolemia.In the process of blood exchange, serious adverse reactions such as acidosis, hypokalemia, hyponatremia, and transfusion reactions may also occur.
Doctors will not consider transfusion unless it is absolutely necessary.
(End of this chapter)
It is said that in order to prevent the members of the isolation medical team from being too bored, other medical teams arranged various colorful entertainment activities for them.Of course, in order to ensure that the team members are isolated from each other during the isolation process, these activities are basically carried out online and through the Internet.
At this moment, the Internet is not just as simple as "having an advantage".It is simply the only driving force that supports everyone to continue to adhere to isolation.
With the help of the Internet, medical team members can contact their families in the isolation hotel.Chatting with medical team members from other provinces who have also fought together in Yunhe, who also started to isolate.You can even pass the time with content such as games and movies.
The younger players have basically completely turned into a dead house style.In other words, the belief that "it's too bad not to soak in hot springs" can still support them to take a bath on the balcony. Other than that, the young doctors and nurses have all turned into perennial sleeping bugs.
If staying at home is a basic respect for isolation regulations, then sleeping at least 12 hours a day when not working is a minimum respect for the medical industry.
The older doctors and nurses have other things to do.The hotel provided them with a lot of "hobby goods" for entertainment.In addition to basic newspapers, books and magazines, the hotel also specially provides you with puzzles, Rubik's cube and a lot of small toys like Nine Links.
Most of the elderly doctors don't like to stare at the computer screen for a long time, but during the isolation period, they can't find old friends to set up a chess game and kill a few games, and it is impossible to make enough four-player mahjong.These means are the limit of what the hotel can do.
As for Sun Lien... Although he also wanted to pay tribute to the medical industry, the reality did not allow him to do so.While other colleagues are trying to rest, Sun Lien has gradually started to resume work.
Not being able to stay idle is on the one hand, and on the other hand, it is because there are indeed a lot of accumulated problems.
Two months after leaving the Comprehensive Diagnostic Center, many patients and their family members who made appointments and planned to come to the Fourth Hospital for medical treatment were forced to temporarily cancel their travel plans.What is even more worrying is that some of the appointments have been directly cancelled.
When the staff staying behind in the comprehensive diagnostic center called to inquire, the answer they got was often helpless—the patient had passed away due to illness, so the appointment was canceled.
There is still a week before the end of the quarantine, but Sun Lien is ready to gradually resume work in the first and second departments of general medicine.In particular, Zhang Zhifu estimated that he would not be able to return to Ningyuan in a short time, and the Second Department of Comprehensive Clinic urgently needed a leading third-line doctor to take over the place.
Before he found a third-line doctor who could control the situation, Sun Li'en could only take the lead by himself.
The case currently in front of Sun Lien... is not too complicated in nature.It's just a neonatal hemolysis.But the problem is, what causes hemolysis in newborns is somewhat troublesome.
Since she has settled overseas all the year round, the woman did not undergo regular check-ups during her pregnancy in accordance with domestic regulations.In the 25th week of pregnancy, the mother decided to return to China to prepare for childbirth.After returning to China in the 32nd week, during the first routine check-up on the parturient, the Laboratory Department of the Fourth Central Hospital of Ningyuan City found that there was a problem with the parturient's blood type identification.
Her positive blood type is B, but her negative blood type is O.
Although the mainstream of human blood types is divided into "A, B, AB, O" four blood types.But this classification does not fully describe the blood type characteristics of all people.In fact, in addition to the ABO blood group system and the RhD blood group system, there are eleven other blood group systems discovered by humans.
And there are as many as seven subtypes of blood type A in the ABO system.Different subtypes show different results in positive and negative determination of blood type.
The results of the positive and negative blood typing of the parturient did not match, which made it difficult for the doctors in the laboratory department.Although they do know that there are many types of human blood type systems, with the technical level of the laboratory department of the Fourth Hospital, there is currently no way to directly determine the specific blood type of the mother who returned from overseas.
The task of identifying blood types was handed over to the Ningyuan City Blood Center.After a series of serological identification and gene sequencing by the staff of the blood center, the blood type of the final parturient was determined to be B blood type, CCDee, MM, p phenotype - this is the ABO system, RhD system, The MNS system and the P1 blood group system performed the most accurate results for multiple identifications.Among them, p phenotype is the rarest type among the four blood group systems.
P1血型系统中一共有五类分型，分别是占比最多的P1型和P2型，以及非常罕见的P1K、P2k和p型血。
Just figuring out this blood group system is enough for Sun Lien to have a headache - the antigens on the red blood cells and the antibody performance in the serum simultaneously determine what blood type a person is in the P blood group system.And these relationships together form a lot of long and wide tables.
The form of the P1 system is not only long, but also has a feature of "just not letting you understand".Doctors in the blood transfusion department may not be able to figure out this blood type without looking at the watch, and Sun Lien is even more confused.
Anyway, all in all, this woman was identified as a No.10p blood carrier registered nationwide.The rarity of her blood type directly aroused the great attention of the blood transfusion doctors of the Fourth Hospital.
Maternal bleeding will occur during childbirth, and it is difficult for doctors to accurately estimate the amount of bleeding.
If it is only RH-negative "panda blood", in case something happens, the doctors can directly contact other panda blood carriers through the blood station, and then ask them to donate blood urgently.Although it is troublesome, at least there is still a way to think about it.
But... p-type blood, there is really no way.Since the number of registered p-type blood carriers is too small, it is impossible to ask them to donate blood urgently.What's more, he is a p-type carrier of blood type B - in the case of ensuring the matching of other blood group systems, he must also ensure the matching of ABO blood group system before blood transfusion.
All in all, it is impossible for this woman to receive blood support from free donations.
In order to deal with possible maternal hemorrhage, the Blood Transfusion Department of the Fourth Hospital proposed two plans—prioritizing the cesarean section with more controllable damage, and actively using the autologous blood purification and reinfusion system during the operation.And preoperative autologous blood storage.
The autologous blood purification reinfusion system is easy to understand, it is a huge special purifier.During the procedure, all body fluids mixed with blood are drawn through a tube into the purifier.After being separated and purified by the purifier, the blood that can be safely returned to the patient is separated from it.Although this technology is very mature, it is not widely promoted in the country. At least in the entire Song'an Province, only the Fourth Hospital has the ability to purify and reinfuse autologous blood.
Preoperative autologous blood storage is an important insurance measure for rare blood type carriers before elective surgery.
Elective surgery means that the bleeding time can be controlled.Then, doctors who are good at "tearing down the east wall to make up the west wall" should naturally make good use of this "controllable".The patient's blood was drawn about two weeks in advance and then stored in a cryopreservation.In this way, at the time of operation, at least one unit of blood can be ready for retransfusion at any time.
With the close cooperation of the blood transfusion department and the obstetrics department of the fourth hospital, the woman was sent to the operating room for cesarean section at 40 hours due to premature rupture of membranes at 16 weeks of pregnancy.There was very little blood loss during the operation, and the 300ml of blood prepared by the parturient was not transfused back—you don’t need to guess, this blood was hidden by the blood transfusion department as a treasure.
P phenotype of rare blood type blood, and there are 300 ml!And this is a good thing that can at least come out of Shui San's attending doctor.
At this point in the story, a little other problem suddenly appeared.
The baby responded well after birth, but then she started developing severe jaundice.
Transcutaneous bilirubin (TcB) levels were measured, and the bilirubin levels in the child rose rapidly.From the level of 70~104μmol/L at birth, it rose all the way to 251μmol/L.
If considered according to the conventional plan, this child can undoubtedly be diagnosed as hyperbilirubinemia caused by neonatal hemolysis.But... If things were that simple, this medical record would not have been sent to Sun Lien by the blood transfusion department and neonatology department.
It is a difficult problem to determine the blood type of a newborn baby.Newborns and the elderly have low serum antibody levels, and it is difficult to produce clinically meaningful results.Therefore, it is generally done by taking more positive detection.In the case of knowing that the mother of the child has P phenotype blood, doctors have to take into account the possibility that the child is also a rare blood type.
However, in order to find evidence of rare blood types, positive and negative determination of the ABO blood group system is a must.
This is only the first problem.
The infant who has just been born on the third day must still have a large number of blood cells from the mother.These p-phenotype blood cells are likely to cause false negatives or false positives in the blood group identification of children.
In other words, at this stage, although doctors can speculate that the hemolytic hyperbilirubinemia in the child is due to the incompatibility with the mother's blood type.But conclusive evidence is still lacking.
The doctors of the blood transfusion department and the blood department together with the staff of the blood station discussed online several times, and finally came to a conclusion - as long as hemolysis caused by other factors is excluded, it can be judged that the child is of the same species caused by blood type incompatibility. Immune hemolytic disease.
As for Sun Li'en... he is the unlucky ghost who was used to "eliminate other factors".
Of course, Sun Lien has long been used to being an unlucky ghost.Anyway, being idle is idle, and it would be nice to find something to do.His current "office" not only has a big bed, but also has a hot spring and a balcony - working in such a good environment makes him feel better.
So... First of all, it is necessary to determine whether the elevated bilirubin level in the child is pathological or physiological.
Newborns will have a physiological increase in bilirubin.Most newborns experience a bout of jaundice right after birth—it doesn't mean there's something wrong with them.The cause of physiological jaundice is simple - the child's digestive system has not yet started to work normally.The total amount of bilirubin produced in the human body is greater than the amount excreted, which will lead to a rise in physiological bilirubin.
In other words, as long as the newborn can excrete normally, such jaundice can be controlled naturally after about a week or two.
The mainstream scheme for the folk treatment of neonatal physiological jaundice is to let the child bask in the sun.Stripping off the newborn baby, and then putting it in the sun for a while, can help the children fade away the yellow stain as soon as possible.
The principle of this treatment plan is actually not difficult to understand.The blue light contained in the sunlight spectrum can convert bilirubin in the superficial layer of the child's skin to its water-soluble isomer.This process can promote the disappearance of jaundice.
But sunlight also contains many light waves that may cause damage to the human body, such as ultraviolet rays.Therefore, the current mainstream treatment plan still allows newborns to receive blue light exposure directly in the hospital.
For pathological jaundice, the main treatment methods are drug therapy and blood exchange except for blue light irradiation.Hepatic enzyme inducers such as phenobarbital or luminal sodium can speed up bilirubin metabolism.The hormone slows down the production of bilirubin.
Needless to say, blood exchange is a "big killer" for the treatment of immune diseases and blood diseases, and this method has a remarkable effect.But it's also very risky -- for newborns, exchange transfusions are risky.Even with the smallest tubing, a lot of blood will still be drawn before the machine starts, which will cause the child to face hypovolemia.In the process of blood exchange, serious adverse reactions such as acidosis, hypokalemia, hyponatremia, and transfusion reactions may also occur.
Doctors will not consider transfusion unless it is absolutely necessary.
(End of this chapter)
Tip: You can use left, right, A and D keyboard keys to browse between chapters.