The ideas are different, but at least the means at the beginning are not different. Before the patient came to the Fourth Hospital with other information, Sun Lien and others had no way to figure out what was wrong with the patient.

"When the people arrive, I'll take him for an MRI. Xu Yourong took the rare initiative to take over the job of accompanying the examination, "Doctor Sun, are you here too?"

Sun Lien thought for a moment and shook his head, "I'm going to go to the pharmacy department again." He stretched and took another sip of black coffee.

Xu Yourong was stunned when he heard this, and hurriedly began to bow his head and find the case report, "Has Qian Aiwu's situation been repeated?"

"Huh?" Sun Lien was also a little confused by Xu Yourong's reaction, and after being stunned for a few seconds, he realized where Xu Yourong was wrong, "No, no, I want to ask about the mechanism of action of phenobarbital and levetiracetam." ”

"You want to rule out the cause through this, right?" Xu Yourong suddenly realized, and then stopped looking for information in his hand, "I thought Qian Aiwu had a problem again." ”

Qian Aiwu is now the object of the most attention of all the doctors in the comprehensive diagnosis center. The reason is also very simple - in every sense, her situation is even more pitiful than Xiao Yanran. The pain of illness is already the simplest and easiest kind of injury. Her pair of children are over-beautified when they are described as "turning their eyes into hatred" - one of their eyeballs has dropped, where can it be summed up with "turning their eyes"!

Qian Aiwu's mood is very low every day, and even eating is much less than normal needs. In order for her to recover as quickly as possible, and to allow her to consume enough calories and protein, Bruen had to prescribe a nutrient solution for her again. With his previous experience this time, Brune at least knew how to record the total amount of food Qian Aiwu ingested every day, and then ask the nutrition department to calculate the total amount of nutrients and calories that needed to be supplemented at around 5 p.m.

Although she is awake, the difficulty of nursing and follow-up treatment is no less than when she was in a coma.

"This afternoon the psychiatrist will come over and do a preliminary assessment. Zhou Ce reminded on the side, "According to the results of the assessment, she may need to be given medication or psychological intervention." ”

"It's better not to use medication. Sun Lien scratched his head, "It's antibiotics and nutrient solution, plus a psychotropic drug...... The devil knows if there will be some bizarre drug reactions. ”

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"The mechanism of action of both drugs is not well understood, and there are two popular hypotheses for phenobarbital – although there is still no conclusive evidence to prove them. As for levetiracetam, there is not even a relatively convincing hypothesis except that its molecular form is different from that of mainstream antiepileptic drugs. Han Wenping sat in the office with a set of tea sets in front of him, and he pushed a cup of tea to Sun Lien, "Why did you suddenly remember to ask this?"

"Huh?" Sun Lien was disappointed, he also wanted to infer Shen Xi's cousin's condition through these two ineffective anti-epileptic drugs. "There is a case that will be sent to our department in the afternoon to be examined and treated. I'll preview it in advance. ”

"Preview?" Han Wenping thought for a moment, "This patient doesn't respond to either phenobarbital or levetiracetam?"

"Yes. Sun Lien nodded, took a sip of the tea in the cup, it tasted good, and the tea tasted a unique fragrance, "His epilepsy is still very stubborn, and there is numbness in one limb - the range of numbness is still extending." ”

Han Wen calmly listened to Sun Lien's general description of this case, he knocked lightly on the table, muttered a few words to himself, and then said to Sun Lien, "Have you understood the two mechanism hypotheses of phenobarbital?"

Sun Lien shook his head honestly, if he had understood, he would not have come directly to the pharmacy department for advice, "I just saw the case and found that this patient's epilepsy symptoms are unusual, so I hurried to ask first." ”

Another major reason why Sun Lien was a little nervous about this case was the amount of medication. The second hospital has thought of a lot of ways to suppress Shen Xi's cousin's seizures, and the dosage of phenobarbital and levetiracetam has approached the upper limit stipulated in the pharmacopoeia. It was a familiar feeling he had encountered before—Gao Yan, a patient with acute methamphetamine poisoning with grass-green urine, had shown a similar situation after he was admitted to the hospital.

Gao Yan did not undergo an autopsy, and the specific type of nerve damage he endured is unclear. But the epilepsy symptoms that can't be suppressed by medication are really impressive.

"There are two main hypotheses for the mechanism of action of phenobarbital, one is to act on the GABA receptor on the postsynaptic membrane, prolonging the opening time of Cl- channels, resulting in hyperpolarization of the nerve cell membrane and reducing its excitability, and the other is to act on the presynaptic membrane to reduce the permeability of the presynaptic membrane to Ca2+ and reduce the release of Ca2+-dependent neurotransmitters (NA, Ach and glutamate, etc.). Han Wenping refilled Sun Lien's tea and continued, "Let's assume that one of these two hypotheses is correct. ”

Sun Lien nodded, the two points of action of the presynaptic membrane or postsynaptic membrane are the main structures for nerve cells to receive and transmit nerve impulses. In order to stop the abnormal firing of nerve cells in a certain area, neurotransmitter interference or blockade of these two structures can certainly play a role in suppressing epilepsy.

"If phenobarbital is ineffective, it means that the abnormal discharge may not be due to abnormal nerve impulses. Han Wenping took a sip of tea and said thoughtfully, "It's not because it received or transmitted the wrong nerve impulse, but because of other reasons." ”

"It's not a neurotransmitter problem, it's not an ion channel problem. Sun Lien speculated along Han Wenping's train of thought, "In other words, it may be glial cell abnormalities that cause epilepsy?"

"Possibly. Of course, it's only possible. Han Wenping nodded, "Specifically, you still have to ask the doctor in the god to come for a consultation, after all, our inference is only based on 'one of the existing phenobarbital mechanism of action conjectures is correct'." If your test results disprove these two conjectures, you can send another article with five or six points. ”

In China, doctors always have such a "bad habit", every time they make a new discovery, everyone's first reaction is to ask "how much can this thing publish an article", and then think about "what is the clinical significance of this discovery". ”

There is no way, everyone is forced out of the current system of occupational diseases.

"I see. Sun Lien nodded, after Director Han's analysis, he had a little speculation about Shen Xi's cousin's condition, "When the patient arrives, I'll see if I want to arrange a consultation." He stood up and said with a smile, "Director Han, this time it's thanks to your help." I'll treat you to dinner when I get back. ”

"Invite me to dinner? Han Wenping laughed, "But I have to name you to find someone to accompany you - the kid surnamed Luo from the imaging department who had dinner last time is now in your comprehensive diagnosis center, right?"

Sun Lien nodded, and then was a little puzzled, "You want to take Brother Luo with you?"

"Hmm. Han Wenping nodded, "Director Wei has a recent project to cooperate with manufacturers in Japan. He wanted to recruit a PhD student to focus on the project...... After eating last time, he thought that Xiao Luo in your Cory was not bad. ”