"After the patient is admitted to the hospital, he still continues to take antihypertensive zero, I want to know, is there this medicine in the pharmacy of your hospital?" Lin Lin asked suddenly.

"No, it's the patient's." Zhang Yin replied immediately.

"Okay, understood, thank you."

"The patient's blood pressure is really well controlled. However, behind this stability, there are hidden worries, which I will talk about later. ”

"Next, I will analyze the patient's diagnosis and subsequent treatment."

"I agree with you on the diagnosis and management of neurological disorders."

"Why is this patient getting so bad in the short term, and it's continuing to get worse? This point is worth pondering. ”

"Let me start by talking about why this patient has changed so significantly in a short period of time. I believe that the trigger is closely related to the death of the patient's friend. ”

"The patient's friend has hypertension, so after hearing about it, the patient became more concerned about his own treatment of hypertension, and changed the habit of taking medication intermittently and insisted on taking the medicine until now."

"Antihypertensive Zero is a compound preparation that contains a special antihypertensive drug called Reserpine."

"Reserpine's antihypertensive effect is really good, I remember, in the second year of my graduation, that is, in 1985, a patient because of high blood pressure, the doctor on duty injected him with a reserpine, and his blood pressure immediately fell to a state of 'shock'."

"Later, I relied on dopamine to maintain stable blood pressure, and after a week, it slowly returned to normal. So, I'm particularly impressed with reserpine. ”

"Reserpine mainly affects the uptake of norepinephrine by sympathetic nerve endings, depleting norepinephrine stores and blocking the transmission of sympathetic impulses, resulting in vasodilation, lower blood pressure, and slowed heart rate."

"In addition, reserpine also has a sedative and central nervous system depressive effect, which may be the result of reserpine entering the brain and depleting central nervous system catecholamine stores."

"Now, reserpine has withdrawn from the stage of history, and regular hospitals do not have reserpine, a blood pressure drug. But this does not prevent some manufacturers from taking advantage of its effect and taking advantage of its cheapness to earn high profits. ”

"From the mechanism of action of reserpine, we can see that it can cause depression, bradycardia, arrhythmia, and even congestive heart failure in patients."

"Now, these side effects, mild or severe, are showing up in this patient."

"The change in the patient's mood, the change in temperament, I think, is directly related to reserpine. The patient's treatment effect is not good, which is also related to reserpine. Because, until now, the patient has not stopped taking this drug. You can imagine how the patient's condition can be improved? ”

"So, next, I recommend switching out this blood pressure medication. It can be switched to calcium antagonists, angiotensin-converting enzyme inhibitors (ACE inhibitors), or the latest angiotensin receptor antagonists (ARBs). ”

"These drugs work well and have few side effects. However, at the beginning of the dressing, Dr. Zhang should closely observe the changes in blood pressure and adjust the dose or type of medication in time. ”

"If the effect is not good, you can add diuretics, such as hydrochlorothiazide tablets, one tablet a day. The use of diuretics, in addition to helping to lower blood pressure, is good for the heart and kidneys. However, changes in blood electrolytes must be closely monitored. ”

"I believe that after replacing the antihypertensive zero, the patient's condition will slowly improve. Of course, this will take a little time, and you don't need to rush. ”

"Finally, let me have another question." After Lin Lin finished speaking, he paused and took a sip of the mineral water handed to him by Director Han.

In the doctor's office, it was very quiet, and the doctors had been impressed by Lin Lin's analysis. Yes, they already have a "specialist disease", and they can only think about the disease of neurology, and their knowledge is already very limited.

Lin Lin's analysis made their eyes shine, but also made them see their own shortcomings.

"The patient has a history of hypertension for more than ten years, and the patient has not been formally treated. Such a result will definitely lead to damage to the target organs due to high blood pressure. ”

"In this patient, the damage to the target organs is very clear. damage to the small blood vessels in the brain, resulting in small subcortical ischemic foci seen on magnetic resonance; The heart has been affected by high blood pressure for a long time, and the heart muscle has become hypertrophied and heart function has also declined. ”

"There is another vital organ that has also been damaged, and that is the kidneys. The patient's blood biochemical tests have been unmistakably told to everyone. For example, urea nitrogen and creatinine are increased, mild anemia, albumin is at a sincerely low value, and the ability to regulate electrolytes is reduced......"

"All of this tells us that the patient's kidney function has been impaired. Just now, when I was doing a combined palpation of both hands and abdomen, I felt that the patient's kidney was smaller than the normal medicine. As for whether my hand feels correct, I will ask Dr. Zhang to prescribe a test to see the size of the kidney. ”

"Long-term, uncontrolled high blood pressure can lead to hardening of the blood vessels that supply blood to the kidneys, and eventually kidney damage."

"Often, the function changes first, and then the organic changes in the kidneys, such as kidney atrophy."

"For this aspect, some albumin can be used appropriately. When using, be sure to pay attention to the condition of the heart and control the drip rate. ”

"In terms of electrolytes, it is best to regulate them through diet and oral medications. After all, the patient's kidney function is not very good. ”

"Oh, by the way, did you get the biochemical results you just said?"

"I got it, and the patient's kidney function was indeed impaired." Zhang Yin replied. Now Zhang Yin has long admired Lin Lin so much.

She is in the neurology department, how has she ever seen such a ward round?

"Okay, that's all I have to say, if there is anything wrong, please criticize and correct Director Han and you." Lin Lin ended his speech with a smile. There was a lot of confidence in that smile.

"Thank you very much Dean Lin for your guidance. Dean Lin's ward rounds today have brought us not only knowledge, but also thinking methods, learning methods, and the direction of our future efforts. ”

"Yes, we used to suffer from 'specialist diseases', except for neurology diseases, other diseases, which seem to have nothing to do with us."

"After listening to Dean Lin's ward rounds today, we realized that we were very wrong. The human body is a unified whole, and any organ problem will affect each other. ”