Of course, Wang Lin's treatment has not yet begun. Sun Lien tried his best to finally suppress the immunosuppressive treatment plan first.

"The samples sent to us detected Staphylococcus aureus. Zhao Weiguo took the report and handed it to Zhou Jun with a serious face. "I looked at the pathology department's report and it was a patient with pulmonary hemorrhage-nephritic syndrome. However, if you have a Staphylococcus aureus infection, you can't just use immunosuppressants. It's a tricky matter, so I'm here to tell you about it. ”

Zhou Jun had heard of the skirmish between Zhao Weiguo and Sun Lien. He glanced at Zhao Weiguo with some surprise, and then took the report, and after a pause, he nodded and said, "I'm sorry for you." ”

Zhao Weiguo, an old fox, knows very well that it is not an overnight thing to reverse the hostility of the previous conflict. Anyway, the current Sun Lien has no direct threat to him, as long as he slowly releases his goodwill, he can resolve the contradictions between the two sides. He nodded to everyone in the room, then turned and left the room.

"Intensive care, nephrology, respiratory medicine, and rheumatology and immunology are invited to consult. Sun Lien rubbed his face, only to feel a sense of exhaustion and powerlessness surging up from the bottom of his heart one after another. The patient's condition is so complex that he can't think of a more suitable treatment on his own. After thinking about it, I had to call experts from other departments to come together and give advice - I couldn't have a headache alone anyway.

Zhou Jun said loudly, "I'll contact you, this patient is more troublesome, and you may have to ask their director to come over for a consultation." He looked at Dr. Pascal and said, "I won't invite the director of the rheumatology and immunology department to come, just have Professor Pascal here." ”

Dr. Pascal smiled wryly, he had seen two patients with the same disease before, but that was many years ago. It was so long that he almost forgot whether the two patients were male or female. But Pascal remembers their ending very well. Neither survived, and one patient died after being diagnosed with the disease in the Rheumatology and Immunology Unit at Massachusetts General Hospital. The other died of DIC the day after treatment began.

The prognosis for patients with pulmonary hemorrhage-nephritic syndrome is generally poor. Prior to the widespread use of haemodheresis plus immunosuppressants in the medical community, with high-dose glucocorticoids and long-term dialysis regimens, the general five-year survival rate for patients with pulmonary hemorrhage-nephritic syndrome was less than 10%. More than 80% of patients die within one year of onset. But with advances in medicine, the five-year survival rate for the disease has increased to 70 percent.

However, these patients have isolated pulmonary hemorrhage-nephritic syndrome. They do not have an infection with Staphylococcus aureus.

Staphylococcus aureus is a ubiquitous bacterium. They are most likely to enter the bloodstream from wounds on the surface of the patient's body, or infect surrounding tissues to cause a purulent infection, or settle in the heart and lungs as the blood settles, causing pericarditis or pneumonia. And even more terrifying than the ordinary Staphylococcus aureus is its evolution, methicillin-resistant Staphylococcus aureus (MRSA).

Sometimes we often see reports of so-called "superbugs" on TV. This report is about methicillin-resistant Staphylococcus aureus infection. Because the medical community did not pay enough attention to bacterial resistance, a large number of antibiotics were abused before the 70s, which led to the rapid evolution of Staphylococcus aureus. The newly evolved Staphylococcus aureus is extremely insensitive to methicillin, and is resistant to both β-lactam antibiotics and cephalosporin antibiotics with the same structure as methicillin. And because of the modification of the target site of antibiotics, they even have varying degrees of resistance to antibiotics such as aminoglycosides, macrolides, tetracyclines, fluoroquinolones, etc. Among the antibiotics currently available to humans, only vancomycin is effective against methicillin-resistant Staphylococcus aureus.

But it is not yet possible to confirm whether Wang Lin was infected with this terrible bacteria. The status bar is not clearly stated, and it takes at least four hours for the testing department to confirm the presence of MRSA in the sample with PCR.

"The first thing is definitely to control the infection. Wu Faxian, director of the Department of Critical Care Medicine, who came to participate in the consultation, made a speech, "For patients with GMB nephritis, kidney damage has already formed. To put it mildly, people can still live without kidneys, but if the infection progresses to the point of sepsis, it will not be saved. ”

Tian Huaguang, the director of the Department of Nephrology, pondered for a while, and he frowned and asked, "The patient's kidney condition is not bad, if the anti-infection treatment can be ended as soon as possible and transferred to immunosuppressive therapy, there is still hope that his kidney will be saved." He looked at Dr. Pascal and asked, "I remember that in the mainstream treatment options now, double nephrectomy is no longer the usual strategy, right?"

"Not really. Dr. Pascal nodded. "In addition to plasmapheresis, the commonly used combination drugs such as methylprednisolone, prednisone and cyclophosphamide are commonly used. Probably similar to the immunosuppression regimen after organ transplantation. However, a high-dose pulse therapy with glucocorticoids alone is needed to relieve pulmonary bleeding. ”

"How about a little adjustment to the treatment plan?" Listening to the discussion of many bigwigs, a bold plan suddenly popped up in Sun Lien's little heart with some ghost ideas. "Is it possible to use plasmapheresis to reduce the number of GMB antibodies in his blood at the same time as anti-infection treatment, delay the progression of lung and kidney damage, and then administer immunosuppressive therapy after confirming that the infection has been eliminated?"

Zhou Jun's eyes widened, and he was about to criticize Sun Lien for not playing according to the routine. Dr. Pascal exclaimed first, "Good idea!"

Plasmapheresis is the extraction of the patient's blood from one side of the vein, and the extracted blood is divided into plasma and component blood through a centrifugal pump. It is a treatment method in which the patient's own plasma is discarded and injected with plasma substitutes such as fresh plasma, albumin solution, or balance solution at the same rate.

The fundamental purpose of this treatment in this case is to reduce the absolute number of GMB antibodies in the patient's blood.

Antibodies floating in the bloodstream are separated from the body along with the plasma, and this alone can reduce the amount of GMB antibodies – plasmapheresis typically replaces about one-third of the plasma in the body at a time. In other words, without the use of immunosuppressive drugs, plasmapheresis can reduce the antibodies in the patient's body by about 30% over a certain period of time.

Of course, the amount of plasmapheresis can be adjusted according to the needs, and it is not impossible to replace all the plasma in the patient's body in one go. However, this limit amount of plasmapheresis can easily cause systemic hemolysis and other more troublesome conditions. Considering that Wang Lin's lungs were still bleeding, whole-body plasma exchange was obviously not suitable. Therefore, after the expert discussion with the director of the Department of Hematology, Li Li, everyone unanimously agreed to perform plasmapheresis with 50% of the total blood volume on Wang Lin first, and after the plasma exchange was completed, anti-infective treatment should be started immediately.

The boss of the hospital infection department came uninvited after hearing that there might be an MRSA infection. Before the PCR test results were available, the hospital infection department firmly opposed the direct use of vancomycin to treat patients.

The reason for the hospitalization is simple: "Even if it is an MRSA infection, the use of traditional antibiotics can destroy a considerable number of non-resistant bacteria." Truly methicillin-resistant Staphylococcus aureus multiplies slowly, and both methicillin-resistant and methicillin-susceptible strains are present in all MRSA colonies. After the first antibiotic is used, a large number of susceptible bacteria are killed within a few hours. When the drug-resistant strains grow and multiply slowly, it will be a few hours later - and the PCR results of the laboratory will definitely be available by then. Based on PCR, vancomycin should be considered. ”

Anyway, in the medical records of patients suspected of MRSA infection, the hospital infection department has the highest decision on the use of antibiotics. And their reasons are indeed sufficient to follow their protocol and ensure the safety of patients. Sun Lien and the others naturally have no opinions.

But no one expected that the fiercest opposition would come from Wang Lin's daughter.

"You all know my dad may have a superbug infection, why not use vancomycin?" she said, looking very angry, and her high-pitched voice pierced the door of the conference room.

Sun Lien plucked his ears in distress and persuaded in a harmonious voice, "The current antibiotics are not completely ineffective. Regardless of whether he is infected with superbugs or not, a safer antibiotic is the most appropriate solution. ”

"I don't care!" she slapped the table hard, "We're not out of money, why don't you give my dad the best medicine?"

"What's the best medicine?" Sun Lien smiled bitterly, "As long as it works, it's the best medicine." We doctors can't just use a certain drug because it's new, or because some medicine is very famous. ”

Hu Jing, the head nurse, heard the voice and came over, she glanced at Sun Lien, and motioned for Xiao Sun to get out of the way and let the professional come. Sun Lien also obediently gave up his position, Yu Gong, Hu Jing is the head nurse, she will definitely not be able to stop Sun Lien if she wants to get started. Yu Private, as Hu Jing's quasi-niece and son-in-law, and he definitely can't beat this Hu Jia's maiden aunt, he can only obediently give up his position.

"Little girl, it's a poison. Hu Jing began to persuade in a homely tone, "Vancomycin has great side effects, do you really think doctors are reluctant to use it? This medicine is precious, according to the regulations of our Song Province, vancomycin is not included in the medical insurance." This is self-financed medication. The doctor didn't let me use it, but it definitely wasn't because of the money......"

A little farther away, Sun Lien listened to the head nurse's explanation and felt a little congested. Obviously for the good of the patient, how can you explain it clearly and pour some dirty water on yourself first?