Wang Ge was sent to the comprehensive diagnosis center, and Sun Lien finally returned to his familiar post.

As for the emergency clinic...... Dr. Cao Yanhua decided not to interfere, and he invited other doctors to come over and take Sun Lien's place.

"Long time no see. Dr. Brunn hugged Sun Lien, then patted him on the shoulder with his big thick hand, "Welcome back." ”

Dr. Pascal waited for the Texans to walk away before he came over and shook Sun Lien's hand, "Come back, come back, what are you bringing a gift for?"

Sun Lien thought for a while before he realized that Dr. Pascal was talking about Wang Ge.

"He's in trouble, so I think it's best to ask you to take a look. "I think he has SLE. ”

"Then go to immunosuppression. Dr. Pascal spread his hands, "That's not the problem—you know the plan to control SLE. ”

"He also has coronary heart disease, three lesions. Sun Lien nodded, "The emergency monitoring shows that he has an acute kidney function injury. ”

Dr. Pascal frowned, it was a bit tricky. "Blood lipids are normal?"

"Yes. Sun Lien gave an affirmative answer, "The three-piece stenosis should be the result of SLE, and the upper stent is a little dangerous at this level." ”

If people with SLE experience arteritis or other immune attacks on the lining of their blood vessels, the walls of their blood vessels begin to lose their elasticity. Becomes both hard and brittle. In this case, the stent is placed with an interventional procedure, and the metal guidewire responsible for the installation is likely to directly puncture the artery or even the aorta. In addition, the three lesions themselves mean that the stent installation is of little significance, so Sun Lien said this.

"This one is a bit of a hassle. Dr. Pascal pondered for a while and was a little helpless, "This kind of patient can't take hormones, in case hormones cause hyperlipidemia, then his narrowed coronary arteries are likely to be directly blocked." ”

"I'm worried about that, too. Sun Lien honestly said the reason for his request for help, "My idea is to see if I can treat him conservatively first." ”

It's not that Sun Lien has changed too much before and after, but the current situation is really not suitable for bypass surgery.

After Wang Ge was admitted to the hospital, he quickly developed acute kidney impairment. There are many possible causes of injury, whether it is lupus, renal hypoperfusion due to coronary heart disease, or even renal hypoxic injury due to the use of contrast agents and the inability to rehydrate large amounts of fluids.

Bypass surgery is the best way to treat all three lesions, but in cases where the patient has already developed kidney damage, it is too risky to perform further surgery.

Now Wang Ge is like a glass doll, there are problems everywhere, but the whole body can't touch it.

The situation is far from rosy.

"If surgery can't solve a problem, it can only be solved by internal medicine. Sun Lien gave his first instruction as the deputy team leader, "First find a suitable immunosuppression program, give him CRRT (continuous hemodialysis), increase the amount of fluid appropriately, and let him metabolize the contrast agent as soon as possible." ”

It's going to be a long and urgent process. Due to the existence of SLE, many commonly used methods cannot be applied to Wang Ge, and many organs that should not have problems will also fall into failure one after another. In order to save Wang Ge, Sun Lien and his team must control the current situation and intercept the falling domino queue called SLE before many organs in his body become problematic.

The first thing that needed to be addressed was his acute kidney injury.

Zhou Ce rushed back from the inpatient department and began to participate in the treatment process. He has some different opinions on Sun Lien's judgment, "If it is acute kidney failure caused by SLE, the speed should not be so fast." I personally tend to contrast nephropathy. ”

Dr. Pascal also gave his advice, "This patient's condition is clearly a heavily active SLE. To be on the safe side, I recommend taking a hormone shock first, at least suppressing SLE – as long as CRRT and hormones are working, as long as his blood lipids are measured frequently, and lipid intake is controlled, the risk of coronary artery blockage should be minimized. ”

Sun Lien nodded, and then paused for a moment.

He didn't bother to continue talking to Dr. Pascal and Zhou Ce, and walked briskly from his office to Wang Ge's hospital room.

Wang Ge had just been transferred to his room, and the only thing that accompanied him here was his girlfriend - his parents were rushing to Ningyuan on the high-speed train, but there were still four hours to go.

Sun Lien broke into the ward without saying a word, and then did not respond to Wang Ge's inquiry at all. Sun Lien glanced at the top of Wang Ge's head, then picked up the test sheet on his hospital bed and looked at it.

"Doctor...... Wang Ge's girlfriend asked a little worriedly, "he...... Is there anything wrong with him?"

"The problem now is huge. Sun Lien replied with a frown as he read the test report, "The biggest problem is that I think there is something wrong with his problem." ”

This is very difficult to say, but Sun Lien really can't explain it directly to the patient's family, how can this be said? "Your boyfriend's SLE activity is different from what I see from the plug-in"?

The degree of activity in SLE is estimated by a clear score – different scores are given for different symptoms. Scores are given according to the symptoms exhibited by the patient, with 0~4 points being quiescent, 5~9 being mildly active, 10~14 being moderate, and more than 15 being severe.

The status bar clearly states that Wang Ge's SLE is in a quiescent phase. In other words, the sum of the symptoms he exhibited should be less than 4 points.

However, vasculitis has a score of 8 in the SLE score, and if the bar essence is a psychiatric symptom, then it is also 8 points plus the proteinuria suggested in the status bar is 4 points, and if these three symptoms are caused by SLE, then Wang Ge's total SLE activity score is as high as 20 points. This cannot be considered a "static period" in any way.

That's why Dr. Pascal believes that Wang Ge's SLE is in a severely active phase. And it is this contradiction that makes Sun Lien rediscover the contradiction in the status bar prompt. Patients with SLE with proteinuria and vasculitis could not have been quiescent, and Wang Ge did have vasculitis and proteinuria—urine routine confirmed proteinuria, while vasculitis was the only explanation for his presence of three lesions in normal lipids.

It's not right, it's very wrong. Sun Lien can be sure that since he got the ability of the status bar, the status bar has never made a mistake. Since the "quiescent period" is suggested, then Wang Ge's SLE must be a quiescent period.

Sun Lien put down the inspection report in his hand. If there's nothing wrong with the status bar, then ...... What went wrong?