The first possibility that Sun Lien can think of is the coordinate system. Three points seem to be just right to form the XYZ three-axis coordinate system. And these coordinate systems may directly point to the regions and organizations involved in the state. But this conjecture was quickly rejected by himself - the number of common iliac vein thrombosis was 78 in the first group, while the popliteal vein thrombosis in the left lower extremity was 73, and the stroke was 05. If the numbers are a coordinate system, then there shouldn't be a situation where the coordinates of both the head and legs are lower than the common iliac vein below the lower abdomen – this is not logical.

Could it be something else? Match the three sets of numbers...... Sun Lien sat on a stool and began to scratch his head, all of them only had numbers and no letters, which was not an ICD10/11 disease code. The most important thing is that Sun Lien doesn't think that these numbers may be passwords that need to be interpreted additionally - the status of the status bar is a clue directly related to the patient's current disease, and since it is a clue, it does not add to the meaning of the password system.

"You want results. Sun Lien was scratching his ears and cheeks, but Shi Yan walked out of the laboratory. threw an inspection report in Sun Lien's face again. "Coagulation is normal. ”

"Normal?" Sun Lien was stupid when he heard this result, "How is it possible?"

"What's impossible?" Shi Yan was very confident in the results he had prompted, "The result of the experiment is this, and we are responsible for every sample!"

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"The result is there. Sun Lien was stunned as he looked at the blood clotting time, and the baked gluten in his pocket sang again. On the other end of the phone, Xu Yourong said calmly, "Multiple blood clots." ”

"There's no blood clot, right......" Sun Lien hadn't been able to get rid of the results of the normal blood clotting time, and Xu Yourong's tone was so calm that he completely misheard the content.

"There are multiple blood clots. Xu Yourong re-emphasized, "Your ears are fine, right?"

Sun Lien suddenly came to his senses, "In addition to the deep vein thrombosis, where else is there a thrombosis?"

"There are ischemic foci in the small intestine under CT, and there may be avascular necrosis. However, the specifics may need to be found out by opening the abdomen. Xu Yourong replied, "It seems that there is also an ischemic foci in the brain, which is located in the thalamus. However, no sclerotic plaques were found in the systemic arterial CAT ”

If there is no sclerotic plaque, then it is not a cerebral artery embolism caused by arteriosclerosis. But the clotting time is normal, and it shouldn't be a blood clot - especially in the absence of pulmonary embolism, it is impossible for a blood clot to skip the lungs and go directly into Xia Hongyuan's brain.

"Got it. Sun Lien rubbed his face painfully, "Take the patient back to the emergency room first, and I'll call for a consultation." ”

There was a strong sense of powerlessness lingering in Sun Lien's heart. He originally thought that after he had a status bar, he would be able to move forward from now on, and all kinds of strange diseases would be at his fingertips. But now he realized that he was a little too wrong. Even after doing so many tests, he still didn't have any clue, and he didn't even know what kind of disease Xia Hongyuan had—was it an autoimmune disease, or was it caused by an infection? Sun Lien had no idea at all.

The lack of ideas means that when he calls experts from other departments for consultation, he needs to invite more doctors from more departments to try his luck. And you can't have a rough suspicion range as before, and then invite experts from the corresponding department.

Doctors from the Department of Hematology, Interventional Medicine and General Surgery came to the emergency room.

"My recommendation is to stay in the hospital for observation. The doctor in the Department of Hematology first expressed his opinion, "Coagulation dysfunction may fluctuate, and the first test is normal, but the patient has obvious hypercoagulation, which is definitely to be kept in the hospital for observation." ”

"This case of stroke is not a large vascular embolism, and mechanical thrombectomy is basically impossible. "The doctor of the interventional department looks at his own one-third of an acre, "intravenous thrombolysis can be considered, and the part of deep vein thrombosis can be mechanically thrombectomy, and from the results of CTA, the patient's deep vein thrombosis is not too big, and there is no free thrombosis." ”

The attitude of the general outside is more frustrating, "the patient's deep vein thrombosis is too close to the renal vein, and the strainer surgery itself is fine, but the effect is not necessarily good, and it is difficult to guarantee that there will be no thrombus falling off during the operation." Since the interventional department recommends thrombolysis, it is better to simply treat conservatively and use anticoagulation and thrombolysis as the main means. ”

The doctors from the three departments all put forward their own opinions on the patient's situation, but there was no diagnosis that Sun Lien wanted to know most - what disease did Xia Hongyuan have?

"According to the preparation of thrombolysis treatment, how long will it take for the interventional operating room to be ready at the earliest?" Facing the doctors of these three departments, Sun Lien thought about it for a long time and decided to treat the symptoms first. At least Xia Hongyuan's cerebral infarction was relieved first, and his deep vein thrombosis was treated with mechanical thrombectomy.

"Take the green channel, you can do it in ten minutes. "The doctors in the interventional department attach great importance to Xia Hongyuan's condition, and they are indeed the best department to deal with deep vein thrombosis and cerebral infarction when the patient's coagulation function is normal. "I'll leave it in the operating room now. ”

"I went to ask the family for an autograph. Yuan Ping'an consciously took on the responsibilities of a junior doctor, and he didn't even need Sun Lien to take the initiative to ask for anything, he took the treatment consent form and went to Xia Hongyuan's parents to sign it.

The doctors from the Department of Hematology and General Surgery left immediately, and in the small conference room, only Sun Lien and Xu Yourong were left. Xu Yourong sat in his seat and looked at the information, and suddenly asked Sun Lien, "You haven't figured out what disease he has?"

Sun Lien smiled bitterly and nodded, "What I can't understand the most is this-what kind of magic did his blood clot use to start from the deep veins, bypass the pulmonary circulatory system, and drill directly into his brain." Sun Lien really didn't understand, and he didn't even plan to continue to dwell on how people with normal coagulation function developed deep vein thrombosis.

"I can't figure it out the same as you. Xu Yourong closed the laptop in front of him and frowned, "A physical education teacher who has to run around every day is not like a person with a high incidence of DVT (deep vein thrombosis) - he is not an otaku who sits in front of the computer all day long and plays games." ”

"The three main factors of DVT are slow blood flow, damage to the venous wall, and hypercoagulability. Xu Yourong continued, "A national first-class athlete has very normal cardiopulmonary function. And the usual work requires frequent exercise, so it is unlikely that the blood flow is slow. Damage to the vein wall had been ruled out by CTA, and hypercoagulability was even more inexplicable – his clotting time was normal. ”

"If there are only three possible causes of this condition, and all three are ruled out, then either there is a cause of DVT that we have never identified, or there is some change in all three states after causing the patient to have DVT. Sun Lien frowned, and followed Xu Yourong's train of thought and said, "The probability of a new cause of illness is too small to be considered for the time being." The damage to the vein wall doesn't heal so quickly, and the slow blood flow doesn't go along with his daily work life, so he must have had a hypercoagulable state?"

Speaking of this, Sun Lien suddenly had a flash of inspiration. If Xia Hongyuan has been in a hypercoagulable state for a long time, then it is too normal for him to have a blood clot in his brain - it is not only the deep veins of the lower limbs that can produce blood clots, in the hypercoagulable state, other blood vessels produce blood clots and fall off, and even it is possible for blood clots to form directly in his cerebral blood vessels!

Xia Hongyuan's cerebral thrombosis was not caused by deep vein thrombosis falling off, but by systemic hypercoagulability!

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Compared with traditional surgery, the most important feature of interventional surgery is that it is less invasive and faster. Seriously, before the birth of the interventional department, it was simply impossible to perform a craniotomy to rule out the thrombus and DVT treatment on the leg at the same time. The interventional department only needs to insert an implant sheath in the patient's left femoral vein and right femoral artery to perform two surgeries at the same time, and the wound is only two slightly larger pinholes. It has to be said that the difference in the performance of scientific and technological progress in medicine is indeed very obvious.

An hour later, Xia Hongyuan's interventional treatment ended. The effect of thrombolysis in the brain is obvious, and both venous thrombosis of the lower limbs have also been removed. But the follow-up work was not over, and the removed thrombus was directly sent to the pathology department for pathological testing. Sun Lien hopes that the pathology department can clarify the nature of the emboli, so that it is more convenient for subsequent diagnosis.

And Sun Lien found his strongest helper.

"Well...... Such a complex and variable condition, such a troublesome situation, does feel like an autoimmune disease. Dr. Pascal made a not-so-funny joke. "CAT determines that there is no thickening of the blood vessel wall?"

Sun Lien nodded, "I used this result to rule out blood clotting caused by vasculitis, but I really can't think of any other disease that can cause this kind of multiple blood clots when the blood clotting function is normal." ”

"We haven't been able to say for sure it's a blood clot. Dr. Pascal corrected Sun's statement, "Until the results of the pathology department come out, we can only think that the blood clot is the most likely." ”

After correcting Sun's statement, Dr. Pascal frowned, "Do a test for autoimmune diseases and see his antibody status first." ”

"I've just had the operating room take a sample, a blood sample taken before thrombolysis. Sun Lien replied, "Including the latest blood routine and coagulation status, the results should be available soon." ”

"I bet with you. Dr. Pascal smiled, "This blood sample must be hypercoagulable. ”

Sun Lien was shocked when he heard this, and he couldn't understand why Dr. Pascal was so confident.

"You forgot a very important reason that affects blood clotting. Dr. Pascal smiled, he was actually a little disappointed, after all, in the previous cases, Sun Lien had noticed this difference in time and made a correct diagnosis. This time, however, he didn't seem to be aware of the variable.

"Body temperature. Don't forget, when he was admitted to the hospital, his temperature was only 33 degrees. Dr. Pascal shook his head, "Hypothermia reduces the number of platelets and lowers blood clotting. You took a sample to check the coagulation function shortly after he was admitted to the hospital, and the results were normal. In other words, when his body temperature is normal, he should be in a hypercoagulable state. ”