第二百一十四章 介入科(为盟主颠覆理论03)(1 / 2)
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罗三观.CS
1082 字
2022-04-26
单从治疗胃出血的角度就可以看得出来,现在的医学教育体系和实际应用中有多大的差异和不同。在教科书中被封为金科玉律唯一正确解的胃出血止血方法,是使用三腔二囊管。将三腔二囊管放入患者胃部后,通过注射器向管中注入空气,膨胀胃囊以达到压迫止血的目的。
从理论上来说,三腔二囊管副作用小,而且设备便宜,操作也没有太大难度。是理想的用于胃出血止血的治疗手段。但现实却是,三腔二囊管使用范围严重受限,因为需要患者配合,在实际使用中远不如胃镜下使用止血剂,或者烧灼止血好用。面对更严重的胃出血,医生们则会在胃镜止血无效的情况下,选择通过介入手术对胃动脉进行栓塞,以缓解出血症状。
而吴友谦院长却直接决定使用介入治疗,而非胃镜止血的思考过程,其实和孙立恩的“推理诊断”非常类似。
重症感染的情况下,患者在无进食饮水时突发严重的胃出血,这可能意味着DIC的发生。
DIC有五种主要诱因,最常见的就是全身严重感染。紧随其后的是外伤、器官损害、肿瘤和产科灾难、以及其他原因导致的凝血因子大量消耗。
一个病史不明的全身严重感染患者,在没有胃溃疡诱因下突发中度以上胃出血,作为医生,首先应该想到的绝不是临床上常见的溃疡导致出血,而是DIC的第一阶段表现,既自发性出血症状。
对于这种病情严重的患者治疗,医生们必须时刻高度保持警惕。尽量在第一时间排除掉最严重的可能性。这也是吴友谦院长直接决定进行栓塞治疗的主要理由——如果是DIC,胃镜止血不光不会有效,反而还会因为消耗凝血因子而导致DIC进一步加重。而如果不是,栓塞治疗也能够发挥效果,对于患者本身而言,并不会面临更多的风险。
在医疗行业,经验,一直都是实力的一部分。
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孙立恩站在洁净室外,听到了吴院长的安排后,心里长舒了一口气。老院长不愧是当年能够在法国的手术室里果断进行徒手止血的狠人,对于患者情况的判断简直和状态栏有的一拼——患者吐出第一口血后,孙立恩才从状态栏上看到了(轻度DIC)的状态提示。而与此同时,吴院长就已经开始安排输注冰冻血浆和全血以补充凝血因子和患者失去的血液。第二次吐血后,吴友谦院长直接决定对候慧英进行栓塞止血。这应该是已经判断出了患者出现了DIC症状,所以才会选择这么坚决的止血手段——真是快准狠的决断。
孙立恩开始见贤思齐焉,开始反思自己平时在医疗活动中,过于注重检测证据会不会影响抢救的及时性。然而在一番深思熟虑后,孙立恩有些沮丧的发现,吴院长的这一套技术,他根本就学不来。
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