Rebirth of Medicine Practices the World

"After the patient was admitted to the hospital, he continued to take antihypertensive No. 0. I would like to know if this medicine is available in your hospital's pharmacy?" Lin Lin suddenly asked.

"No, this is what the patient brought with him." Zhang Yin replied immediately.

"Okay, I understand, thank you."

"The patient's blood pressure is indeed controlled very stably. However, there are hidden worries behind this stability. I will talk about it later."

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

"I agree with your opinion on the diagnosis and treatment of neurological diseases."

"Why did this patient's condition become so bad in a short period of time and continue to get worse? This is worth pondering."

"Let me first talk about why this patient has undergone such obvious changes in a short period of time. I think the trigger is closely related to the death of the patient's friend."

"The patient's friend has hypertension, so after the patient heard about it, he became more concerned about the treatment of his own hypertension. He changed his previous habit of taking medication intermittently and has been taking medication to this day."

"Hypertension No. 0 is a compound preparation that contains a specific antihypertensive drug called reserpine."

"Reserpine has a very good antihypertensive effect. I remember that in the second year of my graduation, in 1985, a patient had very high blood pressure. The doctor on duty gave him an intramuscular injection of reserpine, and his blood pressure immediately dropped.

Falling into 'shock' state."

"Later, I relied on dopamine to maintain blood pressure stability, and it slowly returned to normal after a week. Therefore, I was particularly impressed by reserpine."

"Reserpine mainly affects the uptake of norepinephrine by sympathetic nerve endings, depletes the storage of norepinephrine, and blocks the transmission of sympathetic nerve impulses, thereby leading to vasodilation, lowering of blood pressure, and slowing of heart rate."

"In addition, reserpine also has sedative and central nervous system depressant effects, 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"Now, reserpine has withdrawn from the stage of history. Regular hospitals do not have reserpine as an antihypertensive drug. But this does not prevent some manufacturers from taking advantage of its effects and its low price to make 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, whether mild or severe, are occurring in this patient."

"I think this patient's changes in mood and temperament are directly related to reserpine. The patient's poor treatment effect is also related to reserpine. Because the patient has not stopped taking this drug so far.

Drugs. You can imagine how the patient's condition can be improved?"

"So, next, I suggest changing this antihypertensive drug. You can switch to a calcium ion antagonist, an angiotensin-converting enzyme inhibitor (ACEI), or the latest angiotensin receptor blocker (ARB)."

"These drugs are effective and have few side effects. However, at the beginning of changing the drugs, Dr. Zhang is asked to closely observe the changes in blood pressure and adjust the dosage or type of drugs in a timely manner."

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

"I believe that the patient's condition will gradually improve after replacing the antihypertensive No. 0. Of course, this will take some time, so there is no need to rush."

"Finally, let me ask another question." After Lin Lin finished speaking, she paused and took a sip of the mineral water that Director Han handed him.

It was very quiet in the doctor's office. The doctors had been impressed by Lin Lin's analysis. Yes, they had suffered from "specialist disease" and could only think about neurological diseases. Their knowledge was already very limited.

Lin Lin's analysis not only made their eyes shine, but also made them see their own shortcomings.

"The patient has had a history of hypertension for more than ten years and has not received regular treatment. Such a result will definitely cause damage to target organs caused by hypertension."

"In this patient, the damage to the target organs is very clear. Damage to the small blood vessels in the brain resulted in small subcortical ischemic foci seen on magnetic resonance imaging; the heart has been affected by high blood pressure for a long time, and the myocardium has become hypertrophied.

Heart function has also declined."

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

, the ability to regulate electrolytes decreases..."

"All of these are telling us that the patient's kidney function has been damaged. When I was doing compound palpation of the abdomen with both hands just now, I felt that the patient's kidneys were smaller than normal. As for whether my feeling is correct, I will wait for a while.

Please ask Dr. Zhang to order an examination to specifically check the size of the kidneys."

"Long-term, poorly controlled high blood pressure will cause the blood vessels that supply blood to the kidneys to harden, eventually leading to kidney damage."

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

"In this regard, some albumin can be used appropriately. When using it, you must 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, have you got the biochemical results you just mentioned?"

"I got it. The patient's kidney function is indeed damaged." Zhang Yin replied. Now Zhang Yin has already admired Lin Lin to the point of admiration.

In the neurology department, had she ever seen such rounds before?

"Okay, that's all I have to say. If there is anything wrong, please ask Director Han and everyone to criticize and correct me." Lin Lin ended his speech with a smile. There was a strong confidence in his smile.

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

"Yes, we have suffered from 'specialty diseases' before. Except for neurological diseases, other diseases seem to have nothing to do with us."

"After listening to Dean Lin's ward round today, we realized that we were totally wrong. The human body is a unified whole, and any problem with any organ will affect each other. Just now, Dean Lin's ward round analysis

It taught us a good lesson in this regard.”