第4章 推演成功

huidaojiazhonghou,jiangchensuiyixileyibalianbiankaishizuozaofan。

zaofanzhuyaoshiniunaijidantang,waijialianggemantou。

buguoniunaijidantanglijiangchenzhifangledanqing,bingmeiyoufangdanhuang。

huiqudelushang,jiangchenrenzhenshulizhetongtongxianzaidebingqing。

youzhebinglixuedezhishizuoweijichu,jiangchenduiyushulitongtongdebingqingyouzheyidingdebawo。

dangtahuidaobingfangshi,tongtonghaizaishushui,ertayijingchedigaoqingchuletongtongdebingzhengmailuo。

xianzai,chulerongxuexingniaoduzhengheshenshuaijiezhiwai,tongtongzuizhuyaoderongxuexingpinxuedaozhidexinlishuaijieyijigaoxuejiazhenghedianjiezhiwenluan。

xiangyaozhiliaopinxue,zuihaodefangfabianshishuxue,buguodangxuejia>6mmol/lshi,jiubixuxianbaxuejiajiangxialai,suihoucainengshuxue,fouzehuanzhehuiyoushengmingweixian。

erjiangdixuejiadefangshihejiejuedianjiezhiwenluandefangshiyiyang,neibianshixueyetouxi。

guigenjiedi,touxishibixuzuode。

jiangchenxianzaishouxianyaobimiandeshi,tongtongdexinlichedishuaijie。

dangxinlichedishuaijiehou,jiubixuyongecmolaijinxingxinzangzhichi,daoneishi,qingkuangjianggengjiaweiji。

suoyi,tadediyiyaowushichedijiejuetongtongxinlishuaijiedewenti。

erxiangyaotuiyanchuzhiliaoxinlishuaijiedefangfa,jiubixuzhangwoxiangguandeyixieyixuezhishi。

所以....

江辰仍需努力。

zaoshang,zhuzhiyishengyangdantongqitadafuhushi,yiqilaichafang。

chakanguotongtongdangxiadebingzhengzhihou,yangdanjihushixiaolijichuleduiyingdechufangdanzi。

suihou,takanxiangyipangdejiangchenxunwendao:“zenmeyang,shukandehaishunlime?”

jiangchenkeqidedianlediantousuihoudao:“ng,haibucuo,binglixueyijingkanwanle,jiexialaigaikanshenglixuehezhenduanxuele。”

tingdaojiangchenzheihua,yuanbendasuanjijiangchenshuoshengjiayoudeyangdanqueshiyileng。

daozuibiandejiayouzuizhonghaishiyanlehuiqu。

yiyeshijiankanwanbinglixue?

这无疑是在开玩笑。

yaozhidao,yixueshujibutongyuqitazhuanyedeshuji,meiyibendounengdingqitashujidesiwuben。

erqie,limianjizaidebinglizhishikeshinangkuoleerke、fuke、neike、waikedengyixiliedefangmian,keweishibaoluowanxiang。

daxueshengxueyiniandouweibinengchitou,kejiangchenjuranshuozijiyiyeshijianduwanle。

zheidaoshishidejiangchenzaiyangdanxinzhongdeyinxiangdadajianfen。

yixuekebushiyimenhunongdexueshuo,jiangchendezuofawuyishizaihuazhongquchong。

tongyangyouzheizhongxiangfade,haiyoutongxingdeqitayishenghehushi。

zaitamenkanlai,jiangchensuoweidecongshuzhongxunzhaojiuzhifangfa,buguoshijuyishixingqidewanxiao。

“neinijiayou,kanwanjidehaihuilai,sunhuaileyaopeide。”yangdandingzhu。

“嗯。”

jiangchennenggoucongyangdandebiaoqingzhongkandaomingxiandebuxiangxin,kezheibuzhongyao。

tazhixuyaozijixiangxinjiukeyile。

jiexialaidejitian,jieshihezuoriyiyang,chulezhaogutongtongzhiwai,shengyudeshijianjiangchendouhuikanshu。

youzhejingliyaoshuidejiachi,tayizhouweimian。

duanduanyizhoushijian,jiangchenyijingchedixuewanleyixueshengdaxuewuniandeyixuezhishi。

bingqie,tahaijiangzheixiezhishilaolaodejizailexinli。

xianzai,jiangchendeyixuesuyangyijingkeyikanbiyiminggangbiyedezhuyuanyile。

hongzhetongtongchiguowufanzhihou,jiangchenjiangxinsichenrulexitongzhizhong。

jingguoyizhoudexuexizhihou,tazhongyudasuanzheshoutuiyanle。

“xitong,tuiyanxinlishuaijiezhiliaofangan。”

【xitongyishoudaosuqiu,zhengzaituiyanjieguoqingshaohou。】

【muqiansuzhuzaixinlishuaijiefangmiandezhishibijiaoqianbo,tuisuanjieguozhiliaofengxiangaoda90%,shifoutiqu?】

tingdaozheihua,jiangchenfangqiletiqu。

kanlaihaishizijixiangdetaitianzhenleyixie。

yiweizijixuewandaxuelideyixuezhishi,jiunenggoutuiyanchuzhiliaoxinlishuaijiedezhiliaofanganle。

没想到....

tuisuanjieguodeshishifengxianhuineimegao。

“kanlai,bixuyaolejiegengduodexinlishuaijiefangmiandezhishicaixing。”

xinnianluoxia,jiangchenjiangzhuyilifangzailezhiwangshangmian。

zhiwangshang,youguoneiwaidingjianxuezhedexueshulunwen。

xianzaijiangchenyouzhejichuzhishi,kandongneixielunwensihaobufeili。

zhiyaobaneixielunwendoukentou,jiuyidingnenggoutuiyanchuzhiliaofangfa。

江辰坚信。

tahelezuihouyipingjingliyaoshuizhihou,biankaishixuexizhiwangshangguanyuxinlishuaijiefangmiandelunwenwenxian。

erzheiyixuexi,youshizuzuyixiawushijian。

yixiawushijianli,tazuzukenle372pianyouguanxinlishuaijiedelunwenwenxian。

qizhong,jiangshulexinlishuaijiedebingyin、linchuangbiaoxian、shiyanshijianchashujuyijixiangduibaoshoudezhiliaojianyi。

youlezheixie,jiangchenzaiyicixuanzetuiyan。

“xitong,tuiyanxinlishuaijiezhiliaofangan。”

【xinlishuaijiezhiliaofangantuiyanzhong,qingshaohou。】

【chenggongtuiyanchusangezhiliaofangan,chenggonglefenbiewei60%、70%、75%,shifoutiqu。】

“提取。”

jiangchenhuayinluoxia,sandaozhiliaofanganchuxianzailetadenaohai。

【zhiliaofanganyi:xinzangzaitongbuhuazhiliao(crt),youyudangqiankejishuipingyouxian,dianzizhulibengzhinengzaizhongduanqineiweichibingrenzangqigongneng,chenggonglv60%,dianjichakanxiangqing】

【zhiliaofanganer:βshoutijiekangjipeihexinxingecmoxitongzonghezhiliao,chenggonglv70%,dianjichakanxiangqing】

【zhiliaofangansan:xinzangyizhishoushu,chenggonglv75%。dianjichakanxiangqing。】

kanzhesangezhiliaofangan,jiangchendiankaixiangqingzixiguankan。

zuzuhualeyigexiaoshi,tafangcaijiangzheisangezhiliaofangandexiangqingxijiegaomingbai。

guigenjiedi,zheisangezhiliaofangangeyouyouquedian。

qizhongfanganyishidangqianbijiaozhuliudeyizhongxinlishuaijiezhiliaofangfa,danshiyouyukejishuipingyouxian,muqiandeyizhidedianzizhulibengwufazuodaohezhenzhengdexinzangyiyang。

zheizhongzhiliaofangfanenggouranghuanzheduohuojinian,danshiwufagenzhi。

xianranzheibushijiangchensuoyaode。

zhiyudisanzhongxinzangyizhishoushu,gengbietile。

suishuoxitongjichudexinzangshoushufangangezhongxijie,yuanyuanchaoqianyuxianzaideyixuelinian,chenggonglvgengshigaoda75%。

dantongtonghuanbingfangcaibannianduo,xianbushuotaxianzaihaimeiyoudadaoxinzangyizhidedibu。

jiusuandaoleneiyibu,yeweibinenggouzhaodaoheshidexinzangyuan。

所以....

jiangchenshijishangnengxuandefanganzhiyoudierzhong。

βshoutijiekangjipeihexinxingecmoxitongzonghezhiliao。

zheishiyizhongzuhezhiliaofangan。

qizhong,βshoutijiekangjizheizhongyaowudangxiajiuyou,bingqiefuhexitongtuiyanchudeyaowubiaozhun。

tanenggouyizhijiaoganshenjinghuoxing,congerjianhuanxinlishuaijie。

buguozheizhongyaowudezuoyongyejinjinshijianhuanxinlishuaijie,bingbunenggenchu。

zheigezhiliaofangandeguanjianjiuzaiyuxinxingecmoxitongshang。

xianzaiyiyuanlisuoshiyongdetiwaimofeiyanghezhichixitong(ecmo)naishicongwaiguojinkoude。

tademuqiandezhuyaogongnengbianshixinzanggongnengdezhichi。

xiangdangyutiwaixinzangdaititineidexinzangyunzhuan。

qizuoyong,qishijiuxiangdangqianjinding,zhihuizaijinjishikedingtiyixia。

shuobailejiushiduanqineiranghuanzhebaochixinzangdezhengchanggongneng。

可患者出院后呢?

tineidexinzangshuaijieyijiumeiyougenzhi,huanzheyijiuhuisiqu。

erxitongtuiyanchulaidexinxingecmoxitongzebuyiyang。

tabujinnenggouzhichixinzanggongneng,tongshihainenggouduanlianxinzang,huifuqizhengchanggongneng。

rangyuanbenneixiebukenidexinzangshuaijiedadaohuifu,congerchedigenzhixinshuaijie。

并且...

xiangyaozhizaochuxindeecmoxitong,xianzaidekejishuipingyijingdadao。

guanjianzaiyuyiliaoliniandezhuanbianheruanjianxitongdechuangxin。

congxitongdefenxilaikan,waiguodezheiecmoxitong,suoyouyingjianshebeiyijingwanquandadaolexitongdeyaoqiu。

weiyimeiyoudadaoyaoqiude,bianshiqizhongderuanjianchengxuheyunxinglinian。

zhiyaojiangxitongtigongdeneixiefanfudechengxujizhu,bingqiezaixianyoudeecmoxitongshangmianjinxinggenggai,biankeyanzhichuyitaixinxingdeecmoxitong。

neiyang,jiubuyongdanxintongtongxinshuaijiele。

buguozheizhongyiqigaodajibaishangqianwandejiage,jiusuanshiningshideshijiyiyuanyejinjinzhiyouliangtai。

gaizenmenongdaozheizhongyiqini?

这又是一个难题。

xianzai,jiangchenshouzhongdedecunkuanzhiyoubudaosanshiwanle。

zheixiehaishitazhiqianzaijiazuoduanshipinzhuanlaide。

genbenbukegougoumaiyitaixinde。

zhangqiuyunyougoumainengli,danshijiangchenbuhuixiangtakaikou。

再者

jiusuanmaihuilai,haiyouanzhuangdengyixiliedeyaoqiu。

并且....

zheizhongjingmiyiqiduiyuhuanjingdeyaoqiuxiangdangyange。

jiusuanmaihuilaifangdaojiali,jiangchenjiadehuanjingtiaojianyedabudaoyiyuandeshuizhun。

所以...

jiangchenzhinengcongyiyuanzheibianxiangbanfa。

xianzai,tongtongzhudebingfanglimeiyouzheizhongyiqi,xiangyaojiechudaoecmo,jiubixuquicu。

“kanlai,dexiangbanfarangtongtongzhudaoiculi。”

xinnianluoxia,jiangchenkaishisisuoduice。

erzheishi,hushixiaoliguolai,shuoshiyaodaixiaotongqianquxuetouzhongxinzuotouxi。

jiangchentuilailunyi,qingqingdejiangnverbaodaolelunyishang,gaihaobeizi,ranhoujiugensuinverquzuotouxi。

jiangnversongjinxuetouzhongxinzhihou,jiangchengenhushixiaolijiaodaileyifan,bianxiangzhezhuzhiyishengyangdandebangongshixingqu。

touxixuyaoyizhengtiandeshijian,xuetouzhongxinyebuyunxuhuanzhejiashujinru,youzhezhuanzhihushixiaolikanzhe,jiangchenkeyizanshilikaiyiduanshijian。

laidaoyishengyangdandebangongshimenqian,jiangchenqingqingdezaimenshangqiaoleqiao。

“进来。”

yangdantaiqitou,kanxiangmenkou。

jiandaojinlaideshijiangchen,tadagaicaicedaolejiangchendelaiyi。

zuoweiyimingzhuanzhinaiba,rujingangganglihun,haiyaodanfugaoedeyiliaofei,tanenggouxiangxiangdaojiangchenjianshangdedanzidaodiyouduozhong。

“想好了?”

tingdaoyangdandewenhua,jiangchenxianshiyileng,suihoudanranyixiaodao:“yangdafukongpawuhuile,wozheicilaibushiweiletongtongchuyuandeshiqing。”

“那是?”

yangdanqiaolianzhishangfuxianyimoyihuo。

jiangchenzeshidao:“woshixianggenyangdafushangliangyixia,rangtongtongzhujinicu。”

tabukenenggenyangdanshuozijizhaodaolezhiliaotongtongxinshuaijiedebanfa。

yinweineiyangbierenrongyibatadangchengfengzi。

jiusuantajiangxitongtuiyanchulaidefangfashuochulai,yiyuanhaixuyaozuolinchuangshiyanqueren、yiwubaobei、shangjiqingshidengyixiliedecuoshi。

dengdaoneishi,kongpatongtongdexinzangyijingchedishuaijie。

suoyi,tazhunbeixianjiangtongtongsongjinicu,ranhouzaixiangbanfagenggaiecmodechengxu。

suishuozheiyangzuobeifaxianrongyijinjianyu,danzheishimuqianweiyikexingdefangfa。

weilebaozhunverdeshengming,tayaoshiyishi。

jiangchendehuarangyangdanyouxieyiwai。

“nishuoshenme?nishuoyaorangtongtongjinicu?”

yangdanturanjianbagaodeyindiao,dunshiyinlaizheizhoubianqitayishenghejiashudezhuyi。