I can see the status bar

Chapter 1151 Recommendations
The bad moments lasted until the next morning.It was not until he took over from Lu Zhimin that Sun Lien finally found a "victim" who could take care of him.

"Trouble." Lu Zhimin made a brief evaluation of the current situation, and then said helplessly, "What did you say?"

"Do the training, wait for the mNGS comparison." Sun Lien spread his hands, "I haven't received the letter of the comparison results yet." He said to Lu Zhimin, "I guess Director Lu, you will receive the results in class today, and we will talk about it at that time Bar."

The results of mNGS come out relatively quickly, but sampling and culturing is difficult.Whether it is using PCR to amplify specific fragments for comparison, or directly using agar plates, it will take time.

Lu Zhimin rolled his eyes and asked, "How's the second bed grab? Are antibiotics helpful?"

The antibiotic Zhou Jun gave Tian Kang was an emergency measure based on experience, and the treatment method of imipenem combined with amoxicillin/clavulanate potassium was itself a "stable" plan.

Imipenem is a special-use antibiotic with the lowest bacterial resistance rate among the clinically used antibiotics.An average 8.4% emergence rate of drug-resistant bacteria makes this drug one of the best weapons against drug-resistant bacteria.

"At present, it must be useful." Sun Lien said with some uncertainty, "The patient's temperature has come down, but the level of white blood cells is still quite high-there is still no other change."

From experience, judging whether antibiotics are effective generally requires at least two days of observation.If the antibiotics work well, there will be a relatively large improvement the next day.

If the drug is resistant, the patient's lesion will continue to aggravate the infection, and more serious symptoms may appear at the same time-such as systemic symptoms of severe infection such as bacteremia or sepsis.

To judge whether antibiotics are effective before things get too difficult to deal with, it requires not only years of medical experience of doctors, but also a lot of data support, test results, drug sensitivity training...and some good luck.

For patients infected with drug-resistant bacteria in the ICU, every operation and judgment of doctors is a matter of life and death.Patients who are infected with drug-resistant bacteria in the ICU and also present with nosocomial pneumonia often have a mortality rate of more than 60%.

Such a threat has made all ICU staff regard aseptic awareness as a necessary operating criterion, but this still cannot completely prevent such infections from occurring in the ICU.

"This kind of infection... Director Lu, you must have more experience than us." Sun Lien unkindly pushed the matter to Lu Zhimin to deal with.The status bar is really useless at this time, it is better to let professionals handle professional issues. "Don't worry about it, this patient's situation is quite special..."

Sun Li'en roughly talked about the shrinkage of Hodgkin's lymphoma on Tian Kang, and the expression on Lu Zhimin's face suddenly became more complicated.

"This kind of tumor patient..." he said helplessly, biting his teeth. "This kind of patient has a weak immune system. If he is infected with a virus and possibly drug-resistant bacteria, God will not like him."

"God doesn't like him", this is of course just a sigh.But there is no doubt that such sentiments are very realistic.Tumor plus viral and bacterial infection, the tumor is currently mainly concentrated in the lungs, and both infections also occur in the lungs.This pair of lungs seems to have experienced too many hardships.

"The tumor is showing signs of improvement, and the viral infection is also rapidly improving—he responded very well to the plasma of the recovered patients." Sun Lien tried to cheer up Director Lu Zhimin, "The problem now is this hospital-acquired pneumonia. As long as he can press it back, This person is stable."

Lu Zhimin rolled his eyes, "If the infection can be suppressed, two community doctors can cure him." He sighed, "Anyway, I'll try my best. We can do as much as we can."

·
·
·
On the 29th, there were 565 new confirmed patients in Yunhe City, 1675 new discharged cases, and 26 new deaths.

On March 3, there were 1 new confirmed patients in Yunhe City, 193 new discharged cases, and 1958 new deaths.

In order to deal with Tian Kang's infection, director Lu Zhimin made a difficult decision-he did not return to the hotel for two consecutive days to rest, and he was on duty all day in the green zone duty room of the North Fifth District.

On the first day of staying in the duty room, Director Lu asked Zhou Jun, who came to change shifts later, to get some thick clothes for him.The next day, he asked Sun Lien to bring a full set of toiletries—in a word, Director Lu Zhimin exchanged a very important "good luck" for Tian Kang with the attitude of "holding the ground, and the infection is here."

Tian Kang's body temperature began to quickly drop back to the normal range. Although the white blood cell level was still a little high, it had reached a completely acceptable level.The lesions of his lung infection are shrinking rapidly, and at the same time, he was negative for the new coronavirus nucleic acid for the first time in a routine nucleic acid test on March 3.

Of course, even if Tian Kang's nucleic acid test was also negative tomorrow, Sun Li'en and the others couldn't let Tian Kang be discharged from the hospital immediately.After all, his resting oxygen saturation is less than 90%, and being discharged from the hospital now will only make him fall into the trap of hypoxemia again.

The progress of Yang Yifei's condition was finally slowed down by four units of convalescent plasma. Although he has been judged as a standard critically ill patient, fortunately he is young and has no underlying diseases.Judging from the current progress, Yang Yifei may be able to turn into a mild patient in about a week.

At present, Yu Xin is the most serious patient admitted to the entire North Fifth District. ECMO supportive treatment cannot be stopped, nor can artificial liver supportive treatment.Fortunately, the artificial liver equipment sent by the manufacturing company works well. This life support equipment replaced with a domestic motor has been running continuously for nearly 50 hours, and there is no sign of any problems so far.The two engineers who were sent to the North Fifth District, ready to enter the red zone at any time to repair the equipment, gradually changed from being nervous to "being idle".

Two senior engineers with a lot of tools are willing to rush to Yunhe from a factory thousands of kilometers away, just to give full play to their professional ability in the place where the epidemic is most severe, and to contribute to this comprehensive fight against the epidemic. Do what you can to contribute.As a result, he had already arrived at the hospital and squatted for two full days, but he could only sit in the office in a daze.Playing poker on mobile phones and eating lunch... these days are really hard.

On the afternoon of the third day of dragging Director Lu to fight the landlord, the two engineers finally couldn't bear it anymore.They threw down the poker cards in their hands, tore off the white paper sticking to their faces, and asked, "Do you have any equipment that is not working properly? We will fix it for you!"

So, in the next eight hours, two engineers repaired three stools, two tables, four wheelchairs, and two routers.And I also used an electric soldering iron to change the shaft of a mechanical keyboard whose "H" key is not working well-the shaft body is transplanted from the Pause key of the same keyboard.

Wearing protective suits and masks, the two engineers found a lot of work for themselves in the red and yellow zones of North Fifth District.And Sun Lien was also occupied by the job he was looking for for some time.

"Yes, you can come here now." On the phone, Professor Liu, a forensic medicine expert at Yunhe University, said excitedly to Sun Lien, "Come directly to my office, and the staff from the relevant departments will arrive in about an hour. They are very satisfied with your treatment plan." I'm very interested and said that I must listen to it."

Sun Lien has been preparing related presentation PPT these days.The effect of tocilizumab is indeed good, but without larger experiments, it is difficult to promote it as a general therapy.The number of new patients in Yunhe has been rapidly reduced to more than 100 recently, and most of the existing patients are in stable condition.The existing more than 1000 critically ill patients have basically passed the best application period when tocilizumab can play a role.Among the remaining more than 5000 critically ill patients and more than [-] ordinary and mild patients, there are not many patients who need precise immunosuppression to prevent inflammatory storms.

The triple therapy with tocilizumab as the core is suitable for severe and critical patients with extensive bilateral lung lesions.Before treating patients, it is necessary to first measure the level of interleukin-6 in the laboratory.Triple therapy can be considered when patients are identified with severe elevated interleukin-6 levels and rapid progression of lung lesions.

But in terms of dosage, Sun Lien still hasn't fully come up with a clue.Only one thing is certain - if the patient does not respond well after the first two doses, the triple therapy will have limited effect.

For these patients, Sun Lien's current suggestion is to use the dose according to the instructions, and a single dose should not exceed 400mg.If the first dose is not effective, the second treatment should be started around 16 hours.As for the precautions... Anyway, the new situation has sounded the alarm for Sun Lien - if the patient has other active infections, he must not take triple therapy.

Most of these suggestions for triple therapy are based on experience after meeting with Professor Liu.Extensive lesions in both lungs mean that the patient's lungs will have a large number of vascular endothelial damage, and these damages should be the main mechanism and cause of the inflammatory storm at present.

The recommendation for a single dose of no more than 400mg is based on the instructions of tocilizumab, while the second dose is determined by the special clearance rate of tocilizumab—as a biological agent, tocilizumab is in the The total clearance rate in humans is not stable.In patients with rheumatoid arthritis, the half-clearance rate is about 4 days at a drug concentration of 11 mg/kg, and the half-clearance rate is 13 days when the dose is doubled.When the dose was increased to 12mg/kg in the treatment of patients with systemic juvenile idiopathic arthritis (sJIA), the half-clearance rate was significantly extended to 23 days.

It can be seen from these research data that the clearance rate of tocilizumab is highly correlated with its concentration in the human body.The higher the concentration, the slower the half-clearance rate.Under such conditions, if patients do not perform well on low doses of tocilizumab, continuing to increase the dose will increase the risk of patients facing more serious infections later.

托珠单抗在人体应用的最大推荐剂量是每2~4周，给与患者8mg/kg的总量进行治疗。而在实际应用中，孙立恩为一名体重67公斤的患者开出了五天内两次400mg托珠单抗静脉滴注的治疗方案。这已经非常接近12mg/kg的使用记录了。

Fortunately, the patient finally made a huge improvement, and was finally transferred to the Fangcai Hospital as a mild patient for further treatment and rehabilitation.

Sun Lien has never used a larger dose of treatment plan.And continue to increase the dosage, the risk to patients has also become unacceptable.Therefore, he finally proposed a single dose of no more than 400mg, and if the effect is not good, he can use no more than 400mg after sixteen hours.

These experiences can at least provide some guarantees for other patients receiving triple therapy in terms of safety.But it is still unknown whether it will be useful and whether it can be widely promoted.

　The state is really not good recently, this chapter is late and less than [-] words... I am really sorry everyone.

　　Today I'm trying my best to find the status, and try to catch the Luo Sanguan who broke out in September and meet you again.

　　
　
(End of this chapter)