Since 1981 Health School Chapter 648

  Zhu Huoyan was very satisfied with everyone's earnestness, so he continued to speak:

"Our Yuezhong Hospital believes that the Chongqing formula is the most suitable for patients with large area burns, while the Shanghai formula is only suitable for patients with small areas and not severe burns. Therefore, our Yuezhong formula is based on the Chongqing formula and revised according to clinical practice. of.

The volume of rehydration fluid for adults in the first 24 hours = body weight (kg) x burn area (%) x 1.5ml (1.8ml for children), that is, for every 1% of the burn area, 0.75ml of colloid and crystal are supplemented per kilogram of body weight. In addition, the daily physiological water requirement is 2000ml.

  The amount of rehydration in the second 24 hours is half of the calculated amount in the first 24 hours, and the daily amount remains unchanged.

  There is one biggest difference between this and the Chongqing formula, that is, we advocate a ratio of 1:1 for crystal gel, while the Chongqing formula advocates a ratio of 2:1.

  And we also advocate the early use of hypertonic saline solution for resuscitation, which can reduce the occurrence of hyponatremia, reduce the content of inflammatory factors in the blood, and reduce the edema and oxidative damage of lung, intestinal tract, liver, kidney and other visceral tissues.

  And when the concentration of hypertonic saline solution is 200, 300 and 400mmol/L, the effect is best when the concentration is 400mmol/L, and when the concentration is 600, 800 and 1000mmol/L, the best effect is when the concentration is 600mmol/L.

  At the same time, we believe that for patients with extensive and severe burns, the first thing to do when supplementing colloid fluid is whole blood, not plasma.

  Because we found that after the early supplementation of whole blood, the supplementation of whole blood during the shock period is beneficial to correct anemia, improve hypoproteinemia, reduce tissue hypoxia and edema, restore hemodynamic stability, protect internal organs, and improve immune function.

And we found in the research that after the application of colloidal liquid hydroxyethyl starch, the tissue residue is relatively heavy, and it may increase the renal function damage and mortality of patients. Therefore, we believe that hydroxyethyl starch should be used with caution. Or not.

  Finally, the Yuezhong Hospital believes that traditional shock resuscitation monitoring is not accurate enough, and these indicators usually include the patient's mental state, blood pressure, heart rate, extremity temperature, and urine output.

However, these indicators have a significant effect on decompensated shock characterized by hypotension, extreme tachycardia, and oliguria, but are not effective on occult shock with normal blood pressure, heart rate, and urine output, which seriously affects the efficacy of fluid replacement. .

Therefore, we advocate that any burn rehydration should not just follow the rehydration formula mechanically, but monitor each index in hemodynamics, and then supplement what is lacking according to each index, so as to improve the hypovolemia caused by burn shock and maintain organ perfusion. Multiple organ failure. "

  As soon as Zhu Huoyan finished reading his manuscript, the entire formation fell silent again.

  Director Zhu looked up at the participants in doubt, Chen Qi also blinked, and there was also puzzlement in his eyes, why didn't everyone respond?

  Actually, what the people in Yuezhong Hospital don't know is that everyone is not unresponsive, but shocked, because the “new formula” of Yuezhong Hospital can be said to be subversive.

  Even the principles and details are out.

  If it wasn't for this newly launched formula, those who didn't know it thought it was the "Guidelines for Clinical Rehydration of Burns".

  Professor Peng and the others knew these contents in advance, but the other doctors in the audience didn't know, so they exploded again.

   "Director Zhu, how many phases of clinical trials has your formula gone through?"

   "Director Zhu, do you have any papers?"

   "Director Zhu...Director Zhu..."

  This academic conference has become like a press conference.

  After hearing this, Zhu Huoyan gestured to the staff next to him:

"Don't worry, everyone. Now our staff will send you the principles and mechanisms, pathophysiology, specific content, experimental data and other information of the Yuezhong formula. Everyone is a colleague of the burn department, and you should be able to tell the truth from the fake at a glance. .”

  He Jia immediately led another staff member, and handed over the documents in hand to the participating doctors.

  The doctor who got it couldn't wait to start reading.

  In fact, these materials are just a paper. Chen Qi has already sent it to the "New England Journal of Medicine Nejm" one step ahead of time, and he is not afraid of being intercepted by others.

  All the data provided in the paper are "falsified", but it must be explained that Chen Qi copied the data from "Surgical Science", and these data are the conclusions drawn after numerous experiments by later generations.

  As for why it is said to be "fake", it is because Chen Qi himself really did not do relevant experiments.

  But the reason why it is not false is because these data can stand the test. It is okay for others to reverse deduce or copy the experiment, and the obtained data will not be problematic.

  This is the advantage of the reborn. Just like copying songs and novels in other entertainment texts, Chen Qi copied medical textbooks, and the nature is the same.

  Professor Ni Zhihua took the material and put it aside, didn't read it, just knocked on the table a few times:

   "Everyone, pay attention to how effective the experience summarized by Yuezhong Hospital is and whether it is suitable for clinical practice. It will take time to test. Colleagues in the burn department can refer to it, and don't take it too seriously."

  The old man is bad, he is trying to downplay the Viet-Chung formula as a reference, not a mainstream medical way.

  As soon as Professor Ni's voice fell, many committee members who are close to Dongshan Hospital agreed again and again:

   "That's right, I don't know what's going on with the Vietnam-China formula."

   "The Yuezhong Hospital is not even a committee member of our Society of Burn Surgery. It's hard to say what level it is."

   "Yes, yes, it's not good to say, it's a family opinion, refer to it."

  Chen Qi, Lao Guo, and Principal Li all felt teeth itch, but they were not members of the Burn Surgery Society, and they only participated in this meeting and had no right to speak, so they could not stand up and object.

  They are "outsiders" and are not qualified.

   But Chen Qi obviously expected this kind of thing to happen. It wasn't Haidong Medical University, but someone from the court.

  At this time, I saw Wang Qizheng, the deputy chairman, took the initiative to stand up:

"In terms of reference, the three major formulas of rehydration we are talking about are also references, and they are not our original ones. They are all based on Evans formula, Brooke formula, Parkland formula, and combined with our clinical summary, so no one can use it. Don't make fun of anyone.

As far as I know, 4 burn papers from Yuezhong Hospital were submitted to the top international medical journals, 2 of which were submitted to the New England Journal of Medicine, and 2 were submitted to The Lancet. Think about our The formula was only published in the domestic "Chinese Journal of Surgery".

  So I think the formula summed up by Yuezhong Hospital in the clinical work of burns is quite authoritative. It is also worth learning and paying attention to. It may even become another authoritative formula for rehydration in China and even in the world. "

  Professor Ni Zhihua interrupted impatiently::

"Old Wang, there is something wrong with what you said. Everyone can contribute to major medical journals, even elementary school students, but whether they accept it or publish it is another matter. Let's talk about something, if you really want to do it, I'll also submit about seventy or eighty articles, what's the point?”

  Wang Qizheng was not in a hurry, he just gave an example.

"Maybe you don't know that Yuezhong People's Hospital has submitted a total of 23 papers to the top ten international medical journals for so many years, and all 23 papers have been successfully published. There is no record of failure so far. Yuezhong Hospital is also published in the top medical journals in the country. The hospital with the most papers.

  What do these 23 top papers represent? Everyone should be clear. I remember that Union Hospital, which ranks second in the country, only published 5 papers in top medical journals. Yuezhong Hospital is far ahead. Doesn't this mean that their papers are of high quality and authoritative? "

  As soon as Professor Wang's voice fell, the doctors in the audience stuck out their tongues in shock.

  Why?

  Because there are so many experts, professors and directors of the Chinese Society of Burns, so far, apart from Professor Peng Yongyan of Southwest Hospital who has published a paper in the American Journal of Surgery, there is no second person who has published a paper in a top foreign journal.

  Domestic burn doctors only play the domestic "Chinese Journal of Surgery", looking for contacts through various relationships, just to publish an article so that they can be promoted.

   Not even a doctor dares to submit his thesis abroad, not even the courage.

  Good guy, Yuezhong Hospital sent out 4 papers in one go, is this the rhythm of going to heaven?

  So many doctors with strong curiosity raised their hands to speak again:

   "Director Zhu, in the four papers you submitted, apart from the one on the formula for rehydration, what do the other three papers involve in burn surgery?"

  At this time, Zhu Huoyan signaled to the staff again to turn on the "movie player", and the video started again on the big screen.

   "Just now everyone saw the condition of the burn patient before treatment and the procedure of rehydration. Now everyone can see that this worker surnamed Lu has a systemic infection because of severe burns. Please pay attention to his right lower limb."

   At this time, the camera zoomed in, and Lu Wenjie's gray-black right lower limb appeared on the big screen:

"Especially the worker's right lower limb has been seriously infected. At that time, we were discussing whether to amputate the limb. However, considering that the worker's master will face great difficulties in his work and life in the future, we wanted to use imported antibacterial drugs as a conservative treatment trial. try.

As a result, we were surprised to find that the patient was a super-resistant bacteria king and was not sensitive to any antibiotics. On the one hand, he had a severe infection, and on the other hand, the antibiotics were ineffective. The patient had already suffered from heartbeat and apnea several times due to shock, so we finally adopted phage therapy. This is the content of the second paper. "

   Phage therapy?

   Those who can come to the meeting are all old experts. Depending on their age, they have heard of or seen phage therapy.

  Because they knew it, many doctors were clapping their hands on the table, with a look of sudden realization:

   "Ah, yes, there is also a phage therapy we all forgot."

   "Isn't this the therapy brought to the country by Soviet experts? It has been eliminated for many years."

   "I get it, I get it, this is indeed a strange move."

  Other little doctors may still be ignorant, and the teacher needs to introduce the principles slowly, but all the top experts present can understand everything.

  Many doctors are urging again:

   "Director Zhu, what is the effect of your phage therapy? It is said that this phage was eliminated because of its instability."

  Director Zhu chuckled, and while continuing to play the video, he said with a smile:

   "The curative effect is very good. The patient's fever started to subside after 24 hours. Now the systemic infection is under control and skin grafting can be done at any time. Although phage therapy is no longer the mainstream treatment plan, it still has positive significance as an alternative plan.

No, our Vietnam Hospital of Traditional Chinese Medicine has set up a phage research group to conduct in-depth research on this topic. We judge that with the development of medicine and the improvement of people's lives in the future, there will be more and more drug-resistant patients. Therapy is life-saving for surgical patients, and it is no longer our doctors who are helpless. "

   At this time, the audience applauded for the first time.

  If the phage therapy at Yuezhong Hospital is successful, under the premise that the Soviet Union has voluntarily given up, Huaguo will be the only country in the world that studies phages.

   At this time, the excited doctors asked another question.

   "Director Zhu, what is the content of your third paper?"

   "About the third paper, please watch the video below."

  The big screen continued to show the movie, and what appeared at this time was the process of Ding Xinjuan's skin grafting operation.

  When Zhu Huoyan, the chief surgeon, and Chen Qi, his assistant, used a brand-new skin grafting technique to solve the problem of too little normal skin in patients with large area burns, and it was difficult to cover the burned skin of the whole body, the audience was in an uproar again.

   So they raised their hands one by one, excitedly asking Zhu Huoyan their questions.

   "Director Zhu, may I ask if you invented this skin graft?"

   "Director Zhu, how many skin grafts have you performed? What is the success rate?"

  Zhu Huoyan was in a happy mood at this time, grabbed the microphone and said:

   "Today I can tell you responsibly that the brand-new skin grafting surgery you saw was originally invented by our Yuezhong Hospital. So far, 20 of them have been performed on patients, with a success rate of 95% and only one case of failure."

   This Zhu Huoyan didn't say anything. Chen Qi actually performed stinky tofu skin grafting on 20 black uncles during his aid to Africa, and the success rate was quite high.

  Anyway, Black Lives Matter, in many eyes, is what it is.

  Chen Qi is not bad, he is saving people, even though the red envelope is soft.

  Actually, many people don't know that Africa is the largest “medical experiment base” in the world, and all kinds of drugs, surgical procedures, equipment, etc. are tested on black people.

   Even many virus experiments require living people as specimens, and most of them are carried out in Africa.

  Those white people shouted that everyone is equal, but they still regarded black people as black slaves behind their backs.

  For example, the safety of some genetically modified foods requires a lot of real-life data, because the cost of experiments in European and American countries is too high, so basically let the black uncle eat first.

   (I won't discuss the good and bad of genetically modified food here, the author's dog's head will save his life, anyway, please eat Uncle Hei first.)

"Colleagues, for this year's annual meeting of burns to be held in Yuezhong Hospital, we specially reserved skin grafts for three patients with burn areas of 75%, 83%, and 90%. Starting tomorrow, we will perform one surgery every day. , everyone is welcome to watch."

  Yuezhong Hospital allowed people to observe the experiment, which shows that they are open-minded, and many doubters have nothing to say for a while.

  After all, no matter how beautiful the PPT is, no matter how good the video is, no matter how much you brag, nothing is as convincing as seeing it with your own eyes.

   "Excuse me, Director Zhu, what is the name of your brand new skin grafting operation?"

   Zhu Huoyan suddenly looked constipated when he heard it, looked at Chen Qi in the corner of the conference room, and said helplessly:

   "In order to reflect the characteristics of Yuezhong, we officially named it Stinky Tofu Skin Grafting..."

   As soon as the voice fell, the conference room fell into a deathly silence again, followed by loud laughter~~~

  Unfortunately, after three days, the people in Yuezhong Hospital could no longer laugh.

Chapter end