He asked, "Is the patient's thyroid hormone level normal?" Li Xue said with a headache, "Yes, hyperthyroidism has been ruled out..." "The patient suddenly had difficulty breathing at noon, and it was also after the two men came?" "Yes, is this related to the current cerebral hemorrhage?" Xu Qiu nodded. Of course there is a connection! When he left at noon, he saw one of the men pressing Li Qianqian's waist to listen to the fetal movement of her pregnant belly. And this... is exactly the cause of subsequent symptoms such as left heart failure and difficulty breathing! The waist of the human body is where the kidneys are located. And the adrenal glands grow next to the two kidneys.
There is a common endocrine disease outside the adrenal glands-pheochromocytoma! This is a tumor originating from the adrenal medulla, sympathetic ganglia and other parts. It releases catecholamines continuously or intermittently. And catecholamines can quickly enhance myocardial contractility, leading to a sharp increase in blood pressure! For example, norepinephrine and epinephrine, which are commonly used shock rescue drugs in the emergency department, are catecholamine substances. For ordinary people, catecholamines that exceed physiological amounts are used to rescue shock. But Li Qianqian has to be stimulated by it all the time! Simply put, Catecholamines are like the blue pills of cardiovascular disease. As soon as this hormone is released, the body will immediately become extremely excited! The man pressed the waist and accidentally squeezed the adrenal glands, causing the sudden release of catecholamines. As a result, Li Qianqian's cardiovascular and internal organs were like taking a blue pill, causing severe high blood pressure, accompanied by sweating all over the body, tachycardia, and dyspnea... In severe cases, it can even cause left heart failure and cerebral hemorrhage! Obviously, Li Qianqian was already very serious at the moment... Li Xue's expression was full of astonishment, "Is that why you asked her if she had high blood pressure at the time?"
"Yeah." "Pheochromocytoma is paroxysmal hypertension! It is not secreted at ordinary times, and blood pressure can be normal.
But if the adrenal glands are squeezed, the tumor will immediately release a large amount of catecholamines into the blood, causing a strong reaction in the body!" Li Xue sorted out her thoughts and felt that she suddenly realized. It turned out to be pheochromocytoma! And... pheochromocytoma during pregnancy! Li Xue broke out in a cold sweat. Any disease combined with pregnancy is a severe test for the fetus and the mother. What's more... it is a pheochromocytoma with a high risk factor! According to literature, the combined mortality rate of such patients can reach 58%! "I... I will arrange blood and urine catecholamine measurements, and report to prepare for MDT!" Li Xue spoke quickly. MDT, that is, multidisciplinary consultation. That is, multiple departments jointly diagnose and treat, brainstorm, and discuss the feasibility of surgery and specific surgical plans. If pheochromocytoma can be confirmed, then Li Qianqian's risk factor will directly rise to the most dangerous column, which is definitely not a problem that a single department can solve. ... More than an hour later. The nurse in the obstetrics and gynecology department measured Li Qianqian's blood pressure during the "attack period". Blood pressure: 240/150mmHg. In addition. Urine catecholamine 324h (normal value 24h) Urine vanillylmandelic acid (normal value 24h) Urine norepinephrine 324h (normal value ～164nmol/24h) Urine epinephrine (normal value ～) All signs point to one disease: pheochromocytoma! In the consultation room, the directors of urology, anesthesia, and endocrinology came. Everyone's face was very solemn! As long as they are surgeons, they know how dangerous it is to remove pheochromocytoma. It is located near the renal hilum, surrounded by the renal artery and renal vein, and there are arteries passing through the tumor. The difficulty and risk of the operation are very high. In addition, the blood supply of pheochromocytoma itself is extremely rich. A slight mistake during the operation may cause heavy bleeding, and the kidney cannot be saved. But this is not the most dangerous.
After all, people have two kidneys, and if one is lost, there is still one. The most dangerous thing is that pheochromocytoma is a powder keg that will explode at the slightest touch! Once the pheochromocytoma is touched during surgery, or there is any disturbance, it will cause a violent reaction, releasing a large amount of catecholamines into the blood. And this will cause a terrible hypertensive crisis. The blood vessels in the brain may burst under high pressure, causing severe cerebral hemorrhage and death. This is not over yet. Even if the patient's life is saved in the hypertensive crisis - after the tumor is removed, the hormones secreted by the tumor into the blood will decrease, which will cause vasodilation, causing blood pressure to plummet, resulting in more dangerous hypotension! Hypertensive crisis, and then turning into hypotension, any one of them is enough to kill the patient within minutes! Therefore. Pheochromocytoma is rare and requires three anesthesiologists to perform the operation! Moreover, each anesthesiologist must have extremely rich experience. One of them monitors blood pressure. The other one presses the rescue drug and gives it at any time. The third person is responsible for taking the overall situation into consideration, and this role is often assumed by the chief anesthesiologist. Just by making the three anesthesiologists nervous, you can see how dangerous this operation is! … In the conference room, everyone looked at the medical records in their hands, and the atmosphere was suffocatingly quiet. The director of the Department of Urology was the first to speak and asked: "Can we delay it for a while? Our department also treats a lot of pheochromocytoma, but not many are complicated by pregnancy... Such patients often need to take ten to fourteen days of anti-inflammatory drugs first." Press medicine..." If you don’t prepare for surgery two weeks in advance, the risk is too high! But Director Hu shook his head and said solemnly: "I'm afraid not! The patient's uterus is too large and has begun to compress the pheochromocytoma... If it is delayed, there is a high probability that the fetus will still be born. In addition, pregnant women may develop uncontrollable high blood pressure at any time, and may even progress to a hypertensive crisis. At that point, it is already hopeless! "
34 weeks… A 34-week-old baby already has the conditions for premature birth. If a cesarean section + chromaffin cell removal is performed at this time, there is still a chance to keep the mother and baby safe. But if it takes a few days, the fetus will most likely be stillborn, and the mother will most likely not survive! However, no one present was sure that the tumor could be removed unscathed. At this moment, Li Xue remembered something, and his eyes moved away from the director of urology department and landed on Xu Qiu. The others also noticed Li Xue's gaze, but shook their heads helplessly. Even the director of brain surgery cannot perform this operation! The medical industry is like a mountain apart. Each department is even more distinct. It is difficult to perform surgeries across departments easily. The director of the urology department said dullly: "I have never seen Dr. Xu perform urology surgery... Forget it, our urology team will come on!"